Doping with thyroid medication?
by on Thursday, April 11, 2013  (12 comments)

This Wall Street Journal article prompted a lot of discussion yesterday about whether or not our sport has a new doping problem in the form of thyroid medication.

It's always tough when medication for a genuine medical condition can also be a performance enhancing medication, as some people think this thyroid medication could. As I began reading this, I instantly thought of the fact that asthma seems to stricken track and field athletes at higher rates than it occurs in the general population. Anti-doping agencies allow inhaled corticosteroids for athletes suffering asthma with a "Therapeutic Use Exception" (TUE), which basically means they are granted permission to use a normally prohibited drug due to a medical condition that requires the drug as a part of treatment. There is no doubt that some of the athletes do have asthma and need the corticosteroid. There is no doubt that others are skirting the rules in order to use a performance enhancing substance.

I get the sense that this is the next generation of that issue. As of now, the thyroid medications being used are NOT banned substances. However, should they be banned? Typically, the drug cheats are ahead of the curve in figuring out what works and what doesn't. It would not surprise me at all if, in the near future, we discover that these drugs are in fact performance enhancing in otherwise healthy athletes.

The question is what happens when this occurs? There are certainly some athletes who truly have thyroid conditions and require the medication to function normally so I'm certain a TUE will exist for these drugs. It already appears elite athletes are suffering from these thyroid conditions at far higher rates than the general population. If this is found to be performance enhancing, what will be the requirement of proof that you need this? Will TUEs for thyroid conditions become popular?

One of my favorite sports science bloggers has already written about this and I generally agree with him. I think this should be a banned substance that is only allowed with a TUE. The concern would then become how to test for the need. The current "quick" test seems very questionable and sounds like it may turn up a lot of false positives. Steve Magness mentioned on Twitter that this test could be used as a preliminary test and there is a follow-up test that is available that, as I understand it, could determine whether abnormal hormone levels are due to a problem with thyroid function or are related to other non-medical factors, such as the hard training that all elite athletes perform. I think this follow-up test should be required in order to get the TUE.

This is a very sticky and still developing topic. Does anyone want to share their thoughts at this point?

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12 comments
rpolly30

I have Grave's disease, a condition that resulted in hyperthyroid and subsequent removal of the thyroid gland. I do not wish hyperthyroid on anyone. Sure it can make you more alert but it also puts you at serious risk for heart disease and it causes your muscles to atrophy. If people are taking thyroid hormone for an extra boost they are playing with fire. Probably not a great idea! At the same time there are people, myself included, that must take thyroid hormones to survive. I'm sure there are elites with legitimate hypothyoridism and they should be treated...but if people are taking levo for performance enhancement without a medical diagnosis, I say it's doping!

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Ryan

I appreciate your thoughts. I was kind of hoping you would chime in, given your first hand experience with the therapeutic use of these hormones.

A lot of drugs athletes take for performance enhancement carry significant risk. Most of us know of the somewhat less severe risks of steroids but there are also some far more severe risks, such as liver and heart disease. EPO use has been tied to stroke and heart attacks. Unfortunately, for whatever reason, some place performance benefit ahead of their own well being.

Almost all performance enhancing drugs were originally created with the intent of being used for therapeutic purposes. There are genuinely beneficial and necessary uses for all of these drugs and I have no doubt that some runners out there truly need this specific one for legitimate hypothyroidism. This is why I believe the TUE should exist. However, in my opinion, the bar should be set high. It should only be allowed if there is a true thyroid problem, no back door for people whose hormone levels are thrown off due to hard training. Let's not see hypothyroidism become the next asthma of the sport, another poorly regulated backdoor way to use PEDs without breaking the rules.

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Charlene
Ryan: no back door for people whose hormone levels are thrown off due to hard training. Let's not see hypothyroidism become the next asthma of the sport, another poorly regulated backdoor way to use PEDs without breaking the rules.



Amen.

Someone please do a side by side comparison of the average legitimate under active thyroid sufferer and a pro runner being treated for this and I think that we will think that one of these things is not like the other...

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Andrew A.

I have seen some comments from elite runners who essentially say, "zero TUE for any known performance enhancer, period." I think the point there is that if you really do have a condition with which you cannot maintain normal health without something that is known to be performance-enhancing (remember, Armstrong would have had a TUE for testosterone and hGH because cancer took one of his boys) then you will simply have to earn a living doing something else as your natural, innate self was not meant to be an elite athlete. On a philosophical level, that makes good sense to me. Allowing a TUE basically tells everyone that people with diagnosed medical conditions can have certain drugs in their system right up to, if not beyond a legal limit while nobody else can have them in their system at all. Seems like an incredibly slippery slope and does not seem like ensuring a level playing field, even allowing for only those who have genuine medical reasons to take the medication.

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Double

I could barely run when I had Graves. Treated in '90 and was good for 15 years. It came back and it wrecked me physically to the point I was in Intensive care. Treated again and have been fine for 6 years. Similar experience for my sister, except she had the damn thing cut out the second time.

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Ryan

Charlene, I suspect you're right for a large number of those who are on the medication.

Andrew, I'm familiar with the "zero TUE" argument. Actually, he doesn't explicitly state it but I think the post I linked to by Ross Tucker (the second link in the original post) kind of makes an argument in favor of no TUE. Basically, part of the enjoyment of watching someone like Usain Bolt is seeing what someone can do with only their genes and hard work. No medical supplementation, whether therapeutic or strictly performance enhancing. If you can't naturally cut it, then you aren't cut out to be an elite athlete.

I am split on where I fall with that. If someone truly has asthma or hypothyroidism and they can compete at a high level with proper maintenance of the condition, why should they not be allowed to compete? On the other hand, isn't the therapeutic use itself performance enhancing? At this point, I don't know what I think the right answer is. I'm simply following the debate and weighing all the arguments. Both sides of the debate make some very good points.

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Charlene

Since there is no stigma associated with use of PEDS in body building there is a wealth of information and instructions on doping online in the gyms. I understand from body building websites and a friend that T3 is used to lose weight without losing muscle.

That would enhance my running performance.

Do any of you think that a thyroid TUE could be used to mask HGH use? Or other drugs we do not yet know of that may more safely or effectively give recovery and response a boost.

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Ryan
Charlene: Do any of you think that a thyroid TUE could be used to mask HGH use? Or other drugs we do not yet know of that may more safely or effectively give recovery and response a boost.



I'm not aware of anything but I honestly don't know. I think it's somewhat unlikely but our knowledge of athletes using this specific type of drug and the potential performance benefit is in its infancy. Anything is possible.

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runner1

Man to play with the Thyroid medicine is insane. I have Hashimoto's disease (Thyroid being attacked by the body)It is not that simple to just pop your medicine and all is good. It takes 6-8 weeks to feel the effects of a dosage change and if it is not the correct amount, you can have too much of the medication and feel worse. I remember not being able to sleep for over a month yet being dead tired during the day when I was finding the right dosage. It took me three years to feel "normal" again. I should say mostly normal. Until my Thyroid is 100% dead I will need adjustments to my dosage. I do remember reading that Galen Rupp was diagnosed as hypo-thyroid. I can't help but feel he really isn't but found a way to cheat legally. I would like to know what his TSH readings were to diagnose him. Sorry to sound so skeptical but I know first hand what this drug can do. I do not remember him having a down time in his career to initiate the search for what was "wrong" with him.

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Ryan

Steve Magness has now weighed in: http://www.scienceofrunning.com/2013/04/thyroid-madness-everything-you-need-to.html?m=1

A very long and deep but interesting read. Honestly, I read through all of it and I'm going to have to read through it all at least one more time before I have any hope of it all sinking in.

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Double

Wow was that a good article and I too would need to read it in more detail to consume it all. When I was diagnosed with Graves in '89 I was not really running. I was over 200 pounds and suddenly I had most of the symptoms listed for hyperthyroid. I was losing weight in chunks, eating 5 meals a day, way stressed, and my resting heart rate was 80-100 a minute. I had three choices; tough it out and let it burn itself up, have it removed, or take radioactive iodine and basically burn the thyroid to a target range. I took the third option and was fine for 15 years. My yearly T tests were in the normal range and I assumed I was fixed for life. I took no other meds at this time. Initially with my new found thinness I went back to running before treatment. It was very difficult because I was always tired and fatigued.

I got back into running in '97 (well after treatment in '90) and was a 15 - 25 mile a week guy. I put more heft into it in '99 (30-35 a week)and showed a little promise. I went all in in 2000 by training for the Lakefront Marathon with Pski and went from a 3:10:58 in February 2000 to a 2:45:19 in October at age 39. I would continue to improve.

In 2002 I was diagnosed with Polycythemia Vera which is a blood cancer. The cancer cells take over production and make bigger and a lot more red blood cells and platelets. I had to take of 8 pints of blood in 7 weeks to get back into the normal range. When we could no longer control production, I went on Hydroxyurea which is an oral chemo drug I take daily. I have been on it 4 years and the dosage tends to increase mildly over time. It is used to cut back on production, but I still have to take off a pint of blood about every 6-8 weeks to keep my Hematocrit under 45%. Unchecked it easily can go over 50% and I have been at an all-time high of 69% which is life threatening. I am primarily on the drug to control platelets as I was over 1,000,000 when the normal range is 200,000 - 400,000. Real easy to get a blood clot. I could go on and on about what's good and what's bad, but it is just something I have to manage monthly. Outside of some mild fatigue this one does allow for a normal life.

Enter 2005. I went from a sound runner to total disaster. It began to feel like '89 all over again. Because I was at the Doctor consistently, I had him do a thyroid panel and sure enough I was really hyperactive again. In a nutshell, the Doctor was hesitant about prescribing radioactive iodine again because there was not much documentation for two timers. We decided to try other meds, but I could not tolerate them. It was just horrible. One I started to consistently go into heart arrhythmia (and ended up in the ICU) we felt it was time to zap it again and get me underactive. Running was a freaking nightmare until we virtually ablated the thyroid. I am now on a daily dose of thyroid meds and back to my old self.

If any one has had these problems, I cannot fathom how you would try to alter meds for a benefit. As a working functioning adult it is all about consistently feeling normal. Nothing is more important on a daily basis then not feeling like total crap. Do it for a few years and you will value nothing else. The value running brought to me was you are always in tune with your body. I can tell when something is not correct and having Doctors which really value your input is huge. There is no playing games. You have to find the sweet spot, listen, adjust, or suffer the consequences.

My younger sister by 8 years would end up mirroring me. Hyperactive, treated, and hyperactive again. As mentioned before she just had the damn thing cut out. My Mother, all three of her kids, and now some of the grandkids all have forms of thyroid ailments. Of the main 5 people, 60% have had serious issues just finding a balance. Again, how would you make a decision to play around with this?

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Ryan

Double, I have no idea why anyone would play around with it. I can't even fathom making that decision. No freakin' way would be my response if anyone even brought up the idea. I also recall your blood condition and you calling it something along the line of natural EPO boosting/blood doping. Why would anyone play around with that? Yet we know a lot do.

So maybe I do have an idea why people would want to play around with it. You're on the verge of greatness. You're on the verge of lifting your entire family out of poverty into the kind of wealth that you and your family can't even imagine. To you and I, solidly in the middle class, risking your life isn't worth even the chance. To someone who has nothing, maybe it is worthwhile. That surely explains why some, though obviously not all, might at least consider it. For some others, it's probably a personality issue. Again, you're on the verge of greatness. You have the opportunity to go down in history as one of the greatest ever. Would I do it? Right now, I'd say no freakin' way. How do you really know if you're not in that position, though? Certain personality types would probably jump at the opportunity to do whatever it takes without even considering the risks.

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