Wall St Journal looks at Houston Doc who treats Rupp, other thyroid users

A Duck wrote:

[Magness it turns out is a thyroid disease sufferer himself, and he lays out for you all very thoroughly the issues.

Magness has an autoimmune disease (Hashimoto's) that causes his body to attack his thyroid gland, causing hypothyroidism. He was 14 at the time of the onset of the disease. To my knowledge, Rupp nor any of these other athlete's have been diagnosed with any type of disease or disorder, only that hard training has caused their "hypothyroidism."

There is a big difference between the two. A BIG difference.

Thyroid Sally wrote:

Magness has an autoimmune disease (Hashimoto's) that causes his body to attack his thyroid gland, causing hypothyroidism. He was 14 at the time of the onset of the disease. To my knowledge, Rupp nor any of these other athlete's have been diagnosed with any type of disease or disorder, only that hard training has caused their "hypothyroidism."

There is a big difference between the two. A BIG difference.

Everyone read this and then read it again.

Consistency is the key wrote:

Dear Steve the Duck - If you read Magness' post, as well as everything else written by sufferers of hypo or hyperthyroidism, there's something significant that stands out: While medication can make you feel much better in day-to-day life, almost no one is able to regain their prior form or maintain that form on a consistent basis. And the more intense the training, the more likely you are to throw everything out of whack and suffer setbacks.

Now, if you look at Rupp and what he's achieved over the last two years in terms of progression and consistency, I don't think anyone suffering from hypo or hyper thyroidism would say that's possible. It's not. There are good days and bad days. Good weeks and bad weeks. Good months and bad months. Rupp hasn't had a bad day, week or month in two years.

Magness went on to run a 4:00 1600 in high school, so clearly it is possible to run well so long as your thyroid is well-controlled.

Thyroid Sally wrote:

Magness has an autoimmune disease (Hashimoto's) that causes his body to attack his thyroid gland, causing hypothyroidism. He was 14 at the time of the onset of the disease. To my knowledge, Rupp nor any of these other athlete's have been diagnosed with any type of disease or disorder, only that hard training has caused their "hypothyroidism."

There is a big difference between the two. A BIG difference.

Most hypothyroidism is due to Hashimoto's. There is a test to tell if the antibodies are present.

I'd be interesting to know if all of these athletes have Hashimotos.

It is all a slippery, slippery slope. I'm sure that Lance Armstrong trained consistently and saw steady improvements over the course of his career. All of those arguments about consistent improvements, cleared by USADA/WADA, etc. are bunk.

The fact of the matter is that these medications are prescribed much more frequently for the elite population. Most importantly, there are performance benefits after taking the medication. Does it fall within USADA and WADA's acceptable medications when prescribed by a doctor? Yes. Should it? Probably not. The guy on the line who has XX blood level .whatever lower than the guy who got it is at a disadvantage. End of story. There needs to be stricter standards and oversight obviously. This stuff is a game elite athletes have been playing for years. Mark McGwire used androstenedione. It was a legal supplement at the time he used it. It isn't legal now. Fam's comments pretty much confirm this scheme. Rupp and many runners are also on an inhaler. I could make the same kind of argument for that medication. There are "degrees" of asthma.

Stomp and scream all you want. The facts are obvious to the public. That's why the WSJ has picked it up.

To give another example, Amy Yoder has tweeted that she is hypothyroid because of celiac disease, had a goiter, and was prescribed thyroid supplements in 1998, long before she was with the NOP. Gabrielle Anderson had thyroid cancer and takes synthroid because her thyroid was removed. Unless you just want to say that hypothyroid is a disqualifying condition for an athlete, these sound like legitimate conditions that athletes should be able to treat.

On the other hand, Floyd Landis sounds highly fishy, along with the use by bodybuilders to treat conditions brought on by doping.

I don't see how, without more information, you can make any assumptions about whether a particular runner's use is legitimate or not. It sounds to me like thyroid supplementation at least needs to be subject to a TUE and review by USADA to help make sure it's for legitimate reasons.

Given that hypothyroidism is rare in healthy young adults (with some obvious exceptions such as those by Amy Yoder, Gabrielle Anderson) then if you are on thyroid meds and are an elite athlete, you should be viewed suspiciously until proven otherwise.

daskalala wrote:

To give another example, Amy Yoder has tweeted that she is hypothyroid because of celiac disease, had a goiter, and was prescribed thyroid supplements in 1998, long before she was with the NOP. Gabrielle Anderson had thyroid cancer and takes synthroid because her thyroid was removed. Unless you just want to say that hypothyroid is a disqualifying condition for an athlete, these sound like legitimate conditions that athletes should be able to treat.

On the other hand, Floyd Landis sounds highly fishy, along with the use by bodybuilders to treat conditions brought on by doping.

I don't see how, without more information, you can make any assumptions about whether a particular runner's use is legitimate or not. It sounds to me like thyroid supplementation at least needs to be subject to a TUE and review by USADA to help make sure it's for legitimate reasons.

Let's Contemplate wrote: Given that hypothyroidism is rare in healthy young adults (with some obvious exceptions such as those by Amy Yoder, Gabrielle Anderson) then if you are on thyroid meds and are an elite athlete, you should be viewed suspiciously until proven otherwise.

Even then, those with TUEs need to be monitored carefully, out of competition, as well as in.

Those with a real thyroid condition shouldn't have any problem agreeing with additional testing. The point of the additional testing to help sports authorities tighten up the requirements to allow TUEs for future athletes.

Those with TUEs that have a problem agreeing with additional testing, are be people to be concerned about.

daskalala: "I don't see how, without more information, you can make any assumptions about whether a particular runner's use is legitimate or not."

That's the thing: there IS other information. They are all US-based, many are under the same coach, they all go to the same doctor, many are world elite, some are penetrating the ranks of the all-time greats, and the prevalence of the condition in their population is insanely greater than that in any greater population. Etc.

If any particular runner belongs to this group, working presumptions that the intervention is not medically necessary for them to lead any kind of a "normal" life, and that the therapy is performance-enhancing, are legitimate IMO.

That is not a conclusion, just a pair of working presumptions, to get the ball rolling. The burden would then be placed upon the individual athletes to disclose information relevant to a deeper inquiry. Failure to so disclose would be grounds for sanction, on the basis of non-compliance with the demands of a reasonable investigation.

IMO

Even then... wrote:

[quote]Let's Contemplate wrote: Given that hypothyroidism is rare in healthy young adults (with some obvious exceptions such as those by Amy Yoder, Gabrielle Anderson) then if you are on thyroid meds and are an elite athlete, you should be viewed suspiciously until proven otherwise.

Agree 100%. Virtually all of the elite athletes are drug cheating in one way or another, some just get doctors to help them do it with impunity.

This is no different than the children of the crazed parents of the Upper East Side of Manhattan who buy fake learning disorders ($5,000 a pop) so their kids can get extra time when they take the SAT and buy fake ADD diagnoses so their kids can have access to Adderall as SAT and AP test aids. And no one does a thing about it. The rate of Learning Disorder diagnoses and ADD diagnoses among children in NYC is off the charts versus the rest of the country.

Welcome to the era of performance enhancing drugs and other diagnoses as aided and abetted by our medical and mental health professionals - - for a price.

A Duck wrote:

I think a lot of the misinformation that is being posted here can be cleared up here:

http://www.scienceofrunning.com/2013/04/thyroid-madness-everything-you-need-to.html#more

This is a fantastic review of the issue, and anyone that wants to debate this issue should read this post before continuing. It's not perfect grammatically, but if you read for the content you will most certainly better understand this issue.

I'm not quite so convinced by Magness. Undoubtedly there is some useful info in his article. But, as he admits, he is not an endocrinologist. To me, it reads more like a term paper written by an enthusiastic student. Magness seems like an OK enough fellow, but scientifically, I sometimes get the impression he is biting off more than he can chew.

Still, one thing sticks out to me when people point to his article and use it to back their claim that TSH at best restores you to normal, and these elite athletes would not be using it as a performance-enhancer. Magness writes:

"But, it’s not a performance enhancer. If anything, I see it as a performance hindrance. Training with a thyroid disorder is about the most complicated thing in the world. You are always on the edge of overtraining, even if your medication is spot on, and you are doing half of what your competitors are. For example, using an athlete who suffers from hypothyroidism on my college team, it’s a tough road. For this athlete, he can only run about 4 days a week, despite treating his thyroid disease AND taking almost 3 months off. He can only do 1 actual hard workout a week, and after races it takes him at least 5 days to recover. He can go from running a 4:12mile as an example, to being unable to run 800m repeats in 2:30 with ample rest."

So, on that line of reasoning, it doesn't sound at all like Rupp genuinely suffers from hypothyroidism. He doesn't seem to have a difficult time managing his training around his thyroid disorder, and he doesn't seem to have a hard time getting enough hard workouts in, and he is remarkably consistent in his racing.

So whatever you get from this article, I find it hard to believe it could be useful as evidence for a lack of wrongdoing by these athletes taking TSH. Basically, Magness claims that having thyroid issues makes training extremely difficult. I haven't heard one whit of evidence that this problem exists for all the people (Rupp, Hall, Begley, etc) who are reputed to use thyroid meds. If it was that difficult, you would think it would be something that would have been brought up more in interviews. Instead, it's more like, "my thyroid was messed up, so I saw this doctor, and now I take medication and it's fine".

When fatigued:

2000s elite runners: something is wrong, see doctor, take medication.

Pre 2000s runners: take a rest day.

Pre 2000s runners will out live 2000s runners.

Look, he could use more Thees and Thous and Big Words, but the scientific evidence is there. You're going to have to dispute that evidence, not just the way it is presented.

There are probably some people abusing thyroid medication, but this whole debate started off as a critique of a doctor's practices. I think our side has pretty well demonstrated that a range of 0.4-2.5 is the probable future for healthy TSH measurement (if you disagree, go back a few pages and read the massive literature reviews I cite). We have also demonstrated that a number of athletes do have legitimate thyroid disorders that are the permanent result of Hashimoto's Disease, which is a result of complex interactions between genetic predisposition, environmental factors, and stress. Depending on the healthy range you use, this disease affects between 5 and 10% of the population. It is entirely possible that Salazar and other training groups have a number of athletes that legitimately suffer from hypothyroidism based on cutting edge diagnosis methods.

Gamera-- hypothyroidism due to Hashimoto's Disease(HD) is a gradient that progressively worsens as a person's body kills their thyroid gland over their lifetime. The rate that this happens depends on the individual's genetics, the environmental factors they are exposed to, and to some degree stress. Rupp's case may have been caught early, but if he has HD he will get progressively worse over his lifetime. Magness, unfortunately, had something about his genetics/environment/stress levels that accelerated his autoimmune response at a much earlier age. That would explain the disparity in their conditions.

runnerxyz wrote:

When fatigued:

2000s elite runners: something is wrong, see doctor, take medication.

Pre 2000s runners: take a rest day.

Pre 2000s runners will out live 2000s runners.

Your post totally makes me think about the difference between the way Rocky trained--in a cold Russian barn--and Ivan Drago--in a state of the art facility and attached to a million machines. The NOP went the route of these same machines from day one when they introduced their altitude house, at the time controversial.

Please review this well known 2003 article -

"The Ultimate Running Machine:

Inside a Soviet-style training camp, corporate scientists are reengineering neuro-mechanics, blood chemistry, and brain waves. Welcome to the Oregon Project, where Nike is rebuilding the US marathon team one high tech step at a time."

AND

from 2007 --

"Rupp said he has actually awoken with the tent set to 20,000 feet "once or twice" and slept through the alarm that goes off when it starts getting too thin. He paid for it, though, with a painful headache that lasted several hours each time. But when it comes to altitude tents, Rupp is a veteran, and he is quite used to them."

We've been way past the arbitrary difference between Performance Enhancer and Performance Enhancing Drug with Salazar and co for a long time. The title of Tilin's article employs "re-engineering" and "blood chemistry". The NOP went "all in" from the beginning and their "state of the art" angles are well beyond the current letter of WADA law. Even now the NOP is after the next angle and the next unknown PE.

As they say, if it walks like a duck and talks like a duck...because a few NOP Oly medals sure have their share of "quack" when you consider their origin article from so many years ago.

Can't not post this Salazar quote from the 2003 article.

"But Salazar won't stray from his innovate-or-bust training formula. "The plan remains doing whatever is necessary to create winners. We'll think out of the box, not just for the sake of being different but to find what really works," says the coach. "I know this is the way to go."

Wants to know how and when you decided to change the title of the thread?

"The plan remains doing whatever is necessary to create winners. We'll think out of the box, not just for the sake of being different but to find what really works," says the coach. "I know this is the way to go."

It is statements like this that I love. In a court of law, I could give someone a world of hurt based on such a statement.

It is absolute gold, especially because it is so easy to combine with other forms of evidence into a believable characterization of events.

Absolute gold.

Gamera: "Basically, Magness claims that having thyroid issues makes training extremely difficult. I haven't heard one whit of evidence that this problem exists for all the people (Rupp, Hall, Begley, etc) who are reputed to use thyroid meds. If it was that difficult, you would think it would be something that would have been brought up more in interviews. Instead, it's more like, "my thyroid was messed up, so I saw this doctor, and now I take medication and it's fine"."

I would like to hear responses to this, other than the response that "NOP athletes don't have the same degree of thyroid disorder as others who have significant problems training", because if the disorder wasn't that significant, there is an equally good argument that they don't need the meds to function normally, and that the "disorder" is simply an effect of training.