Thyroid Hormone Abuse Among Elite Athletes

Abstract

Objective Thyroid hormone (TH) abuse for performance enhancement in sport remains controversial and they are not prohibited in sports under the World Anti-Doping Code (WADC). However, the prevalence of TH usage in athletes is not known. Design We investigated TH use among Australian athletes undergoing anti-doping tests for competition in World Anti-Doping Agency (WADA)-compliant sports by measuring TH in serum and surveying mandatory doping control form (DCF) declarations by athletes of all drugs used in the week prior to the antidoping test. Design Serum thyroxine (T4), triiodothyronine (T3), reverse T3 (rT3) were measured by liquid chromatography-mass spectrometry (LCMS) and serum TSH, free T4 (fT4) and free T3 (fT3) by immunoassays in 498 frozen serum samples from anti-doping tests together with a separate set of 509 DCFs. Results Two athletes had biochemical thyrotoxicosis giving a prevalence of 4 per 1000 athletes (upper 95% confidence limits (CL) 16). Similarly, only two of 509 DCF’s declared usage of T4 and none for T3 also giving a prevalence of 4 (upper 95% CL 16) per 1000 athletes. These estimates were consistent with DCF analyses from international competitions and lower than the estimated T4 prescription rates in the age-matched Australian population. Conclusions There is minimal evidence for TH abuse among Australian athletes being tested for competing in WADA-compliant sports.

Annual banned‐substance review 16th edition—Analytical approaches in human sports drug testing 2022/2023

“…28 Following a continued scientific debate, the status of thyroid hormones did not change in 2023, furnished also by prevalence study data suggesting minimal (if any) evidence for thyroid hormone abuse in Australian athletes. 29 However, the fact that liothyronine (synthetic derivative of thyroid hormone) administrations were shown to affect urinary steroid profile parameters was mentioned to justify consideration of thyroid hormone use in evaluations of the steroidal module of the athlete biological passport (ABP). 30 In continuation of the 15 th edition of the annual banned-substance review, literature published between October 2022 and September 2023 was evaluated (Table 2), focusing on advancements in sports drug testing approaches enabled by complementary strategies, improved analytical instrumentation, and/or optimized selection of target analytes.…”

“…Following a continued scientific debate, the status of thyroid hormones did not change in 2023, furnished also by prevalence study data suggesting minimal (if any) evidence for thyroid hormone abuse in Australian athletes 29 . However, the fact that liothyronine (synthetic derivative of thyroid hormone) administrations were shown to affect urinary steroid profile parameters was mentioned to justify consideration of thyroid hormone use in evaluations of the steroidal module of the athlete biological passport (ABP) 30 …”