Re: Confusing TSH result

[Guest guest]

> Any advice? Apart from 'pulling

> myself together' (Endo's words)

That's entirely unprofessional and just plain wrong. (I had to censor

myself for language here.)

I'm new here so I can't be much help with practical advice but it

makes my blood boil to hear your genuine physical illness dismissed in

this way.

Hope you find some helpful answers from some of the more knowledgeable

folk in here.

All the best.

[Guest guest]

Hi,

First of all I'd say you are not alone.

Secondly, I'd say you need to know what your actual FT4 and FT3 results were.

You have

the right to know.

Thirdly, you state that you take T3, so as I understand it your TSH will be

suppressed,

that's quite normal.

I personally haven't seen Dr P. (yet), so maybe the others will have advice on

whether you

should contact him or not.

I really hope you can get somewhere, I gave up on the NHS and replaced my

levothyroxine

(I was never offered T3!) with Armour... I've got my life back.

Take care,

Cat.

My GP said that it was six

> months since my last blood test and I was due for another. So, when

> I spoke to him today about the results he said that my T3 and T4

> levels were within normal range but he would not give me the figures

> (he has done before) but he gave me the figure for my TSH levels

> which was <0.01. He said that the level was too low to even

> register. He then asked me to tell him exactly what I was taking - I

> told him what I take and he told me to stop all the supplements

> (suggested by Dr P) and only take my prescribed thyroxine (100mcg)

> and T3 (20mcg). What do I do now? He says I am overactive. I would

> love to be overactive if only for a day - I still feel that whatever

> I take, it makes no difference.

[Guest guest]

I think that first

of all, you have to decide which doctor you are going to listen to. On the one

hand, you were not getting better with the NHS doctor's recommendations, so you

paid to see a private doctor. You paid to see Dr P because you had heard good

stuff about him and how he has given the life back to thousands of patients

both here and in the UK. You are either going to drop Dr P and his

recommendations, or drop your GP as far as your thyroid hormone replacement is

concerned. I know which way I would be going. Your doctor should know that your

TSH would naturally be suppressed when taking any form of T3 medication. Going

back to this doctor for your thyroid treatment would put you back in the place

you were before you saw Dr P. It is, of course, entirely up to you which road

you decide to take, but remember, this is your health you have to do everything

you can to get it back again.

Tell your doctor

you want the figures of your all the thyroid function tests that were done. He

cannot refuse you, these are yours by law. If he does refuse you, tell him you

will take this matter to your local PCT - he will produce them. I would

telephone the surgery and whoever you speak with, be assertive and tell them

you will be calling in to collect all of your thyroid function test results,

together with the reference range for each test on such and such a date, and

ask them to be left in reception so you can pick them up.

Luv - Sheila

My GP said that it was six

> months since my last blood test and I was due for another. So, when

> I spoke to him today about the results he said that my T3 and T4

> levels were within normal range but he would not give me the figures

> (he has done before) but he gave me the figure for my TSH levels

> which was <0.01. He said that the level was too low to even

> register. He then asked me to tell him exactly what I was taking - I

> told him what I take and he told me to stop all the supplements

> (suggested by Dr P) and only take my prescribed thyroxine (100mcg)

> and T3 (20mcg). What do I do now? He says I am overactive. I would

> love to be overactive if only for a day - I still feel that whatever

> I take, it makes no difference.

,___

[Guest guest]

Hi Anne, we are all with you, we may be spread all over the country

and the world but support is only the click of a button away. I've

been having confusing blood test result high FT3 7.79 (ref 2.8-6.50)

and high TSH 5.37 (0.4-4.0) FT4 19.9 (10-22) and still having hypo

symptoms, it just goes to show how unreliable their perfect TSH test

really is. If the results don't fit into their neat little world

then they blame the patient. I'm sure someone will be along with

some advise soon. I'm still a beginner and only chip in when I think

I have something relevant to add.

best wishes keith.

> as I cannot seem to get any dosage right. Is it me? Why me? Woe

is

> me ... etcetera, etcetera. What on earth do I do now? Has any

body

> had the same problem? By the way, the NHS endo that I saw in

March

> said that whatever I take (pills wise) I will never feel happy

> because my problem is a 'mental health' issue and nothing to do

with

> a hormone imbalance. All the world is against me! Oh dear - do I

> sound desperate? Yep - that's me! Any advice? Apart

from 'pulling

> myself together' (Endo's words)

> Much luv

> Annie

> X

>

[Guest guest]

HI Annie

I responded to part of the message attached to somebody else's

post and didn't realise that person was you. I am aware of the predicament you

are in and would definitely stick with Dr P because your GP will not look after

your thyroid needs nor will he look after your adrenal needs and these must be

treated in the way Dr P outlined for you. As your GP has made it very clear he

will not give you the medication you need, then you must either take your

health into your own hands (or rather Dr Peatfield's hands) and have to pay for

any necessary medication, or you could try to find another GP who is more open

to listening to his/her patients and knows a little more about the thyroid/adrenal

connection.

Until you get your adrenals sorted with HC, no matter how much

you titrate your thyroid hormone replacement, it just is not going to work.

This is the case with either synthetic combination therapy or natural Armour

thyroid. Your adrenals have become number one priority. Have you ever read Dr

Peatfield/s paper on the thyroid/adrenal connection? If not, please read it and

perhaps it will help you understand what might be happening (or not) to you .

You will find this on the TPA-UK web site here: http://www.tpa-uk.org.uk/thyroid_adrenal_dysfunction.pdf

Again, as mentioned in my previous message, insist on getting the

figures and the reference range for all of your thyroid function tests and post

them here. Your GP has no right to refuse to give you these. When anybody is

taking T3 their TSH is often completely suppressed and this is not a problem.

If this was me, I would definitely go ahead and purchase Cortef

and you can take NAE at the same time, but we need to know how much NAE you are

taking at the moment first. I am not sure about the Nutri Thyroid and would

think once you have started taking combination therapy there would not

necessarily be a need for this anymore, but Dr P would be the one to tell you

about this.

If you were over-active, believe me, you would know about this.

Again, another problem that arises when doctors ONLY go by blood results and

don't even consider a patients symptoms and signs. Please don't allow this GP

to make you feel so despondent and I would write to the Head of Practice

telling them just how this GP has made you feel and that you would like an

apology from him. Nobody has a right to indicate that you could be a liar or

make you feel hurt, embarrassed or ashamed. Don't let this GP carry on doing

this as he is probably also making his other patients feel exactly the same. I

have found you to be a very bright, open, intelligent and honest lady - and your

GP is treating you appallingly. Perhaps he needs to be reminded of the duties

of a doctor by the GMC.

The

duties of a doctor registered with the General Medical Council

Patients must be able to trust

doctors with their lives and health. To justify that trust you must show

respect for human life and you must:

·

Make the care

of your patient your first concern

·

Protect and

promote the health of patients and the public

·

Provide a good

standard of practice and care

o

Keep your

professional knowledge and skills up to date

o

Recognise and

work within the limits of your competence

o

Work with

colleagues in the ways that best serve patients' interests

·

Treat patients

as individuals and respect their dignity

o

Treat patients

politely and considerately

o

Respect patients'

right to confidentiality

·

Work in

partnership with patients

o

Listen to

patients and respond to their concerns and preferences

o

Give patients

the information they want or need in a way they can understand

o

Respect

patients' right to reach decisions with you about their treatment and care

o

Support

patients in caring for themselves to improve and maintain their health

·

Be honest and

open and act with integrity

o

Act without

delay if you have good reason to believe that you or a colleague may be putting

patients at risk

o

Never

discriminate unfairly against patients or colleagues

o

Never abuse

your patients' trust in you or the public's trust in the profession.

You are personally accountable

for your professional practice and must always be prepared to justify your

decisions and actions.

Luv - Sheila

I think that my GP thinks that I am taking something extra

in addition what I have told him. I think that he thinks I am lying

about my current doses of medication. I have never lied about my

dosages and never exaggerated about how I feel. I don't think he

trusts me because I have told him that I see Dr P privately - I think

that he thinks I am taking more T4 than I say I am. If I was, then

surely my T4 level would not be in the normal range. I feel hurt,

embarrassed and ashamed due to the fact that my GP has implied that I

am a liar because of this unusual blood test result. I feel that I

can't face the world. I just want to curl up in bed and never get up

again. I am only 42 years old. I feel like a 92 year old - very

old! I think I have missed out on the best years of my life and I

have a feeling that I am going to miss out on the rest of it as well

as I cannot seem to get any dosage right. Is it me? Why me? Woe is

me ... etcetera, etcetera. What on earth do I do now? Has any body

had the same problem? By the way, the NHS endo that I saw in March

said that whatever I take (pills wise) I will never feel happy

because my problem is a 'mental health' issue and nothing to do with

a hormone imbalance. All the world is against me! Oh dear - do I

sound desperate? Yep - that's me! Any advice? Apart from 'pulling

myself together' (Endo's words)

Much luv

Annie

X

[Guest guest]

Annie

Poor you and no...you don't sound desperate, just poorly! GPs

generally don't understand thyroid, let alone adrenals. My last TSH

was low, so the endo said I was " alright now " (believe me, I

wasn't!). Natural thyroid gives very different results to

levothyroxine. I asked him what he would do if he felt so ill and

his advice was " ...learn to live with it. "

Anyway, in the real world, Dr P's advised me to supplement my meds

(Armour, NAX, Serenity etc) with cortef and fingers crossed, I'm

actually feeling well for the first time in years. It's only early

days yet, but it feels as though " something " is finally clicking into

place.

I've lost count of the number of doctors who've told me that my

problem was " in my head " . As I said, I think they genuinely don't

understand how to treat us and when we don't respond to their very

limited treatment, it must be our fault because it can't be anything

they've done wrong.

I actually found it quite scary to turn my back on the advice of

health care professionals, who I'd always previously had faith in,

but this horrible disease has taught me that GPs and endos don't know

everything. Dr P has certainly come through for me.

The other lesson I've learned (probably the hardest!) is that we are

poorly and that means we can't do everything at once. It does take

time to get better, so when you're exhausted and feeling 92, just go

with it. In the long run, you'll get better quicker.

Don't let them get you down!

Take care

Pen x

[Guest guest]

>Hello Penny

It's great to hear from the people who truly understand and

sympathise. You say you are trying Cortef? Where do you get it

from and how do you pay for it? Is it from America? I've got to

try it - I'm even more determined now I've heard from you.

Sometimes the light at the end of the tunnel seems too far off!

I am glad to hear that you are becoming well.

I don't want to do something where my GP can turn round and say he's

not treating my anymore because I don't take his advice. I also

don't want to get anyone into trouble - and at the same time I feel

when I question something I will be labelled as a troublemaker!

Warmest wishes from

Annie

X

> Annie

>

> Poor you and no...you don't sound desperate, just poorly! GPs

> generally don't understand thyroid, let alone adrenals. My last

TSH

> was low, so the endo said I was " alright now " (believe me, I

> wasn't!). Natural thyroid gives very different results to

> levothyroxine. I asked him what he would do if he felt so ill and

> his advice was " ...learn to live with it. "

>

[Guest guest]

> I actually found it quite scary to turn my back on the advice of

> health care professionals, who I'd always previously had faith in,

That is exactly how I've felt.

> but this horrible disease has taught me that GPs and endos don't know

> everything.

That's where I'm at now.

> Dr P has certainly come through for me.

I did a little happy dance on Sunday for no reason. I always used to

do stuff like that but it's a long time since I have. My husband said,

" It's like having the old back. " It didn't last long but I think

it's a sign of things to come.

[Guest guest]

> I don't want to do something where my GP can turn round and say he's

> not treating my anymore because I don't take his advice. I also

> don't want to get anyone into trouble - and at the same time I feel

> when I question something I will be labelled as a troublemaker!

It is a worry. I'm hoping that as I feel better and with the support

of people in here I'll get back some of my assertiveness. We do have

the right to proper health care and a lot of doctors just aren't

giving it to us.

[Guest guest]

>

>

>

> I think that my GP thinks that I am taking something extra

> in addition what I have told him. I think that he thinks I am lying

> about my current doses of medication. All the world is against me!

Oh dear - do I

> sound desperate? Yep - that's me! Any advice? Apart from 'pulling

> myself together' (Endo's words)

> Much luv

> Annie

> X

>

Hi Annie,

lt looks like it is time to sack your GP, what an arrogant fool he

sounds. lt's no good thinking that these type of Gps will get a

thyroid education and see the light, best to give him the elbow and

move on in my experience.

My sacked Gp said, " your hoarse voice is not caused by your thyroid

because the thyroid is nowhere near the voicebox " Eeeeek, There is

no way round that kind of ignorance.

Chin up, hon there are some good ones out there, it's just a case of

persevering.

rx

[Guest guest]

The last thing you should be worrying about is

your GP Annie - he is most definitely not worrying about you, and if ever he

did decide to kick you out, believe me, you will be amongst good company. Quite

often, you find a GP that treats you 100% better anyway, so that would be a

good thing surely. I know I found wonderful GP's who were happy to prescribe me

Armour without hesitation when my previous GP (who did throw me out) declared

they never prescribed ANY unlicensed medication if the NHS licensed one didn't

work. They just leave their poor patients to shrivel up and die - but they

still get paid - and that's what matters. Ask all your questions here on the

forum - don't bother asking a doctor who obviously doesn't know very much at

all. We will try to find answers for you.

Don't worry about being labelled a

" troublemaker " either - I'm being labelled that all of the time - and

could I care less? - not a jot!

Luv - Sheila

I don't want to do something where my GP can turn round and say he's

not treating my anymore because I don't take his advice. I also

don't want to get anyone into trouble - and at the same time I feel

when I question something I will be labelled as a troublemaker!

Warmest wishes from

Annie

X

[Guest guest]

.....I did a little happy dance on Sunday for no reason. I always used to

do stuff like that but it's a long time since I have.

Keep it up girl......I'm sure you have plenty more dancing days ahead!

Pen x

[Guest guest]

I would question why he won't give you the T3 and T4 results, perhaps

because they are below optimal? It is common on armour to have

supressed TSH so I understand, it doesn't mean you are hyper. So try

and relax hon. Without the hc you may even show a high level of T3 and

have hypo symptoms because the T3 cannot get into the cells and pools

in the blood instead building up. So please tell the endo he has no

idea about mental health that is why he is an endo, then sack im, and

tell the GP you need your results as you are keeping a file of all

your blood tests as you go along the way with your treatments to see

when you felt better and when you felt at your worst. He doesn't have

the right to withold them anyway. Even my doc lets me see mine, in

fact he has got quite used to my asking to see everything letters,

results etc etc notes.

Don't worry about what they say, the times I have been in tears over

these doctors is amazing and disastrous for my adrenals AND my mental

health.

Keep ur chin up hon, things will indeed get better.

God bless

Dawnx

[Guest guest]

That is a good sign Penny, hubby and I used to have a dance for no real

reason at the mo it is just him doing that (which normally makes me

laugh); but hopefully soon I shall be joining in!! Go girl!

Love Ali xx

<pennysometimes@...> wrote:

>

> ....I did a little happy dance on Sunday for no reason. I always used

to

> do stuff like that but it's a long time since I have.

>

> Keep it up girl......I'm sure you have plenty more dancing days

ahead!

> Pen x

>

[Guest guest]

Hi there anne, here is an article which you should print out for your endocrinologist.Funny thyroid function tests by Dr.Mark Gurnell.Http://www.endocrinology.org/education/resthe society for endocrinology- trainingTable 1 shows patterns of funny TFTs this shows in table 3 sub clinical hypothyroidism with heterophile antibody interfering with the TSH assay.in other words you have auto-antibodies binding and interfering with the test.hope this helps you . regards angel.

[Guest guest]

Hi Angel, thought I'd let you Know that the article will be useful

for me to, I have an appointment on the 10th with my endocrinologist

and have high T3 and TSH. Thanks for flagging it up.

Best wishes

>

> Hi there anne, here is an article which you should print out for

your endocrinologist.

> Funny thyroid function tests by Dr.Mark Gurnell.

> Http://www.endocrinology.org/education/res

> the society for endocrinology- training

> Table 1 shows patterns of funny TFTs this shows in table 3 sub

clinical hypothyroidism with heterophile antibody interfering with

the TSH assay.

> in other words you have auto-antibodies binding and interfering

with the test.

> hope this helps you . regards angel.

>

[Guest guest]

Link not working  Angel. Can you try again please as I would

like to see this.

Luv - Sheila

Hi there anne, here is an

article which you should print out for your endocrinologist.

Funny thyroid function tests by Dr.Mark Gurnell.

Http://www.endocrinology.org/education/res

the society for endocrinology- training

Table 1 shows patterns of funny TFTs this shows in table 3 sub clinical

hypothyroidism with heterophile antibody interfering with the TSH assay.

in other words you have auto-antibodies binding and interfering with the

test.

hope this helps you . regards angel.

.._,___

[Guest guest]

Hi sheila, I got through on this link----- http://www.endocrinology.org/education/resource/summerschool/2006/ss06/ss06_gur.htm

regards keith

>> > > Link not working Angel. Can you try again please as I would like to see this.> > > > Luv - Sheila> > > > > Hi there anne, here is an article which you should print out for your endocrinologist.> Funny thyroid function tests by Dr.Mark Gurnell.> Http://www.endocrinology.org/education/res> the society for endocrinology- training> Table 1 shows patterns of funny TFTs this shows in table 3 sub clinical hypothyroidism with heterophile antibody interfering with the TSH assay.> in other words you have auto-antibodies binding and interfering with the test.> hope this helps you . regards angel.> > > > ._,___>

[Guest guest]

Hi Sheila, Just in case you haven't seen it, this is on the same web site---------Thyroid Hormone replacement therapy – "This house believes that thyroxine is not an adequate form of thyroid hormone replacement in everyone…."

Best wishes

keith

http://www.endocrinology.org/education/category.aspx?catid=11

http://www.endocrinology.org/education/resource/EndocrineNurseCourse/ent04/ent04_day3.htm

Thyroid Hormone replacement therapy – "This house believes that thyroxine is not an adequate form of thyroid hormone replacement in everyone…."

C M Dayan

Consultant Senior Lecturer, University of Bristol

Endocrine Nurses Training Course 9-11 September 2004Wills Hall, Stoke Bishop, Bristol, BS9 1AE

There are over 500,000 people taking thyroid hormone therapy in the UK. The vast majority apppear happy with their replacement therapy, but a subpopulation, which we have recently estimated at around 5%1 appear psychological dissatisfied despite TSH levels in the reference range. This has been assumed to be due to coincident psychological morbidity (independent of thyroid status). However, recent developments in thyroid hormone physiology indicate that there are multiple levels at which differences between individuals might results in differential sensitivity to replacement with T4 alone, titrated to "reference range TSH levels". These include variations in the 3 deoidinase enzymes, recently recognised cell membrane thyroid hormone transporters and transcription factors associated with thyroid hormone action. It is possible that variations in these elements means that replacement with T4 alone is not adequate in some individuals. Recent studies use a combination of T4 and T3 have produced conflicting results but we argue that the possibility that a subgroup of patients need combination therapy has not been excluded.

1Saravanan P, Chau WF, N, Vedhara K, Greenwood R & Dayan CM. (2002) Psychological well-being in patients on 'adequate' doses of L-thyroxine: results of a large, controlled community-based questionnaire study. [Article]. Clinical Endocrinology 57, 577-585.

Bianco AC, Salvatore D, Gereben B, Berry MJ & Larsen PR. (2002) Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocr.Rev. 23, 38-89.

Bunevicius R, Kazanavicius G, Zalinkevicius R & Prange AJ, Jr. (1999) Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N.Engl.J.Med. 340, 424-429.

Carr D, McLeod DT, Parry G & Thornes HM. (1988) Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment. Clin.Endocrinol.(Oxf) 28, 325-333.

Clyde PW, Harari AE, Getka EJ & Shakir KMM. (2003) Combined Levothyroxine Plus Liothyronine Compared With Levothyroxine Alone in Primary Hypothyroidism: A Randomized Controlled Trial. JAMA: The Journal of the American Medical Association 290, 2952-2958.

DS. (2003) Combined T4 and T3 therapy--back to the drawing board. JAMA: The Journal of the American Medical Association 290, 3002-3004.

Hennemann G, Docter R, Visser TJ, Postema PT & Krenning EP. (2004) Thyroxine plus low-dose, slow-release triiodothyronine replacement in hypothyroidism: proof of principle. Thyroid 14, 271-275.

Saravanan P, DJ, Greenwood R, s TJ & Dayan CM. (2003) Weston Area T4/T3 (Thyroid Hormone Replacement) Study: Psychological Effects of Combined T4/T3 Therapy. Thyroid 13, 697.

Sawka AM, Gerstein HC, Marriott MJ, MacQueen GM & Joffe RT. (2003) Does a combination regimen of thyroxine (T4) and 3,5,3'-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J.Clin.Endocrinol.Metab 88, 4551-4555.

Siegmund W, Spieker K, Weike AI, Giessmann T, Modess C, Dabers T, Kirsch G, Sanger E, Engel G, Hamm AO, Nauck M & Meng W. (2004) Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14:1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin.Endocrinol.(Oxf) 60, 750-757.

Walsh JP. (2002) Dissatisfaction with thyroxine therapy - could the patients be right? Curr.Opin.Pharmacol. 2, 717-722.

Walsh JP, Shiels L, Lim EM, Bhagat CI, Ward LC, Stuckey BG, Dhaliwal SS, Chew GT, Bhagat MC & Cussons AJ. (2003) Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J.Clin.Endocrinol.Metab 88, 4543-4550.

The opinions expressed in this paper are those of the speaker and do not necessarily reflect the views of the Society

Revised: 02-Dec-2004 © Society for Endocrinology | Disclaimer

> >> >> >> > Link not working Angel. Can you try again please as I would like to> see this.> >> >> >> > Luv - Sheila> >> >> >> >> > Hi there anne, here is an article which you should print out for your> endocrinologist.> > Funny thyroid function tests by Dr.Mark Gurnell.> > Http://www.endocrinology.org/education/res> > the society for endocrinology- training> > Table 1 shows patterns of funny TFTs this shows in table 3 sub> clinical hypothyroidism with heterophile antibody interfering with the> TSH assay.> > in other words you have auto-antibodies binding and interfering with> the test.> > hope this helps you . regards angel.> >> >> >> > ._,___> >>

[Guest guest]

Thanks, Pen

xx

>Keep it up girl......I'm sure you have plenty more dancing days ahead!

> Pen x

>

[Guest guest]

>

> Hi there anne, here is an article which you should print out for

your endocrinologist.

> Funny thyroid function tests by Dr.Mark Gurnell.

> Http://www.endocrinology.org/education/res

> the society for endocrinology- training

> Table 1 shows patterns of funny TFTs this shows in table 3 sub

clinical hypothyroidism with heterophile antibody interfering with

the TSH assay.

> in other words you have auto-antibodies binding and interfering

with the test.

> hope this helps you . regards angel.

>

Hello Angel

Thank you so much

I can use it as evidence in my complaint to my PCT

Regards

Annie

X

[Guest guest]

>

> Hi there anne, here is an article which you should print out for

your endocrinologist.

> Funny thyroid function tests by Dr.Mark Gurnell.

> Http://www.endocrinology.org/education/res

> the society for endocrinology- training

> Table 1 shows patterns of funny TFTs this shows in table 3 sub

clinical hypothyroidism with heterophile antibody interfering with

the TSH assay.

> in other words you have auto-antibodies binding and interfering

with the test.

> hope this helps you . regards angel.

>

Hello again Angel

Can only access table 1

What does table 3 say? What are auto antibodies doing binding with

my stuff?

Regards

Annie

x

[Guest guest]

Thanks

Some interesting stuff there. I am copying the following as this

will be the argument the BTA will use to try to rubbish our complaint to

Trading Standards office of Fair Trading

http://www.endocrinology.org/sfe/endocrinologist/end08008.pdf

Hypothyroidism: The Debate Rages On…

The long-running debate

on the prescription of

thyroid hormone to

patients with symptoms

compatible with

hypothyroidism, but in whom thyroid

function tests (TFTs) are

normal, has recently

resurfaced. This has

prompted discussion among

clinicians and vitriolic

responses from patient groups.

At the beginning of 2006,

the Society received a

petition of over 2000

signatures registering 'a formal

complaint against the

clinical practice of the majority of

the medical profession

with regard to the diagnosis and

management of

hypothyroidism'. The signatories accuse

the medical profession,

specifically the General Medical

Council, of 'over-reliance

on blood tests', 'emotional abuse

and blatant

disregard...over the suffering experienced by

untreated/incorrectly

treated thyroid patients' and

'ongoing reluctance to

encourage debate or further

research on

hypothyroidism'.

Professor Tony Weetman,

President of the British

Thyroid Association (BTA),

responded to these accusations

in an editorial in the

March issue of Clinical

Endocrinology,

countering that clinicians

have 'robust assays to diagnose

the condition and an

effective replacement in the form of

synthetic thyroxine'. His

so-called 'derogatory, anti-patient

editorial' has prompted

dozens of emails from angry

patient groups, as well as

various allegations of 'medical

condescension'.

At the heart of the

dispute is the use of TFTs to

diagnose an underactive

thyroid in a patient, and the

prescription of synthetic

thyroid hormones, such as

thyroxine, for patients

with 'normal' free thyroid hormone

levels. As Professor

Sheppard, Chair of the

Society's Clinical

Committee, points out, 'the symptoms of

thyroid disorders are

diffuse and difficult to link to the

thyroid, especially as

many people in their 50s and 60s

may well experience

fatigue, weakness and weight gain'.

Consequently, TFTs have

proved invaluable in diagnosing

hypothyroidism.

Approximately 10 million

blood serum TFTs are

carried out in the UK each

year at an estimated cost of

£30 million, and are used

to measure circulating thyroidstimulating

hormone (TSH), free

thyroxine (FT4) or free triiodothyronine.

Hypothyroidism is

associated with an

increase in serum TSH

concentration followed by a

decrease in FT4 levels, at

which point symptoms typically

appear and the patients

will benefit from treatment by

thyroid hormone

replacement. Patients with TSH levels

over 10mU/l but FT4 levels

within the reference range are

considered to be suffering

from subclinical

hypothyroidism and will

likewise receive thyroxine

treatment to normalise

their hormone levels.

The present debate

concerns patients whose TSH levels

are within the reference

range and who therefore have no

biochemical evidence of

thyroid dysfunction and are

considered normal. The

reference range is based on a

normal bell-shaped graph,

with serum levels of TSH and FT4

outside the 95% reference

interval described as pathological.

The BTA recommends no

treatment for thyroid

disease if TFTs are within

the normal laboratory reference

range, and their sister

patient support group, the British

Thyroid Foundation (BTF),

confirms that hypothyroidism

should be confirmed

biochemically. Sheppard

agrees unreservedly with

these guidelines: 'the increased

sophistication of TFTs

means that if all three tests are

within the reference

range, a clinician can conclude

without any doubt that a

patient's symptoms are not due

to thyroid disease'.

However, this has not

dissuaded some practitioners.

In 2000, BBC News

highlighted the trend in clinicians

prescribing thyroid

hormone to people with normal

thyroid hormone levels who

were just feeling run down,

and many private practices

continue to profit from

providing thyroxine to

anxious patients. This does seem

to be a particular issue

for hypothyroidism, as Professor

Sheppard acknowledges, 'if

a patient was suffering from

headaches, dizziness and

other symptoms of

hypertension, they would

visit their GP for a blood

pressure test and be

satisfied with the conclusion

provided'.

Prescription of synthetic

thyroid hormone to patients

with normal hormone levels

can prove dangerous,

increasing the risk of

atrial fibrillation by two- to threefold

over a 10-year period in

patients over 50 years old, the

key risk demographic for

hypothyroidism. Excess

hormone can also

accelerate bone loss, though there is

no definitive evidence of

an increase in fractures in such

cases. Rather than the

adverse physical effects of excess

thyroid hormone, what most

concerns practitioners is

that by colluding with the

patient and treating them for a

disease that they do not

have, a clinician could overlook a

genuine and more serious

diagnosis.

Ultimately, it is doctors

who are best positioned to

counter this

misunderstanding. ‘Doctors need to be

honest and tell patients

that there isn't a problem they

can identify rather than

dismissing them by saying that

there isn't a problem at

all’ says Tony Weetman.

Professional bodies also

recognise their role in

dispelling the uncertainty

surrounding TFTs. The BTA, in

conjunction with the

Association for Clinical Biochemistry

and the BTF, is amending

its guidelines for TFTs to

establish a national

benchmark for thyroid function

testing. Likewise, the

Society's Clinical Committee has

published a statement of

principles on TFTs, highlighting

the conscientious work of

UK researchers and clinicians in

their response to thyroid

disease, and stating

emphatically that the

Committee supports the use of

blood tests to construct

precise diagnoses (see

www.endocrinology.org/sfe/thyroid-statement.pdf).

Scientists are unanimous

that TFTs are suitable to

confirm hypothyroidism.

The focus must shift to reassuring

anxious patients that

other diagnoses are being considered

and to highlighting to

borderline cases that their family

history and antibody tests

are being taken into account.

Only by listening to

patient fears, and not dismissing without

discussion an insistence

on a diagnosis of hypothyroidism,

can clinicians hope to

quell the current hysteria.

HELEN

JAQUES

From: thyroid treatment

[mailto:thyroid treatment ] On Behalf Of keith m

Sent: 05 November 2008 19:34

thyroid treatment

Subject: Re: Confusing TSH result

Hi Sheila, Just in

case you haven't seen it, this is on the same web site---------Thyroid Hormone replacement therapy – " This

house believes that thyroxine is not an adequate form of thyroid hormone

replacement in everyone…. "

Best wishes

keith

http://www.endocrinology.org/education/category.aspx?catid=11

http://www.endocrinology.org/education/resource/EndocrineNurseCourse/ent04/ent04_day3.htm

Thyroid Hormone replacement therapy –

" This house believes that thyroxine is not an adequate form of thyroid

hormone replacement in everyone…. "

C M Dayan

Consultant Senior Lecturer, University of Bristol

Endocrine

Nurses Training Course 9-11 September 2004

Wills Hall, Stoke Bishop, Bristol, BS9 1AE

.._,___

[Guest guest]

If this article is read with the two different definitions of

hypothyroidism in mind, then it will make significantly more sense.

For example, when the endocrinologists say that they blood tests

work for hypothyroidsm, they are quite right if the definition is

narrow and goes only to the deficiency of the thyroid gland

secretions. However, the folks who claim that blood test do not

tell all, are also right if the broad definition is used because the

blood tests do not test for the post thyroid operations of

peripheral metabolism, peripheral cellular hormone reception, or the

actual functioning of the peripheral cells.

Hence, both are right depending upon the never stated definition

of " hypothyroidism. "

I do believe, however, that the folks who do go against testing are

as wrong as those who insist that the existing tests are

sufficient. The problem with the tests is not that they are

improper. They are misrepresented by language AND their breadth of

findings do not measure and hence diagnose the whole problem and

represented by the broad definition of hypothyroidism.

It seems to me that to appeal to scientists, one should point out

the shortcomings of science and demand more extensive tests instead

of denying the validity of the tests, since the tests are valid

under the narrow definition of hypothyroidism. Such a demand to

avoid the " objective " in favor of the " subjective " will not fly in

scientific circles.

The problem that we face is that medicine has improperly ignored and

dismissed the physiology that demands these tests for the past 40

years. If this physiology were considered then the tests would

become obvious. Reverse T3, urine T3 would then become at least

second line tests and would replace the idiocy of " functional

somatoform disorders. "

Have a great day,

>

> Thanks

>

>

>

> Some interesting stuff there. I am copying the following as this

will be the

> argument the BTA will use to try to rubbish our complaint to

Trading

> Standards office of Fair Trading

>

>

>

> http://www.endocrinology.org/sfe/endocrinologist/end08008.pdf

>

>

>

> Hypothyroidism: The Debate Rages On…

>

>

>

> The long-running debate on the prescription of

>

> thyroid hormone to patients with symptoms

>

> compatible with hypothyroidism, but in whom thyroid

>

> function tests (TFTs) are normal, has recently

>

> resurfaced. This has prompted discussion among

>

> clinicians and vitriolic responses from patient groups.

>

>

>

> At the beginning of 2006, the Society received a

>

> petition of over 2000 signatures registering 'a formal

>

> complaint against the clinical practice of the majority of

>

> the medical profession with regard to the diagnosis and

>

> management of hypothyroidism'. The signatories accuse

>

> the medical profession, specifically the General Medical

>

> Council, of 'over-reliance on blood tests', 'emotional abuse

>

> and blatant disregard...over the suffering experienced by

>

> untreated/incorrectly treated thyroid patients' and

>

> 'ongoing reluctance to encourage debate or further

>

> research on hypothyroidism'.

>

>

>

> Professor Tony Weetman, President of the British

>

> Thyroid Association (BTA), responded to these accusations

>

> in an editorial in the March issue of Clinical Endocrinology,

>

> countering that clinicians have 'robust assays to diagnose

>

> the condition and an effective replacement in the form of

>

> synthetic thyroxine'. His so-called 'derogatory, anti-patient

>

> editorial' has prompted dozens of emails from angry

>

> patient groups, as well as various allegations of 'medical

>

> condescension'.

>

>

>

> At the heart of the dispute is the use of TFTs to

>

> diagnose an underactive thyroid in a patient, and the

>

> prescription of synthetic thyroid hormones, such as

>

> thyroxine, for patients with 'normal' free thyroid hormone

>

> levels. As Professor Sheppard, Chair of the

>

> Society's Clinical Committee, points out, 'the symptoms of

>

> thyroid disorders are diffuse and difficult to link to the

>

> thyroid, especially as many people in their 50s and 60s

>

> may well experience fatigue, weakness and weight gain'.

>

> Consequently, TFTs have proved invaluable in diagnosing

>

> hypothyroidism.

>

>

>

> Approximately 10 million blood serum TFTs are

>

> carried out in the UK each year at an estimated cost of

>

> £30 million, and are used to measure circulating thyroidstimulating

>

> hormone (TSH), free thyroxine (FT4) or free triiodothyronine.

>

> Hypothyroidism is associated with an

>

> increase in serum TSH concentration followed by a

>

> decrease in FT4 levels, at which point symptoms typically

>

> appear and the patients will benefit from treatment by

>

> thyroid hormone replacement. Patients with TSH levels

>

> over 10mU/l but FT4 levels within the reference range are

>

> considered to be suffering from subclinical

>

> hypothyroidism and will likewise receive thyroxine

>

> treatment to normalise their hormone levels.

>

>

>

> The present debate concerns patients whose TSH levels

>

> are within the reference range and who therefore have no

>

> biochemical evidence of thyroid dysfunction and are

>

> considered normal. The reference range is based on a

>

> normal bell-shaped graph, with serum levels of TSH and FT4

>

> outside the 95% reference interval described as pathological.

>

> The BTA recommends no treatment for thyroid

>

> disease if TFTs are within the normal laboratory reference

>

> range, and their sister patient support group, the British

>

> Thyroid Foundation (BTF), confirms that hypothyroidism

>

> should be confirmed biochemically. Sheppard

>

> agrees unreservedly with these guidelines: 'the increased

>

> sophistication of TFTs means that if all three tests are

>

> within the reference range, a clinician can conclude

>

> without any doubt that a patient's symptoms are not due

>

> to thyroid disease'.

>

>

>

> However, this has not dissuaded some practitioners.

>

> In 2000, BBC News highlighted the trend in clinicians

>

> prescribing thyroid hormone to people with normal

>

> thyroid hormone levels who were just feeling run down,

>

> and many private practices continue to profit from

>

> providing thyroxine to anxious patients. This does seem

>

> to be a particular issue for hypothyroidism, as Professor

>

> Sheppard acknowledges, 'if a patient was suffering from

>

> headaches, dizziness and other symptoms of

>

> hypertension, they would visit their GP for a blood

>

> pressure test and be satisfied with the conclusion

>

> provided'.

>

>

>

> Prescription of synthetic thyroid hormone to patients

>

> with normal hormone levels can prove dangerous,

>

> increasing the risk of atrial fibrillation by two- to threefold

>

> over a 10-year period in patients over 50 years old, the

>

> key risk demographic for hypothyroidism. Excess

>

> hormone can also accelerate bone loss, though there is

>

> no definitive evidence of an increase in fractures in such

>

> cases. Rather than the adverse physical effects of excess

>

> thyroid hormone, what most concerns practitioners is

>

> that by colluding with the patient and treating them for a

>

> disease that they do not have, a clinician could overlook a

>

> genuine and more serious diagnosis.

>

>

>

> Ultimately, it is doctors who are best positioned to

>

> counter this misunderstanding. `Doctors need to be

>

> honest and tell patients that there isn't a problem they

>

> can identify rather than dismissing them by saying that

>

> there isn't a problem at all' says Tony Weetman.

>

>

>

> Professional bodies also recognise their role in

>

> dispelling the uncertainty surrounding TFTs. The BTA, in

>

> conjunction with the Association for Clinical Biochemistry

>

> and the BTF, is amending its guidelines for TFTs to

>

> establish a national benchmark for thyroid function

>

> testing. Likewise, the Society's Clinical Committee has

>

> published a statement of principles on TFTs, highlighting

>

> the conscientious work of UK researchers and clinicians in

>

> their response to thyroid disease, and stating

>

> emphatically that the Committee supports the use of

>

> blood tests to construct precise diagnoses (see

>

> www.endocrinology.org/sfe/thyroid-statement.pdf).

>

>

>

> Scientists are unanimous that TFTs are suitable to

>

> confirm hypothyroidism. The focus must shift to reassuring

>

> anxious patients that other diagnoses are being considered

>

> and to highlighting to borderline cases that their family

>

> history and antibody tests are being taken into account.

>

> Only by listening to patient fears, and not dismissing without

>

> discussion an insistence on a diagnosis of hypothyroidism,

>

> can clinicians hope to quell the current hysteria.

>

>

>

> HELEN JAQUES

>

>

>

> From: thyroid treatment

> [mailto:thyroid treatment ] On Behalf Of keith

m

> Sent: 05 November 2008 19:34

> thyroid treatment

> Subject: Re: Confusing TSH result

>

>

>

>

> Hi Sheila, Just in case you haven't seen it, this is on the same

web

> site---------Thyroid Hormone replacement therapy – " This house

believes that

> thyroxine is not an adequate form of thyroid hormone replacement in

> everyone…. "

>

>

> Best wishes

>

>

> keith

>

>

> http://www.endocrinology.org/education/category.aspx?catid=11

>

>

>

http://www.endocrinology.org/education/resource/EndocrineNurseCourse/

ent04/e

> nt04_day3.htm

>

>

> Thyroid Hormone replacement therapy – " This house believes that

thyroxine is

> not an adequate form of thyroid hormone replacement in everyone…. "

>

>

> C M Dayan

>

> Consultant Senior Lecturer, University of Bristol

>

> Endocrine <http://www.endocrinology.org/education/events.aspx?

eid=3> Nurses

> Training Course 9-11 September 2004

> Wills Hall, Stoke Bishop, Bristol, BS9 1AE

>

> _____

>

> ._,___

>

[Guest guest]

Hi there, glad to be of help to you.I have some very interesting things on my computer.lol.but my doctor is to busy to read any info. question-how are they ever going to catch up on relevant data ,apparently there are 15years behind in updating there education on all subjects. ?I will probably be dead by then . angel.