Online Thyroid Clinic

[Guest guest]

I wrote the

following question to the thyroid experts asking for answers, but none was

forthcoming. Mireille copied my message and posted it under the 'Talking to

Doctors' thread, and lo and behold, Dr Beastall has responded. Please note that

he has not responded to my question. I now need references to as many papers/clinical

studies as possible to send to the RCP/BTA , so, if you have kept lists of

these, or you know of somebody who has, please let me know as a matter of

urgency.

Two

physiologically different definitions for HypoT!

by Mireille

on Mon Jan 30, 2012 5:36 pm

First, thank you for organising this Thyroid 'talkhealth

forum' and giving us the opportunity to ask the expert panel questions.

I would draw the attention of the panel to a very serious problem that exists,

but is not being recognised. My question is, why are

those suffering with peripheral metabolism and peripheral hormone reception

being denied a correct diagnosis and prescribed the active thyroid hormone T3?

Doctors failing to recognise this problem are causing harm to patients.

The problem is that there are two completely physiologically different

definitions of 'hypothyroidism', which is a cause for great concern.

• The Royal College of Physicians define

‘hypothyroidism as " the clinical consequences of insufficient

secretion by the thyroid gland " - meaning 'hypothyroidism' is ONLY

associated with the THYROID GLAND. This definition is the correct and narrow

definition. If this first definition is correctly called

" hypothyroidism " , this can, hopefully, be treated with levothyroxine

sodium-only.

• The British Thyroid Association

however, define hypothyroidism as " the clinical consequences of

insufficient levels of thyroid hormones in the body " . This

‘broad’ definition is associated with peripheral metabolism and

peripheral cellular hormone reception, which produces insufficient thyroid

hormone in the body. This should NOT, therefore be called

‘hypothyroidism’. It should be given a diagnosis of 'Clinical

Euthyroidism’, ‘Type 2 Hypothyroidism’, ‘Euthyroid

Hypometabolism’ or perhaps even the more wordy ‘Impaired Cellular

Response to Thyroid Hormone' - and peripheral thyroid hormone deficiencies

would be treated with the active thyroid hormone replacement T3 and NOT T4.

It does appear, that to avoid suggesting that T3 is needed, the diagnostics

recommended for the symptoms of hypothyroidism focus only on the thyroid gland.

When these symptoms continue, because they come from elsewhere, i.e. peripheral

thyroid hormone deficiencies at cellular level, they are not treated by

medicine. Instead, if a patient continues to complain of the symptoms of

hypothyroidism, and has normal thyroid function test results, and given

T4-only, s/he is given the bogus excuse of “you are suffering from a

functional somatoform disorder” – “your symptoms are

non-specific” or “its old age”. The result of these

continuing symptoms is a reduction in the patient's ability to function, or to

resist the dangerous consequences of low thyroid, which can be many, and they

continue to be a drain on the NHS.

The diagnostic and treatment protocol for those suffering the symptoms of

hypothyroidism must be thoroughly investigated without delay. Such confusion in

the definition is one of the main causes for over a quarter of a million

patients in the UK alone, being improperly diagnosed and improperly treated. If

this issue were fixed, then the NHS would save millions of pounds and the

quarter of a million suffering the symptoms of hypothyroidism would no longer

be ignored. See http://www.tpa-uk.org.uk/pritchard1.pdf

Please will one of the Panel Experts be kind

enough to respond to this request, for the sake of all those being left to

suffer so unnecessarily on T4-only therapy?

Mireille

Mireille

Posts: 23

Joined: Thu Jan 26, 2012 4:14 pm

Top

Re:

Two physiologically different definitions for HypoT!

by Dr

Graham Beastall on Fri Feb 03, 2012 8:23 pm

Mirielle,

I will reply but I suspect that I may not be able to answer your query to your

satisfaction.

I hear a lot of cases in which patients claim to be suffering from poor

peripheral conversion of T4 into T3. Usually there is no supporting evidence

and it is a diagnosis of exclusion in someone who has symptoms of

hypothyroidism but with normal thyroid function tests.

A primary cause of poor conversion of T4 into T3 is extremely rare and not

difficult to diagnose. What is much more common is a relative shift in the

conversion of T4 into T3 in the presence of intercurrent illness. This very

common condition is known as non-thyroidal illness or (as it used to be called)

the sick euthyroid syndrome. A wide range of acute and chronic illnesses can

bring about subtle changes in the conversion of T4 into T3. It is generally

regarded as a normal and necessary physiological response to slow down the

metabolic rate in the presence of a non-thyroidal illness.

It is clear that when the intercurrent illness can be identified and treated

then the conversion of T4 into T3 is altered back to the healthy situation.

This is most easily illustrated in an elective surgery situation where thyroid

hormone metabolism normalises in a few days. In chronic disease it is much more

challenging, especially when the primary source of the chronic disease is not

easily identified and treated. It may seem obvious that in such circumstances

T3 therapy should be considered. However, there are precious few bona fide

clinical trials of T3 replacement in situations like this and the results of

those that have been performed are not clear cut.

Most doctors are cautious and in the absence of evidence to the contrary they

are reluctant to treat what is seen as a normal physiological response to

another condition.

You can read a bit more about this in Chapter 5b of The Thyroid Manager (http://www.thyroidmanager.org)

Dr Graham Beastall

President of the International Federation of Clinical Chemistry and Laboratory

Medicine

Dr

Graham Beastall

Posts: 21

Joined: Wed Jan 18, 2012 5:36 pm