Thyroid treatment "guidelines'?

I was recently informed by a reliable source that no NHS endocrinologist across NHS Lothian or St. John's West Lothian would give a clinical trial of thyroxine where classical symptoms of hypothyroid were evident but bloods were "normal" and in range. Am I right in thinking that the Royal College of Physicians "guidelines" has a provision to suggest that a trial of thyroxine might be possible based on physicians assessment of clinical symptoms where bloods are normal. If so, can someone point me in the right direction please.

8 Replies

  • Read it for yourself! :-)

    But what you say is based partly on truth and partly on a mis-understanding. These documents are expressly about Primary hypothyroidism. So anyone who breathes words like "secondary hypothyroidism" or "tertiary hypothyroidism" or "central hypothyroidism" or "pituitary", or accepts they could be in the equation, needs to look elsewhere. If they then go on to spout from these documents, they do not understand what they are talking about.

    Patients with normal thyroid function tests

    (a) We recommend that those patients whose thyroid blood tests are within the reference ranges but who have continuing symptoms, whether on levothyroxine or not, should be further investigated for the non-thyroid cause of the symptoms.

    (b) A further opinion or help with these patients may be sought from appropriate specialists on specialist registers of the Royal College of Physicians or the Royal College of Paediatrics and Child Health.

    This makes an absolute assumption that thyroid blood tests within range CANNOT occur in someone with a thyroid disorder that needs to be treated. I do not believe that is backed up by rigorous scientific evidence.


  • I love the word 'spouting'.

  • I am not sure if this article has been posted here but it seems to very important

    Dr Pritchard is one of the people who has contributed to the scottish petition.

    (I tried to paste the original article but wasn't able to)


  • The original PDF on its Journal site is available here:

    There is also an editorial referring to the article:

    In this issue we have a landmark educational article by Mr. Eric K. Pritchard, an electrical engineer by trade, on the guidelines and policy statements related to the diagnosis and treatment of hypothyroidism. Pritchard eloquently discusses the need for mainstream medicine to think well beyond thyroxine- the only treatment for patients with primary hypothyroidism. His paper sets a new bar with respect to how all clinicians should approach the conundrum of treating patients with full-blown hypothyroidism as well as those along the “spectrum” of thyroid dysfunction.


  • Thank you for signposting

  • Thanks Roslin. I look forward to reading this.

  • Thanks Rod. Its all clear now. It's amazing how many references there are to possible harm to be caused by anyone who deviates from these "guidelines". Have you any sources that list the harm that can be caused?

  • Thanks Rod. It is now much clearer.

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