British Thyroid Association - mixed messages

[AmandaK]

I read with interest the BTA's response to the petition to the Scottish Parliament.

Yesterday I came across a document written in 2006 by BTA, the Association for Clinical Biochemistry and the British Thyroid Association which seems to contradict some of their statements (I'm not sure I understand what is meant by 'non-thyroidal illness' - see below).

In the response to:

1. We ask for the inclusion of tests for Free T3 (FT3) and Reverse T3 (RT3) thyroid hormones, as these are the strongest indicators of cellular thyroid levels.

they state:

The BTF informs enquirers that these tests are not useful in the diagnosis of hypothyroidism. Our medical advisors inform us there is no reliable scientific evidence to the contrary.

Yet in their 2006 doc:

SECONDARY HYPOTHYROIDISM

Diagnosis: The biochemical diagnosis of secondary hypothyroidism necessitates the use of a

combination of TSH with FT4. Plasma TSH can be low, within or mildly above the reference

range in these patients but combined with a low FT4 measurement is suggestive of secondary

hypothyroidism.

Measurement of FT3 may be required to differentiate secondary hypothyroidism from non-

thyroidal illness especially in older patients where symptoms are often vague and non-specific.

Patients suspected of having secondary hypothyroidism may require referral to an

endocrinologist to accurately make the diagnosis and for additional pituitary function tests (PRL,

FSH, LH, ACTH/cortisol). Tests of adrenal function are mandatory in patients with a high index

of suspicion of hypopituitarism.

Measurement of TSH and FT4 is required to identify secondary hypothyroidism.

Secondary hypothyroidism can be distinguished from non-thyroidal illness on the basis

of clinical history, measurement of FT3 and tests of other anterior pituitary hormones.

Guiding Treatment: Patients with secondary hypothyroidism usually also be deficient in other

anterior pituitary hormones and the degree of hypopituitarism must be established before

commencing thyroxine replacement. In particular thyroid hormone replacement should not be

commenced in patients with cortisol deficiency as this could provoke an Addisonian crisis.

Glucocorticoid replacement should be started prior to the initiation of thyroxine therapy.

Thyroxine should be given in increasing 25 μg doses and optimised such that the thyroid

hormone concentration is within the upper third of the reference range.

The full document is called: Adapted Summary of UK Guidelines for the Use of Thyroid Function Tests (July 2006). Here is the Introduction:

The Use of Thyroid Function Tests Guidelines Development Group was formed in 2002 under

the auspices of the Association for Clinical Biochemistry (ACB), the British Thyroid Association

(BTA) and the British Thyroid Foundation (BTF). The purpose of the guidelines is to encourage

a greater understanding of thyroid function testing amongst all stakeholders with a view to the

widespread adoption of harmonised good practice in the diagnosis and management of patients

with thyroid disorders. This summary is adapted from the July 2006 guidelines.

The full doc can be read here:

pathlabs.rlbuht.nhs.uk/tft_...

Or have I misunderstood what they are saying?

[roslin]

very interesting, they certaily seem to have contradicted themselves.

roslin

[lola1956]

Definitely contradictory. ..wel done on finding it

[JANJAN2]

We need to get the Scottish parliament to read this.A good find!

[Moggie]

Still say that the most recent paper is written by an NHS doctor.

So what's changed in seven years as far as thyroid conditions go, has there been some sort of miraculous cure that we no longer need the FT3 or RT3 tests and what they can tell us - NO. The only thing I can see that has definately changed is the money they NHS now has to spend and that's the real reason appropriate treatments and adequate testing is being denied us.

Well done for ferreting this out - so who is going to bring this to the BTA's attention?

Moggie x

[roslin in reply to Moggie]

Could amanda post it on STP Facebook, I haven't got an account so I can't

Roslin

[Hennerton]

Thanks so much for finding this. It could become so useful to many of us and it is amazing the way they have done an about turn in just a few years. x

[helvella Administrator]

The issue is very often that the words used by BTF and so on apply strictly to primary hypothyroidism. Unfortunately there is rarely proof that the person is not suffering from secondary/tertiary (central) hypothyroidism or any other form. Indeed, there is rarely even a glimmer of a thought that this could be the case. They also fail to make that clear.

I strongly suspect that imperfections in the whole pituitary and hypothalamic areas are probably far more common than has been realised. Indeed, I suspect that long-term thyroid issues could cause such imperfections.

For me, so far, TSH has seemed to move fairly much in line with how I have felt. The problem I could have had was inability to convince my GP with a TSH that was only slightly out of local reference range. I was lucky - that was not a problem.

But it is for so many others.

Rod