A new paper accepted in Clinical Endocrinology

Hi: this is just to report that we've had a new paper accepted and published online in Clinical Endocrinology 2014:

Homeostatic equilibria between free thyroid hormones and

pituitary thyrotropin are modulated by various influences

including age, body mass index and treatment

Rudolf Hoermann*, John E.M. Midgley†, Adrienne Giacobino*, Walter A. Eckl*, Hans G€unther Wahl‡,

doi: 10.1111/cen.12527

What it proves is that there is no such thing as a TSH range that is suitable for everyone, and that the range is different according to the effect of independent influences such as age, body mass, size of working thyroid volume and whether someone is on T4 or not. The T4 therapy range is very much lower than the "normal" untreated and sits around the 1 or lower mark. The 3-4 upper level that works for the normal person is not satisfactory and can indicate undertreatment. Also we're finding that people with no thyroid working at all cannot easily regain normal FT3 with T4 alone and that TSH suppression often has to happen, and in some people no amount of T4 will regain normal FT3 levels. Recent reviews by the gurus now admit that some people cannot handle T4 only and regain health. Just thought you'd like to know that the avalanche is beginning.

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46 Replies

  • This is great news, particularly as I have no thyroid. How can I see and print a copy of this paper? I want to be at the beginning of the avalanche please!

  • I have mailed it to Louise Warvill who I think is putting it on the site as a download.

  • Hi John

    Please can you confirm if it is open-access - thanks! :)

  • $42 for 24 hour access from Wiley Online Library. I'll wait for the download :-D

  • Clutter, Wiley does have a patient access button but it doesn't work for me and their 'contact' link goes nowhere. PR

  • I registered PR but couldn't get the full article without paying the subscription.

  • I registered before they had the 'patient access' button. When I get a chance I will try and contact them to see if it can be fixed so those of us that are patients can get copies at a reduced price. I believe it was something like $3 or $4. PR

  • I think Louise may be posting a download of it PR but if not someone is emailing me the full article tomorrow/Thurs and I'll post it.

  • Thanks, Louise.

  • Thank you!

  • So do I! My thyroid was zapped with RAI when I was too ill to understand the consequences, so 18 months later I had no functioning thyroid hormones at all. Now paying through the nose for NDT.

  • I am too and it has just had a huge price hike!

  • Thanks for posting this. Very complicated and very interesting!

  • Yes, now it is online it is published and plenty of workers have already viewed it. Now it is firmly online, they can dowload.

  • Diogenes, That's very good news indeed and hopefully will be taken on board by medical professionals sooner rather than later :-D I look forward to reading the full article.

  • Congratulations and well done, and thank you! :-D

  • We haven't finished yet! More to come when accepted. Two ideas: 1) TSH controls both thyroid and tissues T4-T3 conversion so that both thyroid and tissues interact to produce the best result in the healthy body and 2) It's probable that the thyroid produces directly a lot more than 20% (the current belief) of the total T3 made in the body. So loss of gland activity would be even more catastrophic as for some people the tissue conversion T4-T3 simply couldn't fulfill the body's needs however much T4 is taken in monotherapy. Because your conversion enzymes in your tissues can't do any more. Thus, T3/T4 combinations or T3 or whatever have to be taken instead to get FT3 up to scratch.

  • I had no doubt you weren't finished! ;-)

    I tore a strip off my GP today so hopefully people will start to question all this nonsense 'received wisdom' and look at your new information.

  • Hi, can you provide a link to the paper/article please?

  • Louise Warvill should have posted it on site. Pls contact her for access.

  • Full version PDF on our website :)




  • Just have to say thank you.

    I have no thyroid, active aggressive TED and my numbers are pretty good on mono therapy. The problem is I do not feel at all well with all.

  • Good hope doctors listen. I was put on 100 a day post op my tsh was 32 so I was phoned and told to change to 200 levo a day . I wasn't overweight. I put on several stone and am still

    On 200 levo a day . Feel crap vitamin d deficiency and on pills for that . Low ferritin which doc said is fine but it's 24 and I know it could be better. Tired of these hypo feelings

  • Diogenes, thanks and I look forward to reading the full paper. PR

  • Nice, all we have to do is get the RCP and BTA to acknowledge it.

  • Thanks for the study and are you hopeful that they will acknowledge it?

  • I've sent Louise Warvill another paper published in the same journal at the same time, by Bianco, a top researcher in thyroid matters. Here he admits the likelihood that FT3 is the best diagnostic in therapy and has supported our work (while carefully not quoting it - so as to maintain an intellectual distance while he figures out how to say "me too" without actually saying it out loud).

  • I'm so glad we have people such as you & Bianco out there!

  • Diogenes, I take it this is the paper you are referring to. PR

    Defending Plasma T3 is a Biological Priority

    Sherine M. Abdalla and

    Antonio C. Bianco*

    DOI: 10.1111/cen.12538


    Triiodothyronine (T3), the active form of thyroid hormone is produced predominantly outside the thyroid parenchyma secondary to peripheral tissue deiodination of thyroxine (T4), with less than 20% being secreted directly from the thyroid. In healthy individuals, plasma T3 is regulated by the negative feedback loop of the hypothalamus-pituitary-thyroid axis and by homeostatic changes in deiodinase expression. Therefore, with the exception of a minimal circadian rhythmicity, serum T3 levels are stable over long periods of time. Studies in rodents indicate that different levels of genetic disruption of the feedback mechanism and deiodinase system are met with elevation in serum T4 and thyroid stimulating hormone (TSH) levels, while serum T3 levels remain stable. These findings have focused attention on serum T3 levels in patients with thyroid disease, with important clinical implications affecting therapeutic goals and choice of therapy for patients with hypothyroidism. Although monotherapy with levothyroxine is the standard of care for hypothyroidism, not all patients normalize serum T3 levels with many advocating for combination therapy with levothyroxine and liothyronine. The latter could be relevant for a significant number of patients that remain symptomatic on monotherapy with levothyroxine, despite normalization of serum TSH levels.

  • Yes that's the one

  • Briliant work. Well done. Will the Endocrinologists read and take notice? That's the problem - when will the British Thyroid Association accept scientific evidence? In the new Millenium!

  • I really think they will. Communication nowadays is lightning fast. It's only the brain that has to take in the new information. When I said that an "avalanche" might be in progress I meant it in that context. Whereas it took years and years (15+) for new info to become accepted, medical conservatism really has to speed up to take in and disseminate new knowledge owing to the flood of better work coming in. There is too much of the professional introvertism and exclusion around in all the professions. I'm an outsider: no medical quals. It may seem trivial but it's not. I can make a contribution as well as anyone else but if you don't appear from the right direction, then there's an easy excuse to exclude and not take notice. I've shouted from the sidelines for many years against the absurdity of the direction of thyroid function testing. It was interesting but ultimately futile if the herd turn their backs. Only in 2012 when I collaborated with a sympathetic medic (Hoermann) could I enter the field at least on substitute terms. And together with our different expertise and knowledge and bringing in others with even more specialisms, could we proceed to the position we're now in.

  • Thank You Thank You Thank You Diogenes and Hoermann for all that you are doing and have done , Its very uplifting to think that things are starting to move quickly now. Roll on the avalanche. :-D

  • Yes, thank everyone concerned. I have had problems with this 'new' forum as I couldn't access is whatsoever and couldn't reply to anyone.

  • This is wonderful news, thank you

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