aDoctor, well, it looks as though I'm talking to an allopathic doctor that has retained his capacity for critical thinking, too many doctors seem to lose that trait after medical school or they are too afraid to express it. You will be a welcome addition to the conversation.
The challenges of Endocrine Disease in the US and UK are comparable from the patient presentation but not from the options available to the patient, we have more options in the US.
The professional organizations in the US (ATA, AACE, Endocrine Society) are closely aligned with the European organizations (BTA, BTF, RCP, ETA). The ATA and AACE's 2012 Guidelines were reviewed by the European organizations before they were finalized. The only real difference is the ETA holds T3 in experimental status while the ATA et al do not. Tick box medicine does seem to be alive and well on both sides of the pond.
I have never been able to find any science to support ten as the dividing line on the TSH scale. It appears to be a leftover artifact from the 1st gen TSH tests, some of whom had 10 as the upper limit of their reference range. Although 10 is in the US guidelines it seems to be applied more strongly in the UK.
I am sorry to hear that you suffer attacks from your colleagues for your treatment standards. I am well aware that doctors have been prosecuted for their views on thyroid treatment here in the US but it seems to have slowed in the last few years. Dr. Jonathon Wright was hauled before the board on trumped up charges just a year ago so I do not believe we have completely turned the corner yet, but they have been trying to get Dr. Wright for years.
I don't know how aware you are of the alternative world to allopathic medicine but this has been the year of the webinar. The NDs, NMDs, DCs, DOs, Health Coaches, Nutritionists and MDs that have transitioned to Holistic, Integrative, Functional, CAM and Anti-Aging Medicine have been out in force and I think it is too late to put the cat back in the bag. There are millions and millions of Americans that are totally dissatisfied with what allopathic medicine has to offer for chronic conditions and they are supporting the growing alternative to allopathic medicine. All western countries need to change their approach or they will end up bankrupt from health care costs.
Are you still working within the insurance model? Have you considered changing to a functional or integrative cash practice? Do you practice in a very conservative part of the country? I realize you probably don't care to disclose your location but maybe something like East coast, SE, SW, West coast, Plains states might be OK?
I am familiar with your links except for the plosone.org article, thanks for that. One thing I have learned is that you cannot absorb the entire catalog of endocrine literature, I have tried and failed. Dr. Lindner made a couple of contributions to the Scottish Thyroid Petition and has been a sane voice for many years.
Have you read Dr. Holtorf's excellent website?
Are you familiar with Dr. Bianco's work?
I'm curious how much you have explored.
A couple of my favorites:
"The guidelines are not inclusive of all proper approaches or methods, or exclusive of
others. the guidelines do not establish a standard of care, and specific outcomes are not guaranteed. Treatment decisions must be made based on the independent judgment of health
care providers and each patient’s individual circumstances. A guideline is not intended to take the place of physician judgment in diagnosing and treatment of particular patients".
"We encourage medical professionals to use this information in conjunction with their best
clinical judgment. The presented recommendations may not be appropriate in all situations."
They do establish a standard of care and doctors are afraid to violate them and use their own clinical judgment and of course in the allopathic model time is a critical constraint.
As for the TFTs, calling the reference range the normal range is a complete misnomer which implies a degree of accuracy the tests cannot support. They all suffer from a 'low index of individuality' so subjecting patients to a fixed reference range is a joke. Then there are the known problems with the width of the reference ranges and establishing the upper limit. There is the work of Drs. Hoermann, Midgley and Dietrich on the standard model showing it isn't quite as liner as thought. The problem that the TSH can lag the clinical presentation of symptoms by years, notable especially in Hashimoto's. The IFCCs attempt to harmonize the results from the TFTs and the great variance in the FT3 tests. And many more problem areas.
Until allopathic doctors start treating the patient instead of the blood test and include the patient's signs and symptoms in the diagnosis it will always be an inferior standard. I realize this is hard to do under the insurance model but it must change.
I think there is growing support for doctors and institutions that practice a 'functional' approach. Not only are millions of patients starting to demand better care but business will be pushing for 'preventive care'. The Safeway experiment will be impossible to ignore, it creates a competitive advantage that others will be forced to adopt. The Cleveland Clinic is going to establish a "Functional Unit' to document results and best practices. Change is coming however painful it will be. PR
PS Doctors can be just as frustrating to patients as patients can be to doctors. It is very difficult under the insurance/allopathic model to get a doctor to actually listen to you, it is almost impossible to have an intelligent discussion, there simply isn't the time for it. There are always exceptions of course.