Thyroid UK
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At long last!

After a long battle with reviewers and editors we've got our latest paper accepted by Endocrine Connections. I summarise the conclusions. The paper will be published online in the next 7 days.

The findings of the present study have several clinical implications. Firstly, they recognize

thyroid hormone conversion efficiency, as defined by the calculated global deiodinase

activity or more simply the T3-T4 ratio, is an important determinant of L-T4 dose

requirements and the biochemical response to treatment. Secondly, in view of a T4-related

FT3-TSH disjoint FT3 measurement should be adopted as an additional treatment target.

Thirdly, in cases where an FT3-FT4 dissociation becomes increasingly apparent following

dose escalation of L-T4 an alternate treatment modality, possibly T3/T4 combination

therapy, should be considered, but further randomized controlled trials are required to assess the benefit versus risk in this particular group.

By global deiodinase we mean the total deiodinase activity in the body, whether directly acting in the thyroid gland itself or anywhere else in the body. By FT3-TSH disjoint we mean a change in the relation between FT3 and TSH in treated people as compared with normal health.

12 Replies


With warmest wishes to you and your team and that's great news and could mean a complete sea change in the diagnosis and treatment of many patients.

I am well on T3 only at present and hopefully patients will be dosed on what hormones suit them best.


Huge well done from me too!

Changing things for the better in relation the T4 mono therapy seems so difficult without any strong documentation. So thank you :-)

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Diogenes, congratulations on finally getting through the roadblocks. Is your other paper on the overall view on track for publication? PR


This is a much harder path! It's (relatively) easy putting down one smaller marker after another in separate papers which together make a story. Critics are like plucking geese - don't take too much at once or they'll squawk. But try to show their overall nakedness in an all encompassing resumee which shows the outcome of all the separate endeavours put together, and the outraged denying/squawking becomes deafening. Joking apart, Dr Dietrich is putting together a group response in a journal which involves others as well, and would include our overarching review of the totality of the implications. But this won't bear fruit until the start of next year I fear..


Well done on getting the paper published, Diogenes. I look forward to reading it.


Congratulations! Am I wrong or you were preparing a paper on the T4/T3 balance of the hormones produced by the thyroid? Is this the one?


Yes it is, but drawing together all the strands of argument is what is wanted, to justify in the deepest scientific analytical proof, that the response of those whose thyroids are compromised or lost to therapy requires careful understanding of the large variation in natural thyroid control of the body (patient to patient) and the resulting intelligent diagnosis and treatment schedules needs to satisfy the individual. Less pompously, whether you can handle T4 alone, a T3/T4 combination therapy or T3 only is a matter of resolving personal genetic makeup and suitable response to therapy.


Well done and thank you so much for your efforts!


Hip Hip Hooray, Hip Hip Hooray, Hip Hip Hooray from all of us.

With all your hard work and effort I feel we are getting nearer to proper treatment. Many Many Thanks

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Looking forward to reading it! Thanks for all your hard work.


Many many thanks for all you are doing to bring thyroid treatment out of its Cinderella status. I shall read the paper with interest.


A big THANK YOU for your hard work, not to mention determination! xx


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