A new review published

Our review of thyroid function in normal healthy people and the implications for future treatment in thyroid disease has been published in Frontiers in Thyroid Endocrinology. If you put into Google "Frontiers in Thyroid Endocrinology" the article should be displayed for free download. To summarise, we show that in healthy people there is a continuous change in the relations between TSH, FT4 and FT3 across the range of FT3. Those at the upper end of the healthy range are the more likely to require T3 supplementation to T4 if they become ill later. You therefore can't just lump everyone in together as being all capable to respond properly to T4 only treatment. That asumption which is the basis of current belief is wrong. Also one again the normal range for TSH in health doesn't apply on therapy what ever that is.

11 Replies

  • Hi Diogenes

    Would it be possible to put up the link to this study please? It is not immediately obvious..well not to me when i type in "Frontiers in Thyroid Endocrinology" in the search engine what i should be looking for and i would very much be interested in reading it.

    Many thanks.

  • When you have clicked on "Frontiers ---" a window comes up with Minireview article on the left. That's ours but only the abstract Click on the Minireview window and the abstract comes up and a the top right of the window you can see Download PDF. Click on that and the article comes up in full.

  • It just looks like a grey dot in my browser and doesn't have any explanatory text, but opens an extra pane with Download Provisional PDF (after enabling about 20 external sites' worth of scripting!)

  • Very useful diogenes, thank you! My brain started going into Fog Mode after the first page, darn it, but I will persevere. :D What I will do is give my doctor that link!

  • "The upper end of the healthy range" of which hormone?

  • Free T3

  • Diogenes, what are your thoughts on the co-activators and co-repressors that Dr. Hollenberg has studied? How important is their role in controlling the timing of when/how FT3 gets to the nuclear receptor? And I've never been able to discern what the control system is for them and how it is tied into the overall control system. PR

  • I'm afraid that all I am cognisant with is the interplay of thyroid and tissue. What happens after the T3 enters tissue and sets to work is not in my sphere of knowledge. Here there are another infinitude of actions that specifally suppress and repress particular gene expression uniquely for that cell. I have no expertise whatever on that.

  • Hi Diogenes,

    I have read your article and was very impressed with your obvious expertise. Whilst not pretending to understand all of it, I note that there is considerable individual variation in optimal thyroid function, and this is something I have always realised was the case.

    However, the one thing I have never understood is the notion that it is difficult to treat people with thyroid hormone optimally according to their genetic 'set point', as it is not possible to know what this is.....? I strongly disagree with this in some instances, for example for patients who have had thyroid surgery like myself, (half of the thyroid removed for a suspicious nodule), there is a clear record of my pre-surgical thyroid function, as this was measured 4 times before surgery and each time my TSH was 0.66 (only differing on one occasion to 0.68) and FT4 15.3.

    MY TSH now varies between 1.78 and 2.5, although my FT4 is broadly similar (has dropped at most to 14.4) (Sadly, FT3 wasn't measured before surgery, but is now 4.1) So surely treatment should be aiming to get me back to my genetic set point of a TSH of aprox 0.66 and FT4 of 15.3, as this is clearly 'normal' for me. Why aren't they trying to get people back to their genetic set point when people have had surgery for nodules, etc, with no signs of thyroid dysfunction before surgery? -I had no hypothyroid symptoms prior to surgery. My TSH was even 0.66 back in 2007, indicating that this was clearly my consistent genetic 'set point', and I felt completely well prior to surgery in Feb 2014.

    I realise this reasoning isn't possible for people who haven't had surgery but lapse into a hypothyroid state or have hashimotos disease etc, but why isn't previous thyroid function used as a guide for people who have had no previous problems with thyroid function, but have had surgery for nodules etc. This seems obvious to me, so...am I missing something?

    Please could you shed some light on this, as it has perplexed me for some time, and I am continually frustrated that Drs/Endo's don't seem to take note of my previous thyroid function tests prior to surgery in 2014 when I had no thyroid function issues, but instead compare me to a 'range'.

    Thanks very much.


  • It's quite unusual for someone to have their thyroid function comprehensively tested when they were well. Anyone healthy turning up at a GP's office asking for thyroid function tests would get a very dusty answer. This attitude we want to change. Regarding "set points". You had a "set point" unique for you when you were well - that is, a certain amount of T3 produced from a certain amount of T4 and controlled by a certain level of TSH. However, depending on how long you were ill before treatment, your body can change to try to keep you as well as possible, and so your set point can change. This is called epigenetic change. It doesn't completely return to your healthy state on treatment, so though you original point would be a target, it wouldn't necessarily be best for in the altered circumstances.

  • << It's quite unusual for someone to have their thyroid function comprehensively tested when they were well. Anyone healthy turning up at a GP's office asking for thyroid function tests would get a very dusty answer. This attitude we want to change.>>

    Amen to that!!

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