GP Online Clinical review: Hypothyroidism

[Clutter]

An overview of the diagnosis and management of hypothyroidism, including causes, investigations, the effect of pregnancy on thyroid function and treatment with levothyroxine.

gponline.com/clinical-revie...

[teenarocks]

"Despite treatment with LT4, some patients (approximately 10%) may have continuing symptoms.

"Such patients should be investigated for other conditions, such as other autoimmune disease (Addison's disease, primary biliary cirrhosis, pernicious anaemia) and obstructive sleep apnoea).

"There is no clinical evidence that T3 therapy in addition to LT4 is of any benefit in primary hypothyroidism."

Makes me want to cry.

[Clutter in reply to teenarocks]

Teenarocks,

They are following the British Thyroid Association party line. I wouldn't expect anything less. I have just tweeted @GPonline that there is a blind random controlled trial which shows that T4+T3 combination may be preferable karger.com/Article/Abstract...

[humanbean in reply to Clutter]

I don't understand Twitter.

If you've tweeted them why doesn't your tweet show up on their Twitter page?

[Clutter in reply to humanbean]

HB,

I think because only the tweets, replies and retweets GPOnline send show in their timeline.

[humanbean in reply to Clutter]

Okay. I hardly ever look at Twitter since I don't have an account, and really haven't grasped the point of it. But now I understand why so many Twitter pages belonging to organisations are so dull.

[JGBH in reply to Clutter]

Clutter,

Did you get any kind of reply/comment from GPonline? It would be interesting to know.

[Clutter in reply to JGBH]

JGBH,

I sent them a link. I wasn't expecting a reply.

[JGBH in reply to Clutter]

Thanks Clutter. Was not sure whether they would comment or not.

Would have been interesting to know whether they would have consented that T4 T3 combination would be really important for some patients, making big difference to their health.

[Clutter in reply to JGBH]

JGBH,

They're a GP newsheet. I wouldn't expect them to have an opinion on the link.

[lola1956 in reply to teenarocks]

Me too ..its awful 😢

[Justiina in reply to teenarocks]

If there is no clinical evidence then hypothyroidism before developing synthetic thyroxine was ineffective and patients must have suffered horrendously.

Armour has never worked if that's true.

Ok I admit a bit one eyed, but basically if T3 adds no value whatsoever I do not understand how come on armour people recovered.

If it's considered just as that ofc T3 in armour is effective , then it doesn't matter are patients getting T4 or T3 as long as it helps.

[Clutter in reply to Justiina]

Justiina,

Lack of evidence doesn't mean there is a lack of benefit. Some of the L-T4 and L-T3 trials have been very skewed with huge reductions of L-T4 when small amounts of L-T3 have been added. Many L-T4 + L-T3 combination trials have been done with patients who are well on Levothyroxine only so they wouldn't be expected to find a preference one way or the other.

NDT was the only treatment for hypothyroidism until Liothyronine (T3) and later, Levothyroxine were produced so there was no necessity to do clinical trials and because NDT had been around for decades it was 'grandfathered in' without trials. As far as I'm aware there were no clinical trials to prove the effectiveness of Levothyroxine back in the day either.

[teenarocks in reply to Clutter]

I didn't realize Liothyronine came into being before Levothyroxine. That makes it even more puzzling why the medics don't accept it as beneficial.

[Clutter in reply to teenarocks]

Teenarocks,

President John Kennedy was treated with Liothyronine for hypothyroidism.

[teenarocks in reply to Clutter]

Not to belabor the point but it was OK for the U.S. president but it's not ok for us!?!

[Clutter in reply to teenarocks]

Teenarocks,

Sadly Liothyronine and Armour etc. have never had the marketing behind them that Levothyroxine and Synthroid have.

[Kelloggs36 in reply to teenarocks]

Eell iit works fir me. Do they actually ask patients???

[Baggiebod]

If only those who insist that T3 is not helpful, because they 'toe the party line' could experience T4 resistant hypothyroidism for themselves...

[Kitten1978 in reply to Baggiebod]

I wish they could...

[cwill]

What really got me is that management by TSH alone and levo. results in an excellent prognosis. Job done! As you all say try it and see preferably without a thyroid to really experience the full merry go round.

[stiltzski]

As I have said before, please could one of our admins initiate a members' poll (know it's possible as Ken - admin on Fibromyalgia forum - does them) asking who has benefitted on Levothyroxine alone, T3+T4 and T3 only. I think the results would be very interesting and could perhaps be used to take further action to ensure T3 remains available?

[Clutter in reply to stiltzski]

Stilltzski,

I have no idea how to do a poll. Perhaps LouiseRoberts could arrange a poll?

[helvella Administrator in reply to stiltzski]

I suspect that a poll on this forum would not make much difference.

The fairly major Patient Experience Survey was far more comprehensive than could be achieved:

thyroiduk.org.uk/tuk/TUK_PD...

[stiltzski in reply to helvella]

Maybe but every little helps and it would still be interesting for members to see the results.

[Hidden]

Have added a statement showing some of the true facts. I wonder if it will be deleted just like my comments were about the BTA and ATA recommendations last year concerning hypothyroidism treatment.

[Clutter in reply to Hidden]

Panda321,

Where have you added your statement?

[Hidden in reply to Clutter]

At the bottom under a pseudonym. Ben Turpin.

[Clutter in reply to Hidden]

Panda321,

Probably a mistake to say you are a patient when the site says it is intended for healthcare professionals. Pulse got around it by making people register with their GMC registration.

[Hidden in reply to Clutter]

I didn't see anything about having to be a professional.

If the "professionals" hear only the views of other "professionals", then they'll never know the truth.

[Clutter in reply to Hidden]

Panda321,

There's a strapline across the top of the page.

[Hidden in reply to Clutter]

Oh dear, my friend Ben is in serious trouble. He may have to emigrate to escape a life sentence at Her Majesty's pleasure.