Third of patients on levothyroxine have no reason to take the drug, claim researchers

Pulse article.

pulsetoday.co.uk/clinical/m...

[diogenes Remembering]

I would agree that if a patient has no hypo symptoms, then just because they have a slightly elevated TSH especially in the elderly, there is no obvious reason for giving T4. This is a case of patient presentation dominating over the biochemistry, which is what is desirable. However the rest of the article is very questionable. It is NOT the case that keeping TSH in the reference range is adequate for monitoring T4 therapy. The claims about increased AF and osteoporosis (fractures) are also confounded by the fact that the trials were done on unselected patient panels, where no doubt there were some patients with suppressed TSH that were overdosed , but others that because of different biochemistry were correctly dosed. That part of the story is the error of shoehorning patients into one category and one outcome based on biochemistry alone when the individiuals have different responses to the same biochemical values.

[helvella]

Among the 67% of patients who also had free T4 data available...

Isn't this ridiculous? 33% were diagnosed without an FT4 test (let alone FT3).

... no classic hypothyroidism symptoms ...

OK - so we can have any number of non-classic hypothyroidism symptoms (which might miraculously resolve on treatment). But if we do not present one of their definition of classic symptoms (not identified in article), we shouldn't be treated?

[Hillwoman in reply to helvella]

Articles like this one are alarmingly free of basic logic and proper interrogation of sources.

It took me 22 years to present some of the establishment's definition of 'classic' symptoms, by which time I was also losing consciousness several times a day. That didn't impress the thyroid specialist at the hosp - he waited even longer to offer treatment, until my FT4 almost vanished from serum test results.

[RedApple in reply to helvella]

... no classic hypothyroidism symptoms ... for example, if we aren't TAT (I wasn't) and FAT (I wasn't) we can't possibly be hypo. No wonder my GP admitted that he almost fell off his chair when my TSH came back at 69!

[humanbean]

Just wanted to point out that the article was published in October 2013. The reason it appeared in the most popular list today is that a doctor left a new comment on it.

[RedApple in reply to humanbean]

Good point. Shame the GP that commented today appears to think that endos are better at sorting this problem out

[Rapunzel]

A poster listed as a practise manager GP has commented, after many others commenting on this article,

It becomes clear from all of the above that this issue is well outside of gps competence and needs to be endocrinologists who address the matter.this is not a copout but good practice.

This issue, if you follow HU TUK, is also well outside the competence of many endocrinologists. Then what?

[RedApple in reply to Rapunzel]

You know the answer to that Rap... withdraw the medication and leave us to fend for ourselves

[Nanaedake]

Yes, seeing an Endo seems to add endless layers of complication rather than simplify things. Even getting a copy of one's own blood test results from a hospital seems to require leaping through ridiculous hoops.

[Zephyrbear]

Levothyroxine is NOT A DRUG! It's a HORMONE REPLACEMENT!!! It's for people whose thyroid is struggling or has given up altogether! The healthy thyroid produces all the hormones in a balanced formula and when things go wrong these need to be replaced by either the natural form, NDT, or synthetic T4/T3. The body does not make aspirin, hence that is a drug!

[lady_eve in reply to Zephyrbear]

I want to like this 100 times.

The classification of substances such as thyroxine, whether natural or synthetic, as a 'drug' is totally counterproductive. I am confronted with the same situation over DHEA (an adrenal hormone replacement) in which I am also deficient. Medicine should be the most nuanced profession, yet it's been reduced a tick-box exercise.

[cwill]

OK replace thyroid and TSH with blood sugar level and type 2 diabetes. Do docotrs really believe that we have to be close to collapse, unconsciousness, and serious damage to our health before we are allowed the elixir that is T4? What is it about this super powerful hormone that they are so worried about prescribing... My TSH reached 16.5 and I couldn't do anything at all and yet they were in no hurry to let me have levo even then.

[Hillwoman in reply to cwill]

TSH 16.5!!

[Rapunzel in reply to cwill]

Ignorance? Misogyny? Sadism? Not a pretty list of justifications, is it?

[cwill in reply to Rapunzel]

But they hide behind guidance and opinions. My antibodies had tested 1000 at diagnosis of ME, raised TSH 6.5 and low T4, family history of autoimmune disease but told to go home and not come to see them again as they couldn't do anything. Too right as it turned out but it was a choice of theirs, not good or even normal medicine. No humane doctor will withhold levo once TSH is above 10 and patient has symptoms. Or perhaps that should be paper patient with gender and name withheld.