We've just received notice that our review paper, which summarises the work we have been doing for the last 7 years, is accepted by Frontiers in Thyroid Endocrinology. Its abstract is now available at:
Frontiers in Thyroid Endocrinology
MINI REVIEW ARTICLE
Provisionally accepted The full-text will be published soon (I expect around mid January).
Minireview: Recent Advances in Thyroid Hormone Regulation: Towards a New Paradigm for Optimal Diagnosis and Treatment
Rudolf Hoermann*, John E. Midgley, Rolf Larisch and Johannes W. Dietrich
The whole paper shows a) in control and expression of thyroid activity everyone is an individual - so that mere placement of values in or out of range is not diagnostically helpful or appropriate. b) TSH is unsuitable for monitoring thyroid hormone therapy, especially T4-only. All parameters TSH, FT4 and FT3 must be used in diagnosis c) the response of a person to thyroid dysfunction is unique and needs therefore unique individual treatment and control of treatment modalities. d) all Randomized Clinical Trials attempting to assess i) preferences for combined T4-T3 treatment over T4-only, and ii) those trying to show correlations between suppressed TSH and atrial fibrillation and osteoporosis are as a class wrongly devised and cannot demonstrate satisfactorily the phenomena they are studying. This comes about from a statistical error that all the studies have made in using nonselection in choosing their patient panels. I hope the paper will be strong ammunition for change in the upcoming review of NICE guidelines on thyroid treatment.
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diogenes
Remembering
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Well, when the full paper is out, I plan to let Dr Toft have a copy because I think we need as many allies as possible - always assuming he's happy with our paper.
Thank you Diogenes, I can't wait to read the full text and find out more. I really do hope that it helps to inform the NICE guidelines and that the Dr's who seem to be so sure that thyroid is simple to treat, finally realise that patients need personalised care and treatment.
I have been a strongly advocating that pre selection of a thyroid research cohort should be done. Those patients within the cohort with polymorphisms for DIO2 and DIO1 (and possibly others) should be identified and be a statistical entity on their own. Any thyroid clinical paper that does not do this is meaningless.
Diogenes, I have just read the abstract, WOW!!! This new paper should stir things up a bit. Thank you to you and your colleagues for all your hard work. PR
I'm very glad to be part of the team that is producing this work. Previously before I helped to assemble the present Anglo-Australian-German team I spent many years battling the bad science with which some carping but influential users of FT4 and FT3 tests tried to discredit them, on utterly spurious grounds which they were quite unwilling to retract when their incompetence was displayed to them. My wife is a long term Hashimoto - no thyroid - sufferer who is fortunate enough to use T4 only, but at the expense of undetetectable TSH over nearly 50 years. Obviously, she has been on the cusp of tolerance to T4 only. It makes me indignant that medicine in thyroidology not only took the wrong turning (TSH is all) 30 + years ago, but has stubbornly refused to consider that it might have been wrong, no matter what contrary evidence was produced (and rejected by them as not following the dogma). It takes enormous effort, not by any means just by us, to change things and unfortunately there are only a few that will look further than the end of their noses. This is bad science, bad medicine and indeed bad morality and it is accordingly anathema to any honest professional scientist. I'm glad that Toft, whatever his past failings, is coming on board.
"There are none so blind as those who will not see" !
How many times have these so called blind had the theories in this adstract flashed before their eyes! They appear to persist in clutching current treatment protocols to their very being as if they are carved in stone. It would be wonderful if this work manages to smash those tablets of stone.
The evidence that updating is required is staring the nay sayers in the face, but losing face seems to be a greater fear than any concerns for sick people suffering quietly at home and struggling to have their difficulties heard and addressed.
Yes, the NICE guidelines are due to be reviewed but what appears to be happening is that instead of these being viewed as "guidelines" they appear to have been interpreted as rules without any room for deviation. Will this change I wonder!
Medics appear to be (understandably) afraid to veer from the course set solidly in front of them in case they are hauled up for malpractice. Symptom based diagnoses appear to have been replaced by yet another box ticking exercise and until this mould is smashed thus allowing for more professional judgement then little will change in the near future. If we stop trusting people they will eventually stop trusting themselves!
Optimal is the keyword....
And to ensure that this aim is possible medical students need to be given a better understanding of thyroid issues...the work (revolution!) needs to start in the lecture theatres! They can only work with the tools they are given, and currently these appear to be tightly bound by outdated ideas in the heads of outdated thinkers!
Best of luck with this one and thank you for "flying the flag" which hopefully might help lead the way to providing better diagnostic tools for better informed doctors who will eventually better the lives of so many unnecessarily ill people.
Thanks, I will bookmark this and look forward to reading the whole article. From the abstract, similar stuff has been repeated again and again by the leading medical journals in the world, from America to Europe. It really is time until the science trickles down to practice and guidelines for treatment are updated.
Doctors are so clueless it’s like teaching evolution to a creationist. Not the best comparison but you get the idea! Over here I need to find a new family doctor within 3 weeks before my next labs. My doctor is so blind that he was worried I might be over medicated because my TSH was barely in range (0.44) despite Free T4 and Free T3 being in lower end of range.
Like man I wonder why even the conventional labs as a protocol, if TSH is below range, then automatically run T4 to confirm hyperthyroidism and if that’s above range run T3. From then on it’s a game of the doctor metaphorically pulling out a paper out of their behind citing their years of experience as a doctor. Most often, the greater the number the more behind the times they are!
I think we got in a bit earlier than others, having put down our marker in 2010. From my reading of the literature, others have come in since in the sense of doing experimentally more than just grumbling that something, somehow was wrong.
This should be required reading for all GP’s. Hope some of them find it on here. Thank you so much, like so many others I really appreciate all your work. You are a little ⭐️
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DIAGNOSIS OF ENDOCRINE DISEASE: How reliable are free thyroid and total T3 hormone assays?
