Thyroid UK

Present for Christmas

This is to announce that, far more quickly than I anticipated, our Review in Frontiers in Thyroid Endocrinology is fully published in time for Christmas. The speed by which this has been reviewed and published tells me that the journal and reviewers realised its importance. You can download it from the Frontiers in Thyroid Endocrinology website on

Front. Endocrinol. doi: 10.3389/fendo.2017.00364

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oldestnewest

Thanks for posting diogenes and I have begun to read the following and I assume this is the link? You and your team will be very happy.

frontiersin.org/articles/10...

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thanks for the link Shaws

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diogenes,

Last time I visited my GP [1], he dismissed the short article I took and said he was a well-qualified doctor who understood research, next time bring a real paper rather than a summary document.

Your paper has come at the most opportune time for me to take to him early in the new year.

Thank you. Much better now officially published. :-) Hopefully it feels like a Christmas present to the authors!

[1] All I wanted was enough levothyroxine - not using 12.5 microgram Teva but instead getting 25 microgram something else even if I split it. And my last test was 2.9 (I knew I was low in thyroid hormone). He said that TSH was fine, it was FT4 that mattered. I pointed out that it hadn't been tested so what was he going on about???

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He was showing 'off' his knowledge :) Most hypo patients have never heard of Free T4 and Free T3 as it's never been taken so accept the doctors' words.

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It's also important to click on the links under the figure and table to get them up to print separately.

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Sorry, I should have said click on the figure and table icon to get the up.

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WELL DONE! CHEERS 🍾🍸

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Thank you Diogenes! This is great. GP will get this early next year.

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Diogenes, Oh My Goodness, this is going to make a lot of people uncomfortable. It is about time! A sincere thank you to you and your colleagues. PR

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Please would it be possible to summarise what the article is about and the conclusion, as I can't understand the terminology. Then I can decided whether its something that is relevant to me in my case to take to the GP regarding the removal of my Liothryronine. Thank you.

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First things first. Are you on T3 only or combination T4/T3? What the article says is 1) everyone is an individual and unique in how their thyroid works, how that interacts with the body converting T4 to T3, how efficient T4-T3 body conversion is and how sensitive the body's cells are to T3. 2) because the thyroid is no longer working, its direct T3 production that helped you keep well is no longer available, so if you take T4 only the body conversion has to work harder to produce the T3 you require. This requires more T4, and this suppresses your TSH. Thus TSH levels in health are not appropriate to T4 therapy. With T3 only or combo this is not so true but TSH can still be misleading. 3) FT3 must be measured in whatever therapy to control your level of helalth and response. 4) When you become ill and go on to a particular therapy (T4 only, combo or T3 only) for a long time, your body adapts to the treatment. Changing the treatment then is dangerous, because your body won't respond quickly if at all. This is called allostatic epigenetic transformation, where your gene readouts have been permanently altered from normal health and can't easily be restored back again exactly to what they were. This often happens if you become critically ill close to death and partially recover. If your doctor simply thinks that you can change things early and quickly respond, then this is a dangerous, wrongheaded thing to suggest and has been scientifically condemned and could cause you permanent harm.

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Hi Diogenes. Sorry to be rude by asking this, but please can you tell me what your credentials are in terms of medical knowledge, just so I can tell my GP what you have said. I am currently on Levothyroxine 50 mcg and Liothyronine 10 mcg per day (I was on previously on Liothyronine 20 mcg but reduced 2 months ago) for the past 18 months. My GP is removing my Liothyronine and increasing my Levothyroxine to 150 mcg per day from January at the request of the CCG. If I feel ill and have symptoms again by doing this he will help me with a case to the CCG to reinstate my Liothyronine.

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Foggy73,

My medical qualifications are zero. But I guarantee that switching 10 micrograms of liothyronine into 100 microorganisms of levothyroxine is utter madness!

There has been tendency to under-dose liothyronine by using a grossly exaggerated equivalence ratio. So when adding, say, 10 micrograms of liothyronine they reduce levothyroxine by five times as much, which is 50 micrograms.

In so far as there is any valid equivalence ratio in people who have conversion issues, something like three to one would be more sensible - maybe four to one at a push.

Using ten to one would absolutely certainly result in an effective under-dosing, possibly by a big margin.

Trouble is, using that same ridiculous ten to one ratio when converting back will tend to indicate a far too high dose of levothyroxine.

It is all too easy for me to say this, and so much harder for you to do, but can you get them to back up their use of a ten to one ratio?

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Hi Helvella. I will have to ask my GP. I had my Liothyronine reduced because my T3 was very high and I was having mild anxiety for a couple of months so I thought I had better get my bloods taken again. My test results in September were (I had them taken about 2 - 3 hours after I took my medication:

T4 = 10.3 (range 12 - 22)

T3 = 10.3 (range 3.1 - 6.8)

TSH = 1.3 (0.3 - 4.2)

My previous results in June 2016 were:

T4 = 6.2

T3 = 4.6

TSH = 6.53

My anxiety reduced very quickly once my Liothyronine was reduced and I feel fairly well at the moment.

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) I invented the current tests for FT3 and FT4 in 1981-2. I was c;linical trials coordinator and oversaw and analysed their performance medically before release to the public, cooperating with 55 medical centres in 19 different countries.2) I won the Prince of Wales Award for Industrial Innovation and Production in 1985 for the success of these tests. 3) In 2010 I contacted and formed a partnership with 3 German endocrinologists who are all medically qualified. Together over the last 7 years we have published together 25 + medically devised papers which together come to the conclusion summarized in the review. Will that do?

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Wow diogenes......yes it certainly will!!! Thank you very much, I really appreciate your help.

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It works for me! I don't want to hijack this thread, but since you mentioned developing the FT3 test, could I ask you if there is any shred of validity in my endo's opinion that TT3 is a reliable test, and FT3 is unreliable? Please PM me if you feel it more appropriate.

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You are very welcome to join this thread. The more people involved, the more information we will all receive to help each other

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Thanks Foggy73!

Doctors are such a pain. You show them a 40 page scholarly article and all they can say is they don't go by that because that's not how they were taught! I feel like I'm in the twilight zone!

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My GP has been very good since the Endocrinologist put me on Liothyronine, until the CCG have told him that he is no longer allowed to prescribe Liothyronine to me. Im dreading going backwards again to how I felt 18 months ago.

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You can always get your own if it comes to that. Well, at least if you can afford it, that is.

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It is an option, but not ideal due to finances.

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In the States with our insurance co-pay, it is almost as cheap to order it from Mexico.

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Brilliant, thank you. Definitely feel more inclined to have a Merry Christmas 😊 Cheers Diogenes 😊

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Fabulous Christmas present. Thank you! I'll add that to the list of articles I've printed off to take to my lovely GP in a couple of weeks. He reads the papers I take to him and tells me about it at my next visit :)

Have a lovely Christmas and a wonderful 2018.

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Hi Diogenes

Thank you very much. Happy Christmas to you and your family.

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