We have a new paper out in Experimental Endocrinology & Diabetes entitled:
Symptomatic Relief is Related to Serum Free Triiodothyronine Concentrations during Follow-up in Levothyroxine-Treated Patients with Differentiated Thyroid Cancer
Rolf Larisch, John E M Midgley, Johannes W Dietrich, Rudolf Hoermann
To make it available I sent it to Louise Roberts at TUK as it will be behind a paywall for downloading otherwise. It shows low FT3 rather than FT4 and TSH relate to hypothyroid complaints in patients presenting over a 9 year period.
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diogenes
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The title is "Symptomatic Relief is Related to Serum Free Triiodothyronine Concentrations during Follow-up in Levothyroxine-Treated Patients with Differentiated Thyroid Cancer".
Does that mean this wouldn't apply to hypothyroid patients who haven't had cancer? For example I had RAI for Graves.
Having read the paper, it should apply to anyone. But The paper makes a very useful claim that treated patients are very different from healthy controls, but I could imagine someone that wants to critique that saying: "this person has some %age of their thyroid function remaining, so they don't count as being in this population".
No, it so happened that we had because of the speciality of the hospital, a lot of data on thyroid cancer patients and treatment going back years. The same argument will apply to all hypothyroid patients on therapy, no matter how it happened.
A few notes for anyone that doesn't get a chance to read:
Overall the claim of the paper is that it's freeT3 levels that best predict relief from symptoms, rather than TSH or freeT4, and that to feel well treated patients need it in the top half of the range. Most of the paper is the background on how the data was collected, and the relationship demonstrated.
But there are a few very useful supporting claims. First that many on T4-only treatment will have low, or even below range freeT3, and that even having a high enough dose to suppress TSH may not be enough to give a decent freeT3. Second that the TSH range, and other parameters derived from healthy controls cannot be applied to treated patients, as the whole system is different, and one example of this is that TSHs for treated patients may need to be far lower. As a result of all this discussion, they argue that freeT3 is a very relevant test for those on T4-only treatment.
My favourite thing about the paper, though, is that all the analysis is built around patient's self reported symptoms. The whole paper takes these self reports very seriously, and defines the goal of treatment as a relief of symptoms. This is a huge breath of fresh air when most journal articles treat symptoms and quality of life as some kind of puzzling anomaly. Even worse they are at a loss about how to include them in the analysis, so they are just tacked on as a meaningless afterthought. The intro of this paper includes a nice jab at that detatched puzzlement, by listing some of the weird nonsense that is often suggested for why thyroid cancer patients have low QoL scores. This paper doesn't mess around, and immediately just takes as read what we all know - we have low QoL because we continue to have debilitating symptoms!
A really useful paper that makes contributions in several directions, and best of all completely agrees with everything the forum says about the importance of freeT3 for relieving symptoms (except maybe suggests it can be a tiny bit lower than we say) ;D
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New Article - Diagnosis and Treatment of Hypothyroidism
