TFT guidance for Sheffield - Horrified!

[Laundretta]

"Free t4 is not required once TSH is <10"

"Free t3 measurement is not appropriate in the diagnosis and management of hypothyroidism"

[Nanaedake]

It's pretty much the same most places I think.

[Judithdalston]

I don't really know why we complain about our Gps/ doctors when these are the official guidelines... not due for review to 2021. It is these that are wrong and written in stone throughout the country. My son was trained at Sheffield university and would have done all his training pre qualification in wards/clinics/Gp practices with such guidelines for thyroid, and other, ailments...with Mr Hunt altering the Gps' indemnity scheme is it surprising that doctors stick to the 'rules'?

[helvella Administrator Thyroid UK in reply to Judithdalston]

I suggest that we should complain about our GPs/doctors because these are the official guidelines! Such guidelines are written by doctors.

Doctors who do recognise that the guidelines are wrong but just accept the guidelines and abide by them are behaving in a rather supine way. If they are wrong, then the doctors need to raise questions and get them changed.

Doctors who don't recognise that the guidelines are wrong need to wake up and question why the patients they treat according to the guidelines continue to be ill. Further, they probably need to do a bit of reading and extra study.

All doctors need to understand that guidelines are just that, guidelines. While I appreciate that indemnity scheme issues are important and affect how doctors practice, they also need to understand that blindly following guidelines - never demurring, never looking further - could itself result in claims. It is important to remember the Nuremberg defence.

[Judithdalston]

I was interested to see who had written these guidelines and see both authors are / were in Dept. of Clinical Chemistry; although one seems to be now referred to as a Chemical Pathologist....are they doctors or biochemistry etc PhDs; would they have any patient contact, or just deal with the chemistry/ statistics and pathology of disease in a laboratory? How do practising doctors affect the 'guidelines'; does anybody know if there is a method for patients, Gps, endocrinologists etc to have some imput into the review prior to 2021, or will this be a paper verification exercise more dependent on budgets, or the likes of new blood testing equipment, than patients getting better?

[helvella Administrator Thyroid UK in reply to Judithdalston]

I suggest you could write a request under Freedom of Information Act for all that!

[helvella Administrator Thyroid UK in reply to helvella]

Actually, any registered doctor can readily be looked up on the GMC site:

gmc-uk.org/registration-and...

[Murphysmum]

😱, that’s all!

[MissFG]

My GP’s practice in Rotherham has just brought in testing TSH FT4 and FT3 as standard now.

I always insisted on my FT3 being tested so it’s great to see their listening! Even though now I can’t be tested as I’m self medicating on T3. They give with one hand and take with another.

[helvella Administrator Thyroid UK in reply to MissFG]

Is that just your practice? Or all the local practices?

Which lab do they get sent to?

[MissFG in reply to helvella]

Think it’s just my practice. Obviously it’s been a learning curve for them and me.

I think FT3 maybe sent to a different lab than TSH & FT4, which go to Rotherham. FT3 goes to Barnsley. But that might of changed now and Rotherham might do all 3.

[helvella Administrator Thyroid UK in reply to MissFG]

I'd like to think that there was some sort of overarching research. For example, select a number of practices across the country and ensure they always get TSH, FT4 and FT3 tests done. Then see if the results of doing the full set translate into differences in diagnosis and treatment and, most importantly, treatment outcomes (how well their patients do).

Applying a blanket TSH-only policy means there is no data to compare that policy against - even if TSH-only were shown to be at least as good. (No, I don't believe it c=is or even could be as good.)

[Kell-E]

The only bright spot I noticed on the diagram was with a TSH < 0.1 they will test fT4 and maybe fT3. IF RAISED these confirm hyperthyroidism. This is not what docs usually observe. Low TSH gets your meds lowered across the board with no heed to fT4 or fT3.

So, the moral of the story is to get your TSH really low in order to get fT4/fT3 testing and not be declared hyperthyroid?

[helvella Administrator Thyroid UK]

TSH within reference limits suggests euthyroidism - no further tests are usually indicated.

Trouble is, the words suggests and usually are used but without any advice or discussion about when the TSH being within reference limits just might NOT demonstrate euthyroidism.

No inkling of the possibility of central hypothyroidism, interference with tests, effects of other diseases or medicines or supplements. No "If you think the clinical presentation indicates hypothyroidism but the TSH result suggests euthyroidism, then ...."

Guidelines like this need to cover 100% of cases. Even the extraordinarily rare. Of course we do not expect detailed discussion but these documents are used as if they are definitive and complete.

[Kitten44]

Oh dear, that explains a lot... Maybe I need to move!

Nevertheless, is there anywhere in the country that has a decent standard of care for thyroid conditions?

[Laundretta in reply to Kitten44]

Which part of Sheffield are you in?