Highly Illogical Captain. A GP explains why he relies on Thyroid Stimulating Hormone to measure thyroid performance.

[holyshedballs]

Patient: Doctor, why do you measure Thyroid Stimulating Hormone?

GP: Thats an easy one. TSH is a reliable indicator of Thyroid health.

Patient: So, does the TSH come from the Thyroid gland then?

GP: No, it comes from the pituitary gland.

Patient: So is TSH a thyroid hormone?

GP: Well no, it comes from the pituitary gland.

Patient: Ah, I see. What does TSH do?

GP: It stimulates the Thyroid gland to produce T4 and T3.

Patient: So does TSH have an effect in the cells of the body that aren’t the Thyroid gland?

GP: No it only has an effect in the Thyroid gland. The clue is in the title, - Thyroid Stimulating Hormone, dummy!

Patient: So TSH in not a hormone produced by the Thyroid gland and it doesn’t have an effect in the peripheral tissues?

GP: Err, no, thats right!

Patient: So what does have an effect in the cells of the rest of the body then?

GP: Why, that is T4.

Patient: Isn’t that just a precursor to T3?

GP: Well, er yes. You got me there. Hang on, I know this one. (slowly works this out aloud). The Thyroid gland produces T4 and T3. The T4 is converted to T3. Thats it. The T4 is converted to T3 in addition to the T3 already produced by Thyroid gland.

Patient: Does T4 have an effect in the cells of the body?

GP: No… I think. Not that I know of.

Patient: So, which is the thyroid hormone that actually has an effect in the peripheral tissues?

GP: Why that’s easy, its T3. Definitely.

Patient: If T3 is the hormone that has the effect in the cells, it must be an important hormone?

GP: Correctamundo! T3 is PRETTY important.

Patient: Do you measure that?

GP: No, of course not. Don’t be silly.

Patient: Is there a blood test for T3?

GP: Oh yes. There definitely is.

Patient: Why don’t you measure T3 then?

GP: Because we measure TSH to see how well the Thyroid gland is working, not anything else.

Patient: Eh?

GP: Thats right. We measure TSH to see how much T3 there is in the blood. We don’t measure T3 to see how much T3 is in the blood. Even though we can. No sir.

Patient: Why is that?

GP: Because there is a negative feedback loop relationship between T4 and TSH. The more T4 there is in the blood the less TSH is produced by the pituitary gland. Conversely, the less T4 there is in the blood, the more TSH there is in the blood.

Patient: Hang on, you have just jumped from T3 to T4. Why is that?

GP: All the T4 is converted to T3. And we don’t measure T3.

Patient: So if T4 is the thyroid pro-hormone, could you measure T4 to see how much T4 is in the blood?

GP: Oh yes.

Patient: Do you?

GP: No. Well… sometimes. If we are pushed.

Patient: Let me get this straight. In order to find out if the thyroid gland is producing enough T4 and enough T3 you don’t measure the T4 and T3 the thyroid gland produces.

GP: Yes. Bang on there.

Patient: Even though you can?

GP: Nope. Not gonna measure T4 - unless I have to. ABSOLUTELY not going to measure T3.

Patient: You don’t think that it is a good idea to measure T4 and T3 to find out how much T4 and T3 is produced by the Thyroid gland?

GP: No, its a terrible idea.

Patient: Why is that?

GP: Because we can measure TSH. TSH in the blood tells us how much T4 and T3 is in the blood. Not the T4 and T3 in the blood.

Patient: Hmmm! How do you know if some of the T4 doesn’t get converted to T3?

GP: Im sorry, I don’t follow. ALL the T4 is converted to T3. Everyone knows that.

Patient: Did you know that there is genetic defect that alters the DI02 enzyme so that it doesn’t take an iodine atom from T4 to make T3?

GP: Lost me there I’m afraid.

Patient: The thyroid gland could be producing normal amounts of T4 and T3. If the DI02 enzyme isn’t working, say due to genetic defect, not enough T3 will be converted from T4 for the needs of the cells in the rest of the body. If the regular amount of T4 is produced TSH wont rise and won’t reflect the poor conversion of T4 to T3.

GP: Ah! I see.

Patient: By measuring T4 and T3 as well as TSH, could you work out if the T4 is being converted to T3?

GP: No.

Patient: Why not?

GP: Because we don’t measure T3. You must be suffering from a somatoform disorder.

[Sveistre]

Sounds really good when patient knows more than GP..this is how we are being treated..sad true😥

[Chickenlife]

Add in a conversation about antibodies and I could print this off and give it to my doctor 🤣

[Gcart]

Love it. So true. Bast**ds xx

[greygoose]

Doctors are not logical beings. Found that out years ago!

[bonnyaus in reply to greygoose]

Not taught to be logical or critical thinkers.

[greygoose in reply to bonnyaus]

Neither was I, it just comes naturally.

[holyshedballs in reply to greygoose]

We've all heard the stories. I always thought the reliance on TSH was illogical. I wrote it down to see what it looked like and looks very much like a comedy sketch. Only its not funny because it affects people's lives.

It really is illogical, and to keep on banging the drum, contrary to the Bolitho test.

i think that we as patients need to start challenging the illogical things doctors say. I hope that by seeing the ludicrousness of the supremacy of the TSH in a more readable form, it will give patients more confidence to challenge doctors.

[greygoose in reply to holyshedballs]

Absolutely agree with you. I've been challenging them for years, and have left a string of totally confused doctors in my wake.

[Angel_of_the_North in reply to holyshedballs]

You just need to add in a bit about hypothalamus and pituitary thyroid axis problems for those of us with central hypo. But no one has that; it's very rare. How do you know if you only test TSH?

[holyshedballs in reply to Angel_of_the_North]

Hi, its only a satire on how little knowledge GPs have about thyroid problems.

I did go on about the HPT axis but it wasn't funny!! So I took it out. To be fair, some doctors do test for T4 and some even test for T3 as well. It is just to highlight the illogical thought process for relying on TSH only. Plus my own knowledge of the hypothalamus isn't good enough to write a sketch about it.

[bonnyaus in reply to greygoose]

For some people grey goose. I have a sister-in-law that has no logic at all.

[greygoose in reply to bonnyaus]

Oh, agreed, there are plenty of people who lack logic. A lot of them go on to be doctors.

[bonnyaus in reply to greygoose]

I really believe it is "educsyed' out of them, then peer and career pressure finishes it off. All of these experiences for me made it very important to be involved and proactive in my health and treatment outcomes. Too many of the medical industry do not like that and actively discourage it.

[greygoose in reply to bonnyaus]

Yes, it could be due to brainwashing.

[Hidden in reply to bonnyaus]

I used to believe in Evolution, because of never ever hearing it was other than a scientific fact. When someone challenged me I was so furious it made me realise I'd been brainwashed. On scientific examination it is solely built on unproven and sometimes unprovable assumptions!

That's way off topic of course, just an illustration of something I had believed as scientific fact all my life till then, but if anyone wants to discuss in private you are welcome

[Hidden in reply to bonnyaus]

Just to add a bit of explanation: Living things DO change - sometimes a lot - which can be confusing because many call that "Evolution", as well as the belief that all life had a common ancestor.

Just look at the different breeds of dogs that have been developed by man-made selection over a comparatively short time. But that doesn't prove that dogs and cats had a common ancestor - which is also called "Evolution". I don't now much about the science of logic but think that's called the "Bait and switch" fallacy.

Right better get off my hobby horse and shut up

[JadisFox]

My GP has just given me a blood form which only covers TSH (but rarely T4 too). I shall not go for this test but have private bloods done and send him a copy of the correct test for my hypothyroidism along with a copy of this text!! Well done - a bit of education is needed by all GP's and every single Endo I have met!

[Mamapea1]

Yes, and this is why we have to sort ourselves out if we want to 'live long and prosper'! x

[holyshedballs in reply to Mamapea1]

Very good!!

[Hidden]

HAHAHA Brilliant!

[Hidden]

I didn't know the word "Somatoform", except soma = body, so looked it up, webmd.com/mental-health/som...

Used to be called "Psychosomatic". In other words it's all in the mind. And so is logic

[holyshedballs in reply to Hidden]

Professor Weetman (retired) used to push the idea that patients who has all the signs and symptoms of hypothyroidism but had TSH in the reference range were somatoform.

[Angel_of_the_North in reply to holyshedballs]

Because no one has gene disorders or problems with the pituitary or hypothalamus - they're all just mad, quite mad!

[holyshedballs in reply to Angel_of_the_North]

or too much rT3 or T3 resistance.

[Fifteen]

Not dissimilar from my conversations with my GP.

Even the Prof who sent the 'edict' letter to GPs to stop treating T3 said the same, though he did measure my T3. He decided that the T4 conversion to T3 was starting to work - how that could happen in just 3 weeks off T3 medication he did not explain.

It is clear to me that GPs have very little knowledge and understanding of the thyroid.

I also now think there is something about the way the thyroid works that has never been identified.

An area of study for a Ph.D student if they could ever get it approved.

[holyshedballs in reply to Fifteen]

I think that we as a group should be challenging these doctors more. hindsight is wonderful and I don't mean to chide you, but I would have asked the Endo for his reasoning that conversion has started to work. It sounds like a made up story to stop your T3 to me.

We have to have the confidence to stand up to the poor practitioners who are clearly acting outside of Good Medical Practice.

[silverfox7]

Don't know whether to laugh or cry but I did enjoy reading it, well done!

One thing I can never understand is that apparently we take medication because we have a problem and yet because we take this medication we are now well! I wish it were that simple!

[holyshedballs]

Thats my next script.

Dr. You are clearly ill. Take this medication. Its T4. Too much makes you thyrotoxic so we'll be careful about the dosing.

P. OK see you later

some months pass.

Dr.How are you doing?

P I'm great. Never felt better in years. Still have brain fog from time to time but l feel energised. I didn't realise how poorly I was.

Dr. Glad to hear that. I'm reducing your dose.

P. WHAT!! I've only just got better!!

Dr. I know, you've just told me.

P. Why on earth would you want to reduce my dose if it is making me better?

Dr. There is a risk!!

[Mamapea1 in reply to holyshedballs]

😂😂😂 Yeah! The 'risk' is they won't make any money out of you if you're well! 💊 x

[Aurealis]

Very good holyshedballs, enjoyed reading this. It would be funny if it wasn’t true and affecting so many of our lives