To everyone concerned with this site, my best wishes for 2019. On my scientific side, I'm hoping for significantly greater progress in more people accepting the new concepts of how the thyroid and body work together and what the consequences are for proper diagnosis of the individual and treatment of disease. Already the penny seems to be dropping in the USA where Frontiers in Thyroid Endocrinology are assembling papers for a Research Topic: Research Topic Title: Combination Therapy for Hypothyroidism
Topic Editor(s): Jacqueline Jonklaas, Anne Cappola, Francesco S Celi
This series of papers will look at the circumstances in which combined therapy is advocated and we shall include our paper which has looked at an unselected group of patients on T4 therapy only, and has examined the FT4/FT3/TSH parameters for those contented on this therapy and those who still complained of hypo symptoms. The latter seemed to make a small subgroup of about 20% of the total, and their response (T4-T3 conversion) to the therapy was significantly different from the rest. As we showed before, the FT3 produced from the T4 is the important factor in separating this group from the rest, and TSH has no influence. The paper also shows the futility of combining all together in any statistical analysis; the minority are simply swamped out by the majority. This in turn questions the value of all clinical trials done in this manner as they are not either properly designed or powerful enough to find out what is actually happening. Unhappily I fear the NICE guidelines will simply churn over these ineffective trials and come to the same (non)conclusion.
But I do hope that the likes of Bianco, Jonklaas and Celi will also contribute. They all are impressive thyroid scientists and Celi is certainly happy with T3 therapy in the right circumstances. I look forward to this year as a further advance and acceptance that diagnosis/treatment needs a thorough overhaul.