The paper by Jonklaas et a is now out in full in Frontiers in Thyroid Endocribology. Downloadable as:
Front. Endocrinol., 30 January 2019 | doi.org/10.3389/fendo.2019....
Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members
Jacqueline Jonklaas, Eshetu Tefera and Nawar Shara
Thank you so much.
Have you seen this?
eje.bioscientifica.com/down...
Wiersingas ‘everything you may want to know about combination therapy but we’re afraid to ask’
.......the latest state of play almost perfectly summarised.
These people don't want to commit but want to be seen as being on the right side if it pans out that way. It's what's called hedging your bets. So they can say, we're the good guys.
At least some of them are starting to hedge their bets - a sign that earlier certainties are becoming uncertain realities..... weirsinga seems like one of the good guys although his line on aggressive patients making demands on clinicians causing tension is just as likely seen the other way around!
So another words they play it both ways and the side that wins is the side they take . Either which way they look good regardless . Why can't they just see the truth for what it is and stick with it and call it the way it really is ???? Politics at it's best . At our Expense of our Health and well-being account . What else is New ?????
I thought this was a well-balanced and unbiased review. I I thought this respected both patient and doctor perspectives. I suppose as a ‘fence-sitter’ it’s easier to see both sides. I don’t think the good v bad/ right v wrong perspective serves anyone well (and the author alludes to this). If anything this review calls for collaboration between patients and doctors... surely that is the only way forward?? (Though this perhaps depends on ones world view and many will disagree I’m sure!)
The difficulty is that this is only one of several contributions by this (retired) author and colleagues. And all of them tiptoe up to making a decision about this problem and then diplomatically shy away. Its all done in a language that doesn't offend current thinking in the field but yet gives them a loophole. Maybe, maybe is the line taken. Evidence is evidence - you can't haver about it but have to accept the implications fully.
What is the decision?
That T3 in combination or alone can be valid and safe for treatment in patients needing it.
It just seems fairly objective to me. Just someone summarising the situation pointing out what is and isn’t known. There may be omissions, but perhaps you know this better than me. I can understand if you are very involved in this forum (and the level of anecdotal evidence) and this area of research, that you are frustrated by a postition of uncertainty from this author.
You are welcome to your interpretation.
I should clarify I didn’t get any anti combination treatment stance from it... more the opposite in fact, but outlining a need for more research and I am sure we would all agree this is needed, right?
I interpret that as a put-off until the right people in the accepted positions confirm what others have demonstrated earlier and by that legitimize it. You must remember that accepted research comes from accepted groups. And no acceptance until. Thats been my experience over a research lifetime in several unrelated fields.
I am sure you’re right. I suppose I would be keen to see longer term studies published, though the Leese one was reassuring. The main problem at the moment is cost and rationing, which surely shouldn’t influence clinical decisions...
I loved the ‘patient preferences’ being a reason that combination or T3 therapy is used - which means that patients ‘prefer’ to be well?
