Paper showing cognitive inadequacy in treated patients

[diogenes]

This paper shows that with T4-treated patients at TSH = approx 3 on treatment there is as expected as significantly inferior QoL in all respects. It shows that at these high levels but within the healthy range, treatment is inadequate.

Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement

June 2018 Endocrine 62(3)

DOI: 10.1007/s12020-018-1649-6

Marina Djurovic Alberto M Pereira Alberto M Pereira Johannes W. A. Smit M

At least it shows that high-normal TSH in treated patients is insufficient for health. How far down the range inadequate QoL remains is a moot point.

[SlowDragon Administrator]

Here's a link to this

ncbi.nlm.nih.gov/pubmed/299...

[LAHs]

Well I am awfully glad all those terribly clever medical researchers did that study, I am sure it cost millions. They could have asked me for free ten years ago or they could have spent an evening reading HealthUnlocked. Of course our Q of L is lower! No doc has the time nor interest to do an in depth study of the patient in front of him, hence inadequate dosage of the wrong medication. The sad thing is that if they would study just one patient in every detail until they got it right, it would be very easy to do the next patient successfully. And whoa, think of the kudos they would get out of being a doc who could fix thyroid patients - isn't that incentive enough?

[diogenes Remembering]

I looked again in more detail at this paper. The spread of TSH values in the treated patients went down to just over 1, indicating that subjects with TSH much less than 3 also suffered from low QoL. It was odd that the treated patients didn't show a different FT4/FT3 ratio from controls, but the numbers were small compared with our studies which quite show a difference. I conclude that some subjects on T4 with quite low TSH values around 1 are just as subject to inferior QoL.

[SilverAvocado in reply to diogenes]

Wow, that's a very interesting conclusion, that even those on T4 with low TSH are still suffering low QoL

My assumption is that T3 would improve things. Studies like this make me think everyone in thyroid replacement should have at least some T3.

Is your impression that T3 does improve this a bit? Or could it be just as bad on combination therapy?

[diogenes Remembering in reply to SilverAvocado]

Certainly more patients should be considered. It isn't a sharp boundary between needing T3 and not. As you move up the TSH scale towards more and more undertreated territory, a larger and larger fraction of patients may need T3. It doesn't mean all will for a given TSH, just an increased likelihood.