An Endocrinologist recognises role of T3 in treatment, plus advice on how it affects vocal chords

[holyshedballs]

Will Hashimoto's End Liam Gallagher's Singing Career?

from Medscape Tim LockeSeptember 24, 2019 medscape.com/viewarticle/91...

The former Oasis frontman Liam Gallagher has spoken about how Hashimoto's thyroiditis might shorten his career but a specialist tells Medscape News UK the condition is very treatable.

Hashimoto's thyroiditis is typically more common in middle-aged women and can run in families.

Liam Gallagher first talked about his diagnosis and hoarse voice in 2017, including in an interview with the Guardian .

Now, ahead of a 47th birthday homecoming concert in Manchester in an interview with Apple's Beats 1 he's talked about how the condition might end his career: "I’m ain’t going to get any bigger. If anything, it’s only going to get worse. You are in that zone now, you’re looking about and you’re going. All right. I kind of see what’s going on but, it’s all about the journey man.”

However, he was reflective about his future career: "If it lasts 10 years, it lasts 10 years. If it lasts 5 years, it lasts 5 years. If it ends tomorrow, I’ve still had a f-ing blinder do you know what I mean?"

He continued saying Hashimoto’s disease "makes your voice a lot hoarser. That’s some of the symptoms.”

Dr Paul Jenkins is a consultant physician and endocrinologist at The London Endocrine Centre, and a board member of The Thyroid Trust. He spoke to Medscape News UK.

Q&A

How can Hashimoto's affect the vocal cords?

If it's untreated, it does cause the cords to be swollen, and to result in a hoarse voice. That's one of the classic signs of an underactive thyroid.

What about the singing style?

With a change in their vocal range, the tenor of their voice, in their singing.

Effective treatment should be able to restore this but not always.

And will it, as Liam Gallagher fears, worsen over time?

No, it should not worsen over time. But most of us don't use our vocal cords so strenuously day-to-day. If you're really straining them I guess it's conceivable, but it shouldn't really worsen.

Is a 'rock-and-roll' lifestyle unhelpful for Hashimoto's?

No, I don't think you could say that. Hashimoto's disease is a very common autoimmune condition of the thyroid gland, where the body's immune system starts attacking it.

Liam Gallagher spoke of it possibly ending his career. Would a more positive attitude be helpful?

That's his thoughts on it. I can't say whether it's positive or negative, it depends on one's overall context.

He's been out of the public eye for some time. So he hasn't been singing as much as he used to.

What kind of treatment regime might he be following?

It is thyroid hormone replacement. It's taking exactly the same hormone as the body is not making but in a tiny pill form.

It is for life, because once the thyroid gland has been destroyed, it does not ever heal itself in this condition.

Are some cases more complex?

Some patients need additional treatment, not just with the thyroxin, but they can continue to have symptoms of underactive thyroid, even if they're taking apparently adequate doses of thyroxin. And we increasingly recognise that they require T3, which is the other active thyroid hormone, in addition to thyroxin.

Is Hashimoto's hard to diagnose in primary care?

No, it should not be hard to diagnose overt cases. There is, as always the grey cases, those that you're not absolutely certain about or don't tick all of the boxes. And that's when a specialist can be prepared to even just try some thyroxin to see if it helps. Certainly, specialists are needed to diagnose those individuals who don't convert the thyroxin to the T3, and who need additional T3.

That's a more controversial area but undoubtedly in my experience, very, very much does exist. And that needs specialist input.

Is it helpful for a major celebrity to come forward and talk about a condition like this?

I think it can be helpful for any celebrity to talk about their conditions, if it raises public awareness of the condition and the treatments to restore it.

So the more debate and discussion, and knowledge generally is a good thing, as long as it's responsible knowledge, and people are given the true facts about their condition.

I'm very happy for him to raise awareness of it and to discuss it.

[AmandaK]

How refreshing to read this, but sad that access to such a doctor requires a private consultation and the associated costs.

But, as with others before him, he is having to go down the private route as his conclusions/theories are outside mainstream thinking/protocols.

[Deeseona]

We desperately need more enlightened Endocrinologists who understand the need for adding T3 too for many. All I can do is croak now when I try to sing and it gets worse as I become older. On T4 only. Endocrinologist I saw with the NHS wouldn’t entertain the idea of adding T3 and was so patronising. I know this is the experience of many others sadly. Let’s hope awareness is raised further by Liam’s publicity.

[Hidden in reply to Deeseona]

I didn't even get to first base with an endo. My local surgery sent a referral request because I was still symptomatic even though my results were "Normal. The hospital endocrinologist refused the request on the grounds that my results were.... You guessed it, "Normal"!!!!

[Deeseona in reply to Hidden]

It feels difficult enough when you are diagnosed with Hypothyroidism and are still unwell on the Levothyroxine and needing something different. However, for people such as yourself who are not showing up enough on the NHS screening to require medication I feel this is awful. I now know I have Hashimotos which probably led to my being Hypo. If it had been picked up earlier when I was presenting at my GP around 5 yrs before diagnosis, a bit like you describe, I perhaps would have been able to have had it arrested and then only be on a lower dose of Levo from now. It’s so disgraceful that they wait until our blood matches with the NHS criteria, and that’s usually when you are hardly functioning. In my case I had completely conked out, but was ignored for so long by a hopeless GP. It took months before I could even think again and until the medication really kicked it. So unnecessary if it had been dealt with earlier and at a borderline prognosis. Have you thought of doing the private blood tests? There are a few companies recommended on the ThyroidUK site and members and admin on this forum are so great at helping you interpret them further after you get your lab report.

[Hidden in reply to Deeseona]

I'm on 100mcg Levo, I had to go back down from 100 earlier in the year because TSH was so low.

Of course it made me worse so after about 4 months and heart tests because of breathlessness and ankle swelling I finally got back to 100. I'm now trying for an increase from a very good but wary doctor who thinks I might have something else wrong as well as my TSH is still just below range.

[Deeseona in reply to Hidden]

Interesting as I was on 125mcg and due to breathlessness at times and also ankle swelling I was reduced by GP. Now I’m on 100 one day and 75 the next and so on. Ankle swelling has improved apart from when I fly or hot weather. I am always tired and fatigued, weight never comes off, although I walk, do gentle exercise etc and healthy diet. My GP won’t look any further as says test show adequately treated. I’d love to be able to add some T3 and see if the fatigue is helped. Has this for 20 years since being diagnosed. Sounds like unless we can afford to pay and see someone privately we are stuck with what we are given...

[Hidden in reply to Deeseona]

Exactly the same as happened to me this year, except there was some improvement in breathlessness when restored to 100mcg, but not in ankle swelling.

What were your test results that caused the GP to reduce it?

Do you have any results that include T3 as well as T4? This would show if you are converting OK. I seem to be converting T4/T3 reasonably well for now, but T3 is showing a tendency to decrease.

[Deeseona in reply to Hidden]

The reason my GP decided to lower my medications was because my blood pressure suddenly soared. I’ve always been as highly medicated with Levo as they’ll let me as still really struggle with energy and other problems. The blood pressure is fine now but not sure if it would have been anyway as have never had probs with it before. They never do tests to show conversion and when I’ve mentioned it they say it’s not necessary. I know it is...

[Hidden in reply to Deeseona]

[Deeseona in reply to Hidden]

Yes 🙁

[Hidden in reply to Deeseona]

That's why I've bought a private test a few times. Seems to be no choice if you are to get the necessary results.

[HowNowWhatNow]

Oh I like Dr Paul Jenkins!

Can we get him to come on here for a Q and A? I would be fascinated to hear more.

[Hidden in reply to HowNowWhatNow]

Who is he?The one in Cardiff is supposed to be good but I think his name is Dr Taylor. Never had a memory for names!

[vocalEK]

Unlike in the UK, in the US, there is no prohibition against a general practitioner prescribing T3. Too bad in the UK, the specialists think it is too difficult for GP to order up a Free T3 lab test and then evaluate whether the results are below are are low in range. Furthermore, they might then have to write a prescription for T3, which might further test their abilities. (Snark).

The GPs in the US must be smarter, because mine was able to do that. And I had suggested ahead of time that if the results were low, we do a "trial" of T3.

[holyshedballs in reply to vocalEK]

Professional-ism. plus the general lack of education regarding thyroid issues for GPs and most Endos.

[helvella Administrator Thyroid UK in reply to vocalEK]

Just to make a technical note, it seems to be only NHS protocol that inhibits a GP from doing the required testing and then prescribing T3.

If someone saw a private GP, and there are some, they can test and prescribe.

(An NHS GP who also see some patients privately could be seen to be in an awkward position if they did so.)

That is, it is not a matter of law, but of how the NHS tries to manage what GPs can do. In some ways, more complicated cases should go to an endocrinologist but the delays can be dreadful. And it is very suspicious that this restriction on inititiating T3 came along as the price rose dramatically.

[Cooper27]

He needs to try the Hashimotos protocol as well, try to get his antibodies under control. Between that and better, medication, he'd be much better.

[Hidden]

I'm still on Levo only and trying to convince the doctor i need an increase