The above research upholds everything we know about the current testing regime for hypothyroidism. It’s not for the layperson (that’s me) but I picked out two sections that will chime with all of us:
“Using the overall preference expressed by patients at the end of double-blind studies as a proxy, patients mostly favoured T3/T4 combination therapy [52]”
AND
“Conclusions
Until the situation is clarified all currently available treatment options should remain on the table and the focus should remain on facilitating the free choice of prescriptible treatment options rather than imposing new restrictions. The biochemically based reason for the rise in patient complaints has to be addressed, not a shift on to them of blame and burden of proof.
This invites a resume of the current state of affairs.
It appears that what we are witnessing constitutes an unprecedented historic change in the diagnosis and treatment of thyroid disease, Conclusions
Until the situation is clarified all currently available treatment options should remain on the table and the focus should remain on facilitating the free choice of prescriptible treatment options rather than imposing new restrictions. The biochemically based reason for the rise in patient complaints has to be addressed, not a shift on to them of blame and burden of proof.
This invites a resume of the current state of affairs.
It appears that what we are witnessing constitutes an unprecedented historic change in the diagnosis and treatment of thyroid disease, driven by over-reliance on a single laboratory parameter TSH and supported by persuasive guidelines. This has resulted in a mass experiment in disease definition and a massive swing of the pendulum from a fear of drug-induced thyrotoxicosis to the new actuality of unresolved designation of hypothyroidism. All of this has occurred in a relatively short period of time without any epidemiological monitoring of the situation. Evidence has become ephemeral and many recommendations lag behind the changing demographic patterns addressing issues that are no longer of high priority as the pendulum has already moved in the opposite direction. In a rapidly changing medical environment, guidelines have emerged as a novel though often over-promoted driver of unprecedented influence and change. Treatment choices no longer rest primarily on the personal interaction between patient and doctor but have become a mass commodity, based on the increasing use of guidelines not as advisory but obligatory for result interpretation and subsequent treatment. Contrary to all proclaimed efforts towards a more personalised medicine, this has become a regulated consumer mass market as with many other situations. This is of little benefit to patients who will continue to complain, and with some justification, that the medical profession is not listening, thereby abandoning one of its primary functions in the doctor-patient relationship.
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Loafinabout
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That doesn't mean, you, me, members here, diogenes, et al don't want things to change. Of course we do. But the medical establishment doesn't accept this and other papers. If they did, the NICE guidelines - nice.org.uk/guidance/ng145 - would not have been so disappointing.
Primum non nocere or "first, do no harm." NICE guidelines pretty harmful to an unknown number of ill people - how shameful! Thanks for letting me know that there are some like Dr Toft understand our predicament.
The basic problem is that there are too many reputations at stake to dare to make an abrupt about-turn. In 1985 or thereabouts the ultrasensitive TSH test came on the scene, and it immediately (for financial reasons especially) became the sole test for dysfunction, displacing what was up till then a three-way schedule using FT4, FT3 (total T3 in the USA who still don't get the advantages of FT3 over total) and the more insensitive TSH test which couldn't detect hyperthyroidism. Using the cheap senstive TSH gave the incentive to drop or reduce the others which were slightly more expensive but were seen to be semi-redundant. Over 35 years the paradigm that the thyroid makes T4, so if it fails you take T4 by mouth to restore FT4 and TSH levels back to health (I call it the simpleton's paradigm) has hardened into accepted fact. The rather awesome fact that this paradigm is wrong and needs comprehensive re-evaluation (because the thyroid directly produces T3 as well as T4 and in health fine-controls the whole body system) is too big a dose for the mainstream and current opinion makers to swallow (they didn't do the work so therefore it doesn't exist). To do so would be to admit that over the years they HAVE done and are doing harm to patients strictly against medical ethics. This could be forgiven if they accepted it, apologized and rethought the diagnostic/treatment system. But as I said, reputations are at stake and no one wants to step out of line. They have to face-save by proceeding altogether at snail's pace when at a certain date, lo, the new paradigm is accepted and the old one silently not referred to again. Time and time again this is a comment on medical history.
I am sorry I can't recall and I printed it off but can't find it. There was one paper where someone discredited Dr Toft on a certain article so I thought I was to take no notice of him. Am I wrong?
It might seem like it, but I doubt any of them are 100% wrong, 100% of the time.
If they were, it would be a much easier job. We have to read and decide for ourselves who is right and who is wrong. That might include discussing here (or elsewhere). And what is right for one can be wrong for someone else.
There are several endocrinologists I profoundly disagree with in some areas but find quite helpful and illuminating in others.
Thankyou so much for this insight. I read somewhere that in the medical profession there is “strong pressure to intellectual dishonesty created by the need to be infallible” but I never envisaged that could be maintained in the face of the findings evidenced in this research paper. It gives me hope though that there are those such as yourself “knocking on the door” 👏
Well, it apparently takes around 17 years for research to hit the mainstream and the NHS is not known for being in the forefront of innovation so they have probably reached about the year 2000.
We’re stuffed. There’s not even been any research. We were better off when they tried the ‘well this hasn’t worked so let’s try that approach’ using T4 T3 or NDT. Now it’s all ‘that’s not physiological’ so we won’t try it but the endos’ physiological model is not the way our very varied bodies work.
TSH/T4 only regime is a long running experiment even if we take it from 1985 - how long will it take to rid the medical profession of this dogma , 2 generations ? As Hillwoman says many of us don’t have that much time left. The media ‘name and shame ‘ game does not seem to be working for thyroid related problems - a complete shake up of the pharmaceutical and testing related ‘health’ system is needed . Oh that a post- Covid19 world would bring back thinking caps and integrity and not just in medicine !
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Looking for low or suppressed TSH research papers
Dr John Midgely/ diogenes...his research papers. 
Any good easy read research paper on Hashimoto for my GP?
Why thyroid range keep changing?
