I found this totally by accident yesterday (I was actually googling to check if he was the Queen's physician in Scotland, which someone wrote on another thread of mine. Turns out he was!!).
Anyway, this paper is excellent in my opinion. I've printed it out to give to my Dr along with a letter I've written her. People on here always mention about the article in Pulse magazine where Dr Toft talks about suppressed TSH and high T4 being ok (as long as T3 is normal). However, that article was written in 2010. This paper is from 2017, so a lot more up to date and obviously a lot more detail. I really really hope that my GP takes the time to read it and understand what I have tried to explain to her (probably badly!) in my letter.
We also give a link to that paper when appropriate, that is when it's obvious that members need T3, this is my usual response in those circumstances:
Dr Toft, leading endocrinologist and past president of the British Thyroid Association, has recently written a new article which says that T3 may be helpful for many patients:
The original article is more appropriate when T3 is not shown to be needed, it's much simpler to get across to the GP when looking for an increase in Levo when you just refer to the appropriate question in the article.
Thank you. I should have searched before I posted, just got overly excited!! I did also enclose the article from Pulse magazine with the letter to my GP. I just thought it would be useful for her to have something a bit more in depth. She is convinced my TSH being suppressed means I've "gone the other way" and I think this journal piece shows that isn't the case at all. I have also said in my letter that this is nothing to do with wanting T3 medication as I'm aware at the moment my blood tests don't support that, but that I simply want an increase in levo.
Will see what happens, it was quite cathartic just to have a brain dump of everything going on (,I did get my husband to check the letter to make sure it made sense and wasn't too aggressive in my tone). Hopefully she reads it and take something from it.
This is a welcome paper from Dr Toft but note it specifically deals with primary hypothyroidism, that is reduced or absent secretion from the thyroid gland.
It contains an erroneous statement 'The previously high doses of LT4 would, by the law of mass action, have overcome any impaired D2 activity in affected patients'. The 'law of mass action' is the principle that the rate of a chemical reaction is proportional to the concentrations of the reacting substances. This is not so simple with LT4 therapy. As the dose of LT4 increases TSH falls, D2 (T4 -> T3) falls and D1 (T4->T3, T4->rT3) increases. Not only is some of the extra T4 converted to rT3 by D1 but crucially this conversion takes place in different tissues, tissues dependent upon D2 for regulating local T3 do not get the full benefit of the additional LT4.
Option 3 'We can prescribe a combination of LT4 and liothyronine, ensuring that serum TSH is normal' applies to primary hypothyroidism provided the hypothalamic pituitary thyroid axis is functioning normally. Many patients who need T3 either have a form of resistance to thyroid hormone (RTH) or have subnormal TSH secretion. These patients are denied effective treatment, in fact most endocrinologists don't even recognise that such patients exist.
The general thrust of the paper is to be commended. However, Dr Toft was President of the BTA for a long time during which some BTA members carried out a vendetta against doctors who prescribed T3. They destroyed the career of Dr Durrant-Peatfield and caused the early death of Dr Skinner. We don't know if Dr Toft was a supporter of this group as they invariably incited GPs to submit complaints whilst remaining anonymous themselves. It's regrettable that Dr Toft failed to acknowledge the great doctors who pioneered T3 therapy at terrible personal cost.
Thank you for bringing that paper to our attention.
As I suffer from Primary Hypothyroidism,I found it interesting.
The very first little book I had was Understanding Thyroid Disorders by DR A Toft which I spotted in my local pharmacy many years ago.£4.95.I have written notes in it over many pages.It was published in Association with the British Medical Association, and was from the Family Doctor range.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Dr Toft counterblast to thyroid hormone replacement guidelines worth reading
Follow up on Referral Letter
Dr Skinner needs your Support
Finally!!!
Interesting paper on vitamin D
