Addendum to my previous post

[diogenes]

Separating the individual from the trend has to be the correct way for a doctor/patient relationship to succeed.

A thing we should all keep in mind when reading these studies. They only explain the overall risk in a patient group for a particular problem; they do not apply in the same way to an individual in that group. You cannot as an individual have 10% AF; you either get it or you don't. And the low extra risk means that most do not get AF in these circumstances. So, as always it is or should be a decision by the patient having been told the risk, to act as they feel is best. I think doctors in these situations ought to advise and honestly display the risk if there (I mean to give the actual approximate figure and not simplistically "you will get AF"), but not dictate that they are therefore going to impose on the patient what they personally think is best.

[fuchsia-pink]

It's sad this even needs to be said ...

Thank you, diogenes

[dolphin5]

I've been thinking about the paper (which I haven't yet accessed, but I've read highlights of the Canadian review), and I wonder if the link between FT4 and AF was considered in relation to FT3. When I was on T4 monotherapy, my FT3 was at the bottom of the range or below, while my FT4 was just above range. To me, it would be my low FT3 giving me the risk of AF, not my high FT4. I wonder if the research separated high FT4 from low FT3? This would be an important distinction. I would be surprised if high FT4 was actually a risk, when not in the presence of low FT3.

[diogenes Remembering in reply to dolphin5]

Low FT3 on its own is capable of having effects regardless of the FT4, so long as that is also in its range. But raised FT4 into or above the top of the range, with normal FT3 seems to have some degree of risk. The FT4/FT3 ratio may affect the heart, because it relies on FT3, and more FT4 may compete for theT3 binding sites. That's only my theory. And the effects aren't huge. Remember we all have our optimal levels of hormones for best health, so some patients who can do well on lower T4 therapy might not respond well to higher FT4. And we don't really know who they are, because in health they were not measured, but might have naturally thrived with FT4 in the lower reference range area. So some of these may be outside their comfort zone on too much T4 for them personally.

[dolphin5 in reply to diogenes]

That makes sense. Thank you. There’s no getting away from the fact that we’re all different and one rule doesn’t suit all!!!

[Tythrop]

They're all scared of litigation.. That comrs before patient wellbeing. First PYA.