A very interesting read as ever from Dr Tania Smith about TSH myths, here’s an extract:
The omniscient, omnipotent TSH myth
Doctors have been taught the myth that TSH secretion, which is locally regulated by T4 and T3 being metabolized in pituitary and hypothalamus, is the most sensitive proxy for thyroid status even though it neither regulates nor monitors T4 and T3 supply and metabolism in tissues all over the body.
Physicians have been required to put blind faith in the theory that population statistics for this one hormone can speak for thyroid hormone metabolism and signaling in every bodily tissue and every individual.
To respond to that myth is like telling a flat-Earther that in fact, although it might seem like the earth is flat, the Earth is indeed round.
You might be able to convince a person who doesn’t fully identify with flat-earthism.
You might be able to convince a reasonable physician who has long ago understood that not everything taught in medical school is complete or unbiased.
One myth about the thyroid that I have never understood is the belief of some doctors that taking T3 is pointless and nobody really needs it because it is just a placebo.
The fact that T3 is the active thyroid hormone ought to be common knowledge, so why isn't it?
Do these mistaken doctors thinks that T4 is the active hormone?
Doctors get very little education on hormones, and what there is, is according to a set text with an oversimplified explanation. Over a short time, budding GPs are told that there are three glands (hypothalamus, pituitary and thyroid) and TSH is the controller of the thyroid, so it's obvious? that it should make the thyroid always produce the appropriate amount of T4 (forget the T3 also produced as not important). This is a simple message - TSH stimulates producing T4, T4 is converted to T3 by the tissues to the appropriate amount, and T4 and T3 then control the hypothalamus which in turn controls the pituitary. This is stretched to imply that a given level of TSH is responsible for a given level of T4 because log TSH is inversely proportional to FT4 (T3 not important but assumed proportional to T4 and TSH). Thus no need to measure FT3 by this crude argument, which is all they are taught. It reduces patients to a cipher by drawing on TSH as always being the answer. Too bad it's fundamentally wrong.
Inept doctors shouldn't be able to consult with those thought to have a dysfunctional thyroid gland.
They should be kept well away because I had to diagnose myself, one hour after GP phoned to tell me I had absolutely nothing wrong with me (I had already told him I would have to pay for a whole body scan as I was too unwell as there was something seriously wrong with me.) He told me he would take all tests necessary. After blood draw he phoned a couple of days later to say I was fine and had no problems. He didn't understand what a TSH of 100 meant! I cried but was fortunate I knew someone who realised TSH was too high.
It’s too shocking for words shaws! These are the people that should be struck off not the good thyroid doctors who were hounded to their graves by the BMC
Why is it that some ‘eminent’ specialists (ie even professors of endocrinology) are so reluctant to test T3? I attended a recent webinar where I was gobsmacked by the message given to patients, as if ‘one size fits all’. I know my health has improved massively from having T3 higher in range and TSH surprised.
It was the same professional who said that thyroid conditions do not affect body mass….
I think it’s much nicer than suppressed it has a joyous connotation about it not the miserable containment type adjective that’s accorded it. A highly inappropriate descriptor in my experience!! I do take NDT tho.
I think I was there too for the same talk. It is a good job I was muted or he might have heard me exploding. He's doing a follow up talk later in the year concentrating more on T3, I'm probably going to have to gag myself for that one!! 😱😱
Well I did raise it as question to ask if I had heard correctly but it was not answered. Quite frankly I was disappointed with the talk and felt it was patronising to be told we had to wait to learn his opinions on T3. Learned as he is , he is only expressing an opinion and experience trumps opinion every time . Not sure I will listen to the next one. I didn’t like the ambience of it at all, nor the god like reverence afforded to the speaker - who, quite frankly, wallowed in it.
Completely echo your sentiments, I found his attitude a bit irritating. I'm not sure the chair agreed with him either but I think she was being diplomatic in not disagreeing with him. I might listen to the second one , but I'll do some meditation prior to it , to ensure my BP doesn't go through the roof !!
I can tell you a story about Pearce as a reviewer of one of our papers "Time for a reassessment of thyroid diagnosis and treatment". It under other reviewers got a rapid approval, but earlier in a different journal Pearce had, by issuing what in my long experience was nothing short of an insulting diatribe and not an honest review, rubbished the MS completely. Unluckily for him, others found the paper important and acceptable and it has been one of our more referenced and influential papers. I just write this to indicate Pearce's lack of balanced response to something he didn't like.
Thank you for providing some background diogenes; that’s really helpful. I won’t be signing up for the second round of the webinar as I was shouting at my screen enough during the first one! 🤣
I know what you mean Buddy, but maybe those of us who disagree with him need to challenge him in the Q&A's otherwise he will think that everyone is hunky dory with his assessment of the situation.I was shouting at my computer too, and I'm not too sure the chair agreed with what he was saying, but she was being neutral about it. I would be interested to know if she had any communication from people listening after the talk.
During the webinar I posted a question to the speaker to say that checking my T3 highlighted how poor my conversion was/ was he not concerned that others with conversion issues would be missed if T3 levels not checked? This was not answered.
I also noted in the ‘chat’ how combined therapy has been the only treatment that has alleviated my TED swelling.
I filled in the above feedback link sent after the webinar to say that I felt the speaker had a ‘one size fits all’ perspective and that through membership of this forum, I was aware how many people benefit from full testing of thyroid bloods and that combination treatment was a life saver for a large number. I added that because of ‘narrow minded’ medics (like the speaker), so many people are having to test privately/source T3 privately (options sadly only available to those with sufficient funds for this). I also noted that the speaker’s opinion that thyroid conditions do not affect body mass was questionable (and was contrary to posts on patient forums). I finished by saying that my main worry was that newly diagnosed thyroid patients/ those without knowledge from forum membership or wider reading might think the speakers views were actual ‘fact’ and this may damage their health.
If the speaker won’t take on board academic challenges (as outlined by humanbean and diogenes ), I’m not convinced that my feedback will do much!
No, I deleted it with silent contempt for a travesty of a review. One of my coauthors ventured his thought "Are they on something? If so I don't want any, it's like Happy Clappy land".
Yea I was hoping some here might make him sweat in the q&a part but all it seems to have done is made people angry and depressed. We need a thyroid Rottweiler at session 2. The thyroid trust have a webinar with him. This was the post with details I put up, which has spilled over into this one:
This is a simple message - TSH stimulates producing T4, T4 is converted to T3 by the tissues to the appropriate amount, and T4 and T3 then control the hypothalamus which in turn controls the pituitary.
This is another thing about current teaching on the thyroid that annoys me. Today's GPs and endocrinologists assume that the hypothalamus and/or pituitary never fail or go wrong in any way.
My TSH has never even reached 6. And yet my Free T4 and Free T3 were both very, very low in range before I got my first prescription for Levo. From the first time I was told my thyroid was "borderline underactive" to getting my first prescription was approx 23 years.
On this forum I've seen someone quoting Free T4 and Free T3 results similar to mine from before I first got prescribed Levo, and yet their TSH was about 30. I've also seen a few results with TSH between 10 and 30 which had Free T4 and Free T3 similar to mine.
I know that my pituitary is squashed in one plane and stretched in another. And yet doctors assume it must be perfectly healthy because I still produce some TSH. It's just sadistic nonsense.
A series of investigations, in Sweden - I think, showed that some degree of pituitary damage is pretty widespread. Autoimmune, physical, or whatever. Though less often to the degree that is so obvious it can't be missed - even if you are ignoring it.
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