You may have already seen this study which interviewed GPs, nurses and pharmacists about treating patients with hypothyroidism
Hope the link works!
Attitudes and perceptions of health professiona... - Thyroid UK
Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study
Written by
CaroleM-A
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15 Replies
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How interesting. Says it all, really. Confirms that so much of the challenges we confront with the medical profession aren’t all inside our heads!
Thanks so much for sharing.
Just taking this sentence in the article:
Hypothyroidism is a common chronic disease caused by too much TSH production and we must give Levothyroxine to reduce the TSH. But when TSH drops to a low level, either low in range or below range, we must reduce or remove prescribed Levothyroxine supplied to the patient.
That, excluding central hypothyroidism, is a nonsense. Hypothyroidism is caused by the failing of the thyroid gland , (TO WHICH TSH RESPONDS). And as for the rest, it simply parrots out the discredited paradigm about TSH levels, in that TSH must be normalised, as a control of the process, which it isn't
That’s the complete nub of it all. The mighty TSH paradigm… It’s a bit like the old “the world is flat” position. Those that knew it was round were for years seen as being somewhat crazy. That’s what we’re battling with.
diogenes , I wrote that, it isn't in the article.
I wrote it as an example of how many doctors actually seem to manage and treat hypothyroidism in real life.
If doctors really believed that hypothyroidism was caused by low levels of thyroid hormones then they would actually test them as a matter of routine, rather than testing TSH and apparently believing it can never be wrong.
I doesn't paint a pretty picture of the care thyroid patients receive!
It sounds like a quickly thrown together project featuring a limited number of participants and backed by Big Pharma. It shows (little or) no understanding that not all patients respond to levothyroxine and, they rely far too heavily on TSH results.
It does however vindicate our concerns about the current treatment of thyroid disease!
Will it change the approach of health professionals?
Not holding my breath!!
I didn't understand this...
Method A grounded-theory approach was used to generate themes from interviews, which were underpinned by the theory of planned behaviour to give explanation to the data.
Can anyone explain it?
And as usual the professionals blame the patients :
Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned.
The following sentence from the Conclusion of the Abstract hasn't been true for me personally :
Addressing the differences in patient and professional knowledge and perceptions could reduce the barriers to optimal treatment, while continuity of care and increased involvement of pharmacists and practice nurses would help to promote optimal thyroid replacement.
Because nurses don't have the same medical training as doctors, I have found that they will NOT step outside a rigorous adherence to the letter of the rules. So they err on the side of caution to an extreme degree with everything. I suspect pharmacists would be the same. There may be some nurses who are different, but I've never met them, although I know some of them are good.
And regarding the difference in patient and professional knowledge, there are many thyroid patients who know more about the thyroid than doctors and other professionals do. We've been forced to learn because so many of us never get well.
Hypothyroidism is a common chronic disease caused by insufficient thyroid hormone production.
Doctors pay lip service to this. But many, many doctors treat hypothyroidism as if the following is the truth (which it definitely isn't) :
Hypothyroidism is a common chronic disease caused by too much TSH production and we must give Levothyroxine to reduce the TSH. But when TSH drops to a low level, either low in range or below range, we must reduce or remove prescribed Levothyroxine supplied to the patient.
And for anyone reading who isn't sure... The above paragraph is nonsense and completely misrepresents how hypothyroidism should be diagnosed, treated and monitored. But it does describe how many doctors treat the condition. The following sentence from the article confirms this :
Dose increments are made following initiation of treatment to return serum thyroid-stimulating hormone (TSH) levels into the reference range
Further on in the article :
Hypothyroidism is considered a simple condition to manage
So why are so many doctors reluctant to manage it or even instigate treatment for it? And something I have never understood is how doctors expect to diagnose central hypothyroidism in which the patient's pituitary can't produce sufficient TSH to make the thyroid do what it's supposed to?
However, the therapeutic benefits of levothyroxine are sometimes unsatisfactory, and TSH levels higher than the reference range have been found in 11%—27% of patients receiving thyroid replacement therapy, while the prevalence of low TSH levels has been reported to range from 20% to 41%.
I can't remember ever having come across a patient who preferred a high TSH. Perhaps that is because much of my reading has been on this forum, and we are the people who can't get diagnosed and we are left untreated or under-treated.
I can't go through the whole article - it's too long and I don't have the energy.
And something I have never understood is how doctors expect to diagnose central hypothyroidism in which the patient's pituitary can't produce sufficient TSH to make the thyroid do what it's supposed to?
I don't think the majority of doctors have even ever heard of Central Hypo, and have no idea what it is.
Hello Carole M-A :
Sorry, I tried to read it all but got increasingly cross so I've nothing to say.
Just like a TSH blood test, seen in isolation, when the patient is already on thyroid hormone replacement medication.
The idea of pharmacists having access to TSH data so that we have to fight them as well as our GPS and endos is truly terrifying.
When I read it I thought well that mirrors how hey treat their patients. It’s not the first time I’ve seen patients non compliance with treatment is to blame either.
However I thought you might be interested but not surprised!
It's always nice to know what we are up against, so we can be prepared for some of the nasty and/or useless things they say.
There is a very strong tendency to cite non-compliance without any explanation of what they mean.
There is a world of difference between someone simply not bothering to try to take their levothyroxine as prescribed. And others struggling with side effects, inappropriate doses, lack of access to liothyronine, other issues, poor support, etc.
I mean, I am personally non-compliant because it is said I should take my levothyroxine in the morning, before breakfast. Whereas I actually take it at night. But I am scrupulous about actually taking what I consider the right amount.
helvellaAdministratorThyroid UK
However, health professionals generally perceived they had a lack of in-depth knowledge of medication interaction.
Can very much agree - but sticking with a mechanistic levothyroxine-and-TSH-only view hardly shows the self-awareness of this lack.
On the other hand, pharmacists felt they could provide limited advice due to their lack of access to patient data and lack of time.
Which entirely cancels the message that the medical establishment has been pushing for years. Pharmacists simply do not have the resources to exploit what they might actually know. But we have also seen some woeful ignorance and denial.
Thank you Carole,
Not surprising, but in a very small way validation from the horses mouth that we are not treated appropriately.
Because they don't get bonuses for ensuring patients have annual testing:
"And it used to be a QOF target that each year they
had to have an annual TSH, which was a very easy
target to hit. And then it stopped about two years ago.
So I think some practices, potentially, have sort of let
their thyroid management drop. (GP-2)"
Gaining access to online results has made me very aware that GP's don't bother to look at most results:-
And we’ve got an awful lot on our plates—using that
old excuse again. But we’re really, really busy. And…
Sometimes the blood results come through and
you’re just like, well, actually they might have missed
it for the last few days or whatever. And just bounce
it through, you know. And then the patient… It’s on
the patient’s head to ring up for their results and
check that their levels are okay. (GP-8).
