This new paper discusses the power of FT4 testing against TSH and finds FT4 better. That's at least a small step forward in that it challenges TSH-is-all thinking in therapy. The authors haven't yet caught up as regards using FT3 measurement as well, but even a small step forward is good. Hennessey is an American professor who has in the past been antagonistic to any thing but TSH as a therapy guide, but obviously senses the way things are going and wants to have some of the action. I draw the conclusion that the beginning of catch-up is happening but still far away from the end
As they've been very slow, maybe they should have had their own FT4 and FT3's checked to ensure they're not too low on their T3 and that it is at optimum.
.... that's one small step for thyroid patients .... and one giant leap for stubborn Endocrinologists.
loving this bit :
" As the thyroid state of peripheral tissues and of the individual as a whole is an integration of multiple clinical parameters, the above work therefore provides strong evidence that the definitions of euthyroidism, borderline thyroid dysfunction, subclinical thyroid dysfunction and overt thyroid dysfunction, in terms of the peripheral thyroid state, are better defined by thyroid hormone levels than TSH levels." ......
and this bit :
" The use of FT4 levels for the determination of the peripheral thyroid state in trials would not only allow more precise selection of appropriate subjects but would also allow for more vigorous titration of intervention changes, even to the point of TSH levels becoming abnormal."
well done chaps , got there in the end.
But of course , this is the best bit :
"Other authors have suggested that combining the thyroid hormone levels with TSH levels may best indicate the peripheral state [15]. These hypotheses could be tested."
... well , they could test the hypothesis ,or they could just ask us 'cos we already know the answer..... why would anyone try and drive a car by only looking out of one window , when they've got 2 more to look out of ?
Perhaps I could enlighten on the last paragraph. The paper they refer to is ours, but it is NOT a hypothesis. It is a study using a random sample of patients, not a theoretical proposition. The reason for testing this lies in the relationship between TSH and FT4 and indeed FT3. For TSH and FT4, it's clear that for an individual one is linked to the other in a unique relationship. If you take a set of subjects with measured FT4 and TSH, and simply compared the whole mixed up group with TSH unattached to FT4, you miss and smear out the effect of the individual relationship, but are treating the results as random events unrelated to each other in any personal way. That's why to get the soundest answer, you need to consider the two parameters in pairs. The first way is univariate comparison and the second is divariate. Our results showed a very clear improvement for FT4/TSH pairs over univariate analysis, but adding in FT3 in a trivariate analysis didn't give a much better outcome.
yes . i thought your findings were findings were rather more than a 'hypothesis' .. still, at least they have deigned to acknowledge your groups work exists and have managed to spell 'paradigm' even if they haven't quite understood the implications yet ... now we just have to wait for them to learn what 'individual ' means.
Thank you diogenes - for all the stellar work you and colleagues do to try to change attitudes of those who should be keen to expand their knowledge about thyroid hormones and why some people cannot improve on levothyroxine alone.
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have suggested that combining the thyroid hormone levels with TSH levels may best indicate the peripheral state [15]. These hypotheses could be tested." 
A Win and A Question
Bloods back- they are reducing my thyroxine! 
