Why things are as they are

[diogenes]

Continuously, our team has emphasised a crucial difference between what the discipline thinks is right and where and how this has gone wrong. The question is to put the diagreement into a metaphor that nonscientific people can understand. The received idea is that there is only one process (called feedback) which describes the relationship between TSH, FT4 and FT3. That is the pituitary making TSH is restrained if FT4 levels get too high, thus balancing out the system by telling the thyroid to make less T4. However this concept has deep trouble in explaining why, for example, our bodies change all this if a nonthyroidal illness comes along.

So I'll describe a metaphor (by no means perfect) to illustrate the new ideas.

Imagine a window scene of the country. We have trees growing, cornfields waving, tractors ploughing and so on ( a complicated picture say, looking from left to right).

Now imagine two situations at the window. The first is a curtain say on the right hand side, which when drawn across can cover the whole window. The second is a situation where there are curtains at both sides, each of which can be completely drawn across. If in the first case something happens in the window which needs changing. then the curtain is drawn across to limit the situation (blanking it out) it also blankets out everything behind its front edge. That is there is no chance to isolate a situation in the middle of the window without closing off everything to the right. However if there are two curtains, then one can isolate the situation in whatever way is best - a more fluid responsive system. One can arrange an opening whatever width one needs and where ever you want it. This is a crude metaphor, but it shows that two mechanisms simultaneously working, are needed to explain the situation rather than one. Feed back with feed forward to balance the former out and control the system, but at the same time if things alter, change the window visual setting to suit. We have discovered this mechanism which the field is totally oblivious to, but which explains changes the current believed system cannot do.

This in a crude way describes what we have found and what change in thinking must occur, with large implications for diagnosis and treatment.

[RedApple]

Your crude description works for me Diogenes. Unfortunately I fear that many medics involved with thyroid matters have had an 'imagination ectomy', so this will still not cause any pennies to drop for them!

[Zephyrbear in reply to RedApple]

As Einstein once said…

Hmmm

[tattybogle]

Thankyou for sharing that picture. I will have to contemplate the concept tonight while re-arranging my window furniture .... someone's annoyingly left a light on in the same direction that i'd like to be able to watch the moon coming up over the rooftops, ... so i have need of a similar sort of 'bi-directional' adjustment. (but up and down, rather than side to side)

[helvella]

Many people who have looked properly at older cameras might think about focal plane shutters. Specifically, the two curtain focal plane shutter.

(This Wiki article is quite a reasonable overview: en.wikipedia.org/wiki/Focal... )

Although very different to diogenes' description, it shows that fine control of high speed camera exposures is achieved by adjusting the gap between the curtains. It also shows that at one extreme - long exposures - the fundamental way of controlling exposure is changed and desynchronizes the two curtains.

I guess, my point is really that engineers have long realized that you often have to adjust two, or more, controlling elements together in order to achieve the effect required.

[Hillwoman in reply to helvella]

Even more complicated... The kind of exposure you want is also dependent on the chosen size of the lens aperture in relation to shutter speed, ISO and focal length. There are other variables too, which in film photography could be manipulated at the film development stage. If good thyroid health is equivalent to, say, an Ansel Adams-level intricate tonal rendering of a wide landscape, the kind of 'specialist' understanding and treatment we're curently being offered is on a par with, say, the simple graphic cover illustration of a Mr Men book (with apologies to whoever).

[helvella in reply to Hillwoman]

Let's not get into wavelengths/frequencies and spectra!

[jimh111 in reply to helvella]

Most thyroid doctors forget to take the lens cap off!

[greygoose in reply to jimh111]

🤣🤣🤣

[helvella in reply to jimh111]

Presupposing they have even loaded the film...

[shaws in reply to helvella]

Instead they load the hypo patients with increasing symptoms and insufficient medications and/or not increasing dose.

[crimple in reply to jimh111]

jim111 really liked your reply, really made be laugh.Trouble is its not really a laughing matter.

😂

[Hidden in reply to crimple]

Chill…seriously, none of us think it’s a laughing matter but most of us who are under or inappropriately medicated (often because the medic is ignorant of how the system works and resorts to ‘no’ ) could do with a light moment or two. Laughing is provably beneficial to human beings so give us a break.

[DippyDame in reply to jimh111]

Spot on!!

[FancyPants54 in reply to jimh111]

Or to open the curtains.

[TSH110 in reply to jimh111]

I don’t think most even have a camera

[nancypapa in reply to jimh111]

🤣🤣🤣😛

[TSH110 in reply to helvella]

Well why not?

[LindaC in reply to Hillwoman]

For sure! Love your descriptions!! 😜😅

[tattybogle in reply to Hillwoman]

lol

[TSH110 in reply to Hillwoman]

Lol love it! Ansel Adams sublime print vs Mister Men image - I bet they have never been put together like that before!

[TSH110 in reply to helvella]

Do you think free t 3 is the shutter activation button?

[helvella in reply to TSH110]

They already seem to have their eyes shut, perhaps we need to give the endos an opener?

[shaws in reply to helvella]

Maybe a metal opener!

[TSH110 in reply to shaws]

A crow bar to lift the rubble and shed some light under there!

[Hoxo]

Interesting. I was pondering recently as to why Thyroid researchers are so blinkered. Why are so many studies so TSH biased and subsequent research resources wasted and results feeding into and reinforcing faulty thinking. Could a paper be written to highlight these research mistakes and explain why focusing on TSH or Pilo’s ratios just piles misunderstanding on top of faulty science leading to ignorance and misery for so many. Almost like a back to basics and advice on how to design intelligent meaning thyroid studies. Sounds like this paper is a good start.

[Charlie-Farley in reply to Hoxo]

Egos - most of the inertia in science is down to egos.

[TSH110 in reply to Hoxo]

I think Dr Tania Smith did that already:

thyroidpatients.ca/2021/07/...

[Hoxo in reply to TSH110]

Brilliant link. Thank you.

[ShatteredofLee]

I get the metaphor. It’s bot only the medical sphere where there’s fixed views. As somebody with Hashimotos for 25 years I’m shocked at the resistance I’m finding to a potential thesis exploring the lived experiences of hypothyroid and attending mental health struggles. Counselling/psychotherapy world doesn’t consider physically driven issues.

[waveylines in reply to ShatteredofLee]

Sorry to hear they didnt consider the physical impact on mental health of hypothyroidism. Ive got to say when I had counselling this was definately looked at & infact I was told there is a physical component going on here. Your GP needs to address this.

[Charlie-Farley in reply to ShatteredofLee]

I was sent for counselling because I was under medicated for 6 months on 25 µg of levothyroxine - Barely able to function and feeling suicidal.

At the point at which my GP acknowledged I needed more thyroxine she also wanted to give me antidepressants.

I suggested it would be a good idea to treat the underlying health condition first but I did actually agree to the counselling to get her off my back. After three sessions with the counsellor and my levo started kicking in, we mutually agreed that the counselling was not really required and the problem was physical.

There must be so many GPs throwing their patients at counselling unnecessarily because of their erroneous and entrenched views.

[shaws in reply to Charlie-Farley]

It really is awful of what the GPs lack when treating patients who've dysfunctional thyroid glands. They are so poorly trained they know no clinical symptos at all.

I had a phone call one day from a GP. he said

"Mrs G your TSH is too low, your T3 too high and T4 too low".

My response:-

Yes doctor my TSH is low because I take T3 only. Therefore my T3 will be high and T4 low because I take none!

GP - "but T3 converts to T4". "No doctor it is the other way around"!

[Charlie-Farley in reply to shaws]

Oh shaws, 🤭

up to last year I would’ve thought it unbelievable - now nothing surprises me.

😞

[diogenes Remembering]

I 'm hoping a clinical trial we've just finished will re-examine Pilo's work -not in terms of averages but of the scale of variation of thyroid versus body production of T3. This knocks on to whether in the absence of thyroid, the body can substitute for extra T3 needed or not.

[tattybogle in reply to diogenes]

that sounds exiting.

did you use more than 14 subjects ?

[diogenes Remembering in reply to tattybogle]

I believe so, as it has taken 2 years + to conduct.

[TSH110 in reply to diogenes]

Wish I had been able to help there

[TaraJR in reply to diogenes]

This sounds very interesting. Trials so far have been flawed, but frequently quoted. You mention A Pilo - another worrying factor.

linda96 you'll like to read this thread.

[dolphin5 in reply to diogenes]

I look forward to a paper describing this clinical trial - as someone without a thyroid gland who has to self-medicate with the T3 I lack!!!

[crimple]

diogenes a little late in the day for me to get my head round but I know you always talk sense

[DippyDame]

Much is above my head but like all of us here I've suffered ( for most of my life) from wrong diagnoses and wrong medication...and from the polemic that TSH and the feedback loop says it all, so nothing wrong with me!

It doesn't and there was!

Thank you TUK!

I'm tempted to suggest that the decision makers in medical echelons who are wedded to the status quo might benefit from considering the following words of Robert Burns...

O wad some Power the giftie gie us.

To see ourselves as ithers see us!

It wad frae monie a blunder free us

An foolish notion.

Very best of luck to the group.,,,and thank you.

[Me1157]

Thx for sharing your studies and research. I'm looking forward to hearing more about it. It sounds like there's fertile land out of both your windows, seeds have been planted and a bumper harvest is expected.

[bambuko]

Parables are all fine... but I am still none the wiser as to what my problem is and how to solve it (if at all possible), plus I am uncomfortable with medical professional suggesting (yet again) that I am "incapable of understanding" and need "metaphor".

[FancyPants54 in reply to bambuko]

The metaphor is for the doctor, not us. We understand this stuff much better than most medics.

[humanbean in reply to bambuko]

Diogenes is a thyroid researcher not a medical doctor.

[Geegee777]

This explains how it is thank you 🌸🌸🌸🌸

[Hidden]

Hi Diogenes, can you tell me why my pituitary gland always needs to stimulate my thyroid gland? If my TSH level is suppressed my GP tells me I risk atrial fibrillation or osteoporosis. I have just had my second cup of coffee which will stimulate my bladder and bowels; neither of which in the normal run of things need stimulating and I expect my GP would be concerned if the only way I could get them to work was by constant stimulation.

[diogenes Remembering in reply to Hidden]

TSH stimulation of the working thyroid is part of the system that gives normality in health. When the thyroid is lost entirely, then TSH has nothing to stimulate. It is only affected by the T4 you take as a thyroid substitute. But this is a fundamental difference from the healthy state where TSH is a driver rather than a passenger. The relation between TSH, FT4 and FT3 is quite different.

[DippyDame in reply to diogenes]

The relation between TSH, FT4 and FT3 is quite different.

Why on earth do "they" find this so difficult to comprehend....or maybe that should be "accept".

Rapid descent from (imagined) high pedestal perhaps!

[Hidden]

Thanks for this Diogenes.