Why do doctors dismiss Ft3?

[Alejandrita17]

I'm trying to understand the REAL reason why doctors don't consider Ft3 testing. And if they do test Ft3, they don't put much attention to its level.

Is it money? Is it fear? Fear of what?

[tattybogle]

i think 'fear of poor career prospects if you don't do what you're told by your boss' has probably got quite lot to do with it .

I reckon that there may well be some endo's /GP who do privately think that fT3 testing and combination therapy with T3/Levo might be at least worth a try for some of their patients , but who don't want to deal with the consequences of saying so publicly.

Making waves and insisting the lab does fT3 testing for your patients, when the labs have been given clear instructions that it's an unnecessary test in hypothyroidism won't go down very well.

Previous doctors who have gone against the status quo on thyroid treatment have received a horrendous , prolonged and often career ending 'kicking' at the hands of others in the field , calling for repeated GMC hearings.

Endo's are being told by CCG's to prescribe less T3 and get people who are already on it, off it >>more fT3 testing will give more people the evidence to argue that their fT3 is quite low /below range >> allowing more fT3 testing is likely to lead to more requests for T3 prescription .

[diogenes Remembering]

The problem is that doctors mix up the expectations and dangers from true hyperthyroidism (suppressed TSH, high, persisting and inconsistent FT3) with hormone therapy. It is true that FT3 in hyperthyroidism can fluctuate (usually upwards as the disease worsens) whereas it's not the case for those on T4 only who have no thyroid. It is the case if on T4/T3 or T3 alone because the T3 only has a half-life (50% loss) in 24 h ours whereas it's over a week for T4. However, once again, if the body takes time to respond to a T3 dose, then temporary fluctuations in FT3 won't matter -they will be evened out over the whole period. It is true that the body does not react instantaneously to the T3 spike, after taking T3 so the actual body response is much less unstable than the T3 spike indicates - especially if the dose is split during the day.

[Marz]

Am afraid the cynic in me says that not testing and treating correctly enables many more medications to be prescribed. More profitable ones too. Am afraid the Western Medical model is about the bottom line and has been for many years ...

[Mugs19 in reply to Marz]

Re the western Medical Model: heard Dr Richard Smith one Sunday morning as a guest on Michael Berkeley. He had been Chairman of BMA for several years and Editor of BMJ for several years. He described starting his medical degree at Edinburgh University and went to a symposium at which Illich was speaking(a very anti-establishment character who wrote a book entitled "De-schooling Society") who said that the greatest threat to the Western civilised world was western medicine. Smith had already noticed a few disturbing things such as the wards at Edinburgh Royal Infirmary were organised more for the comfort and convenience of the doctors than the patients. He dropped out. For a week. Then dropped in again determined to change the direction of medicine.

[Marz in reply to Mugs19]

I read recently that 4% of UK hospital beds are taken up with medication mistakes.... and resulting deaths in their thousands annually 🤔

[jjf255 in reply to Marz]

I think you are absolutely correct. There are so many illnesses that over time will start to appear with low T3. My husband was a victim of a Dr. that refused to check T3 levels. Over time my husbands BP and cholesterol started to rise and his kidneys and liver started to have issues...all the while taking levo. His Dr. only tested TSH and even that was too high. Finally I took matters into my own hands and kept searching until I found a Dr. that had a better understanding of thyroid issues. He runs a full thyroid panel and prescribes NDT, but it has taken years to get my husbands health issues going in the right direction. Big Pharma knows individuals with low T3 will have high cholesterol and other issues and those drugs can then be prescribed.

[Alejandrita17 in reply to jjf255]

Yes I think You are right. I still have ibe doubt: if t3 is si important, why do doctors dismiss it during pregnantcy? T3 is completely forbidden if You are pregnant, they just give you t4.Did your husband have low- normal T3, or t3 was out of range? Did he solve his issues with NDT?

[jjf255 in reply to Alejandrita17]

The doctor my husband had for years never checked T3 or T4, only TSH and he was on levo at that time. When he switched doctors and had a full thyroid panel run, his T3 wasn't in range. He has been on NDT ever since. He was on Naturthroid, then when that was discontinued, the next one was also discontinued and finally he is doing so much better on Armour. Even on Armour, it has taken some time to get him to the right dose. We are in the U S, so NDT can be prescribed if you can fine a doctor who understands how important T3 is, whether they prescribe it along with Levo or NDT instead.

[tattybogle in reply to Alejandrita17]

I still have ibe doubt: if T3 is si important, why do doctors dismiss it during pregnancy? T3 is completely forbidden if You are pregnant, they just give you t4.

It used to be thought that maternal T3 could not cross the placental barrier , but i think ? they are not so certain about that anymore ?.

Anything prescribed in pregnancy , especially anything that crosses the placenta, obviously needs extremely rigorous safety evidence in that situation ie. potential effects on Fetus, before anyone is allowed/willing to prescribe it during pregnancy.

So as usual with pregnancy , a lot of things that are considered 'potentially' Ok for use in consenting adults are 'off the table ' due to 'playing it safe' .. which is fair enough. (litigation is also a major concern here)

However , before Levo became the most common treatment for hypothyroidism in the 1950's, NDT (which contains a higher proportion of T3 than is usual for humans ) was used for all patients, including (presumably) pregnant women .. and as far as i am aware , there were no reports of harm to unborn babies from NDT use in pregnancy.

There have even , (i think) been a couple of members on here over the years who had successful 'T3 only' pregnancies.

[tegz in reply to tattybogle]

T3 is demonised- as it suits the finance narrative threaded through pharma - & thus medicine, if that what it still is!Reverse T3 is another hidden bomblet that is even more dangerous to the 'club' & thus also ignored totally..

[Marz in reply to jjf255]

Pleased to hear you were able to help your husband. It seems that in the UK they are obsessed with Mens PSA levels and the prostate. Some years ago my husband was prescribed a drug which he quickly stopped due to side effects.

I was diagnosed with Hashi's in 2005 and a few years later I persuaded hubby to add TSH to his PSA test at the local clinic in Crete. The TSH result was high and so further testing was done. VERY low T3 and anti-bodies. The rest is history. Since starting thyroid meds his PSA is at the bottom of the range. I wonder how many more men are suffering due to a low T3 as a result of inadequate testing. The prostate is part of the endocrine system - is it not ? Apologies for the sarcasm !

[DippyDame]

I suspect medic's ignorance plays a partThyroid education is inadequate.

The scientists are not given adequate cognisance

So with lack of knowledge at play, ill health follows, ending in the ensuing mess as medics fly by the seat of their pants trying to treat struggling patients.

Big pharma have hiked cost to eye watering, unaffordable levels

Stir it all together and we have a horrible T3 mess.

[tattybogle in reply to DippyDame]

See no T3 , Hear no T3, Prescribe no T3.🐒🐒🐒

[DippyDame in reply to tattybogle]

Absolutely!

[tegz in reply to DippyDame]

T3 is demonised- as it suits the finance narrative threaded through pharma - & thus medicine, if that what it still is!Reverse T3 is another hidden bomblet that is even more dangerous to the 'club' & thus also ignored totally..

[Ingrid1234]

Unfortunately some GPs do not fully understand blood test results for T3, T4 etc but will not admit this 😩.

These are hormones and it does take a specialist doctor to fully understand hormones, metabolism and how these glands work. Complex biochemical understanding is required.👆

What you need is an ENDOCRINOLOGIST, a specialist medic to interpret your results. A consultant NHS endocrinologist/diabetologist would be ideal. We as patients must be assertive, expressive and honest with many generalist type medics, many of whom fob us off with the arrogant, “I know best!” attitude 😩

All the best,

👍👆💗

[waveylines in reply to Ingrid1234]

But even with an endocrinologist you have to be careful who you pick as many specialise in diabetes and actually know no more than your average GP re Hypothyroidism. Thyroid uk have a list of Thyroid friendly doctors.

[Dancing_dragonfly in reply to waveylines]

Agree completely! At least about docs in the States…. I’ve been UK enough to see friends and hear their stories as well.

[ASkepticalConsumer in reply to waveylines]

Same here in Canada - remember, we have few doctors as there is only the public system., no private options.The Endo's all focus exclusively on diabetes and the one's I have dealt with for myself and my mother are utterly incompetent for thyroid.

[59Blue]

The problem is the NICE guidelines and the behaviour of generic Pharma companies ( not big Pharma who do R&D). A few generics companies bought up the licences for drugs which are not widely used so not made by many companies and because of the way NHS contracts are written were able to increase prices hugely in the U.K. Liothyronine but also epilepsy drugs and others. There have been fines issued now but it’s taken many many years. In the meantime the NHS and medical profession panicked about costs and reviewed the few academic studies leading to the conclusion that T3 treatment isn’t really necessary. Nice guidelines say it shouldn’t be used apart from in exceptional cases and they are what GPS have to follow or get into trouble with the local Fund holders.Now that costs have gone down a bit what is needed s some good research on patient quality of life with and without T3 as for some patients it makes a huge difference.

If big Pharma were making liothyronine they would pay for the studies to show the benefit and lobby for the Nice guidelines to be changed but generic companies don’t sponsor that type of research.

[tegz in reply to 59Blue]

The system is perfectly tuned now- for full complance & max profits..😕

[lh22]

I think it's a combination of things: their medical education and training puts a focus on TSH and T4 as being the most effective indicators of thyroid issues; having to take into consideration guidelines set by the NHS, NICE etc; a fear of professional disciplinary action if they go against the guidelines and the insurance related repercussions. As someone who worked in a regulated industry, I can empathize with them to a certain extent as to why they are reluctant to go against the 'official' guidance, but there are some brave and open - minded doctors who are willing to consider more up to date and relevant medical research and help you.

[McPammy]

I believe it’s about not doing T3 testing as they might have to prescribe T3 for many patients with low levels. Guidelines are to not prescribe T3 in the NHS due to price hikes of 6000% over recent years. But this only applies to the U.K. NHS. Privately you can buy T3 at a reasonable price in the U.K. EU the price is good and same in the USA. I’ve managed to get my T3 off the NHS. Prior they wouldn’t check my T3 regularly. Now they check it every 12 weeks along with TSH and T4. So Drs can check and labs will do the tests. Mainly for myself to check it as I’m prescribed T4 Levothyroxine plus T3 Liothyronine by the NHS so they must check it.

I’m a very poor converter T4 to T3 only 8% converting. I struggled for many years on Levothyroxine only. I was only living a half life. It was going private only that saved me when I had a successful T3 plus T4 trial. Finally the NHS agreed to prescribe.

[serenfach]

Re the non testing - the labs here wont test T3 as there is a "policy" in place to save money. I took it up with the GPs, then the labs who both said their hands were tied. I then went higher to the Welsh Health minister who was no help at all, and just told me to take it up with the GP even though I had said 3 times that it is a Gov policy and the GPs cannot do anything. I am now referring the Minister to the Council for misconduct, as she takes 3 months to reply and then fobs me off!

Saving 90p on the test is putting lives at risk. This is unacceptable.

[buddy99]

I blame "hypercapitalism". The pharmaceutical industry is super powerful and dictates what goes and what doesn't. The main focus is on profit, the share holders and not on patients. Doctors are educated accordingly. The flipside is that those who pay for meds not as individuals but as organizations (governments and/or insurance companies) try to keep cost down at all cost (even to the patient).

Since doctors have been undereducated about T3 they see no need to test for it. Two things I have heard from endos a) T3 has no function and b) even if we test for T3 we don't know how much is actually in the cells. Also, in medicine centered around TSH administering T3 might have a doctor's beautiful world come crashing down when the TSH goes below range. They seem to have a mortal fear of thyroid storm while myxedema (equally deadly) does not scare them at all. So going way, way beyond the upper TSH range is totally okay whereas even minimally going below causes total panic.

Where I live doctors are very regulated by government as to what they can and can not do. If they decide to go outside those regulations they pay the price. So the majority will not take the risk. So if government tells them to not test for T3 they won't.

[CabbageCat]

Money mainly, if T3 were tested then that would support the argument to prescribe it. It’s not prescribed, mainly due to cost. Also, I think if thyroid issues were predominantly a male condition, T3 would be available and more widely researched.

[tegz in reply to CabbageCat]

It looks like an irreversible game to me- irrespective of patient gender..

[AbigailHolywood]

The more I read about T3 the more grateful I am that my GP has tested for it (yesterday I’m fact) without me asking, before I started really getting to grips with why it’s important. It gives me hope for the first time in over a decade that maybe I’ll finally get answers, maybe I’ve found a rare GP that is actually informed!