I was " honoured" by Bianco who sent me his recent article :
The relevance of T 3 in the management of hypothyroidism
Domenico Salvatore, Tommaso Porcelli, Matthew D Ettleson, Antonio C Bianco
Pls contact Lyn Mynott or who deals with these things to get a copy.
Thank you diogenes 😊👍
Thank you.
thelancet.com/pdfs/journals...
I was shocked by how old some of the references were. Several of them are from the 1970s. Is this common in modern thyroidology?
Yes, me too! I’m not sure that Thyroid patients’ treatments have really advanced much since the 1970s when Levothyroxine became the standardised pharmaceutical choice in Thyroid treatment and ‘care’ and the default protocols became titrations of L-t4 doses in response to ‘Normalised’ TSH ranges?
Some references are old simply because (though it may not be obvious) the old paradigm of the TSH-FT4 relationship (never mind T3) is still the word of God as far as even this article is concerned. Note that the dissatisfaction with T4 only is linked almost entirely to genetics. In a way it is, but only in a very general sense that we are all genetic one-offs. The variants used by Bianco to justify his position (and thus not rocking the TSH-FT4 boat) can be an effect but by no means either the only or the major one.
Taking a Moses-type stance, I'd just like to add a few comments regarding whether and how the thyroid diagnosis/treatment paradigm will change. For the whole field, the intellectual jump will be too much to bear. From the beginning (say about 1970's) the whole paradigm of thyroid treatment was based around TSH and T4 to begin with, and FT4 and TSH when the test became available. Though it was known that the thyroid also produced T3 directly, the value of this was downplayed as it was and is thought to be a negligible contributor to the expression of T3 overall, chiefly from T4 conversion. Therefore one could envisage that, on the loss of the thyroid entirely, the relation between TSH and FT4 would be exactly the same as in health. This is where the field is at now. Unfortunately, the T3 production by the thyroid is an important contributor to the system, as it acts as a balancing action to keep the body's T3 production stable. And as the thyroid dies, the remnant produces as nearly the same amount of T3, as the T4 contribution wanes. This goes on until the last remnants are working.And this is the killer for the current belief. No longer can we relate TSH and FT4 as being the sole determinant for monitoring treatment. And by this finding, it is no exaggeration to say that ALL past papers where T3 production by the thyroid is ignored are fatally compromised. And that means almost 50 years of thyroid publication must be consigned to the garbage can.There is no alternative, however much the field may play the role of the "see no evil monkey". BUT, have they the guts to admit it, or will the field steadily accept the idea, whilst consigning the past to an invisible and noncommented shadow. No blame therefore attached. I think this new reality is going to cause much resistance, to preserve reputations.
Yes ....Accepting they did not previously know the full picture, and then moving quietly on, is one thing . ... but having enough guts to admit to having been wilfully blind to it, and dismissing and ridiculing the possibility of a wider 'truth', when it had been put under their noses for years by more observant and 'curious' researchers (and real life patients) .... is another thing entirely.
Still , as helvella say's .. he's publically acknowledging your groups research exists, which is an improvement over being 'invisible'.
Many thanks, Diogenes! As you say, the TSH fT4 boat has been the dominant paradigm for close to 50 years now, and while it may float for some, it has left others adrift on the turbulent Thyroid seas! Time to rock the boat and look for alternative treatments for those of us who, for a range of reasons, remain effectively untreated by L-t4 monotherapy in the current dogma.
Time to reconsider the ‘design’ of the TSH L-t4 boat and accept the rising tide of evidence of a more complex and dynamic role of T3 and fT3 in Thyroid regulation and control.
Good your work is getting proper recognition, it’s about time! At last the tide is turning, but never mind genetic profiling how about freedom of choice for us to decide the best thyroid hormone therapy to take and a concerted effort to treat us like adults not lab rats to be put into cohorts and experimented on.
At least he can no longer deny you exist!
Thank you Diogenes
