This paper was unavailable because it was behind a paywall. I've got behind the paywall and, if it is still invisible using this posting mechanism, I've sent the whole onto Lyn Mynott so that those interested can see it in full.
The relevance of T3 in the management of hypothyroidism
Article in The Lancet Diabetes & Endocrinology · February 2022
DOI: 10.1016/S2213-8587(22)00004-3
I believe this is it sciencedirect.com/science/a...
But you can't see the whole text as behind a paywall.
thankyou yes , i can now find see full txt on researchgate researchgate.net/publicatio...
"Is serum T3 measurement reliable ? ......... " Surely there are just as many issues that could be said to compromise the reliability of currently available T4 and TSH tests ?
".... because residual hypothyroid like symptoms are not specific to levothyroxine-treated
patients with normal TSH, and might be seen in patients with diabetes, depression, sleep apnoea, vitamin D and B12 deficiency, chronic fatigue syndrome, and adrenal insufficiency—especially in patients with autoimmune thyroiditis. Only once non-thyroid disorders have been ruled out can the addition of liothyronine be considered"
How do you rule out a syndrome for which there is no test ?
He fails to mention what exactly is his problem with us taking T3 in its currently readily available/ tried and tested form .... ? (is this because he can't find any evidence that post dose serum peaks in fT3 do any actual harm ?..... )
Who will benefit from long trials to find a gene profile ?
( and who will be exclude from trying T3 if they don't happen to fit the profile ?)
Who will benefit from more frequent purchase /use of the Liquid chromatography-tandem mass spectrometry (LC-MS/MS) test equipment he suggests may be preferable for testing fT3 ?
Is it too cynical of me to wonder who has got fingers in which pie ?
Well if it were a plum pie, we could put little Jack Horner in the frame, though generally he just uses his thumb. :
Isn't it all just additional research to further one's career and likely mixed up with a good measure of vested interest ?
On the positive side ... it manages to get through the whole 5 pages without using the word 'somatic' , or directly implying that we need some form of CBT to cure our dissatisfaction , which is a huge improvement on stuff from a few years ago.
There are several points to make here. Firstly, the suggestion that FT3 tests may be unreliable has come from a hilarious source in the USA. The advocate of Mass Spectrometry for measuring FT4 and FT3 has alleged that these tests are unreliable, based on his work. I'll deal with the FT3 he did by this method. His published euthyroid range from his measurements gave a FT3 range so ludicrously wide so to have no legitimacy at all. And would you believe that his group determined their FT4 and FT3 ranges at the WRONG TEMPERATURE. I pointed this out in a short paper, to be rebuffed by what I would call high in the incoherent scale of irrelevant bluster. The work has not been repeated at the right temperature, to my knowledge and nor has he ever admitted the error but quietly without explanation performed future work at the right temperature without withdrawing old, and actually conflating the old work with the new. That is frankly dishonesty at the highest level. Secondly, the suggestion that several other diseases may show hypothyroid symptoms doesn't release diagnosticians from testing for hypothyroidism to rule it out, even if the other symptoms don't strongly advocate it. It surely should be ruled out by thyroid testing, where at least TSH is a reasonably test base. Thirdly, he tries to rescue the current test base by emphasising genetic dysfunction as a primary cause. Perhaps it is of some importance, but that doesn't even account for the majority of sufferers. Fourthly, Bianco has developed a slow-release T3 derivative to soften the T3 spike after taking a T3 dose. There therefore is some hidden financial element in this paper (to patent a T3 derivative and gain money & reputation).
I suppose the problem with debunking that sort of dishonesty is the technicalities of testing are too complicated for many to understand.. so it's all too easy for him to blind people with science .. even if it is all cobblers.
.......maybe Tania will do us an infographic to explain where he's gone wrong ..complete with cartoon of a man 9/10th's along the "International Incoherent Bluster scale" .
as for "slowT3 "... methinks it's just that same old chestnut.. " you mustn't smoke the naughty plant from the greenhouse that makes you giggle ... but you can all buy CBD oil now cos we've invested in some massively profitable licensed factories growing it under lights in Canada "
Mmmm ..... all sounds very honourable (not)
Funny isn’t it that a normal thyroid doesn’t halt the supply of T3 to check it might be diabetes, depression, sleep apnea et al by only providing T4 and getting TSH in range. What sort of logic is being applied here to those with thyroid disorder on medication. Decidedly faulty logic i if you ask me. The default treatment should he combination therapy not T4 monotherapy. There’s no justification for it to my mind bar inability to tolerate T3.
I never though of it like that before ... quite a scary thought ~ normal thyroids being made to abide by prescription rules for whether it was allowed to give you any emergency T3 or not . I suspect that wouldn't work out very well.
Totally agree .. logic says the 'default option' should be as close to what a normal thyroid does as possible... which ' one lump of T4 a day' certainly isn't .
They make out like "2 x daily dosing" is such an unacceptable hassle ... but honestly, when you were diagnosed....... if the Doc had said:
" Levo is just one little pill a day .. but for the best chance of feeling like your old self again you will need to take some extra T3 tablets twice a day for life"
... would you have said ... "Naa.... what a palaver, i can't be bothered with faffing around doing that , just give me the one before breakfast and i'll risk being a bit rubbish for life instead"
No ?..me neither
They only gave me 25mcg for three months I felt absolutely dire. I got an idiot Icelandic understudy who thought a TSH of c90 rendered me euthyroid he made me suffer good and proper. The endo whacked It up sharpish when he discovered what had been going on, he even gave a 50mcg increase in one go, it helped but I was never told to split the dose. I used to sit and cry during the consultation I felt so terrible, he never said anything about it but he was very kind & at least he attempted a Toft dose for optimisation. The lack of T3 did for me. NDT was like a miracle. People should challenge them and say it’s ok for you, you’ve T3 on tap why are you denighing it to me with no thyroid function at all? Pity we can’t switch their T3 off and see how they like it. They are always doing it to rats so it must be possible…..poor rats
Thank you so much for posting this link
Many thanks for going to the trouble.
This is a very useful paper to show to my GP. Thank you for posting diogenes.
From the info I’ve just read from diogenes and tattybogle, I wouldn’t be in any hurry to show this to my GP. 🤪
Onreflection, I think you're right
The US gurus are getting worried that they may have been wrong, at last!New book on treating hypothyroidismProposed book on treating hypothyroidism
Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers
Is there a role for Natural Desiccated Thyroid in the treatment of levothyroxine unresponsive hypothyroidism?
