This available paper again addresses the link between low FT3 , poorer quality of life and Hashimoto's thyroiditis. The "well controlled" group on T4 only, were presumably designated so by TSH monitoring.
Relatively Lower FT3 Levels Are Associated with Impaired Quality of Life in Levothyroxine-Treated Patients with Hashimoto Thyroiditis
•March 2022
•International Journal of Endocrinology 2022(1):1-7
•DOI: 10.1155/2022/1918674
•Zhijun Cui, Xiaoyu Ding, Nannan Bian, Guang Wang et al
Objective. Patients with Hashimoto thyroiditis (HT) frequently have some complaints despite achieving euthyroidism after levothyroxine (LT4) treatment. This study aimed to investigate the relevant factors affecting the quality of life (QoL) in euthyroid HT patients after LT4 treatment.
Methods. In this case-control study, 133 participants with HT were included. They were divided into two groups: 64 euthyroid HT subjects (control group) and 69 HT patients were rendered euthyroid by LT4 treatment (well-controlled group). QoL was measured with the Thyroid-Related Patient-Reported Outcome (ThyPRO-39) questionnaire.
Results. Both study groups were well matched with respect to gender, age, BMI, euthyroidism, and thyroid antibodies (TPOAb and TGAb). Compared with the control group, the well-controlled group had lower FT3 ( P < 0.01 ) levels. Of note, QoL was impaired on all scales in the well-controlled group. Moreover, ThyPRO-39 scores among the well-controlled group were significantly higher (worse) than the control group in all scales. Regarding the composite scale, its score was related to FT3 (r = −0.176, P = 0.043 ) but not to FT4 and TSH levels. Further logistic regression analysis revealed FT3 was significantly associated with elevated composite QoL [0.128 (0.029–0.577), P < 0.01 ] after adjustment of potential confounders.
Conclusion. Relatively lower FT3 concentrations, even within the normal reference range, were related to impaired QoL in HT patients treated with LT4. This finding supports the great value of FT3 in clinical decision-making on dose adequacy.
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diogenes
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Thank you for this Diogenes. When might we start to see a firm reduction in the obsession for Levothyroxine only, when more and more studies are beginning to show the truth of the failure of such treatment in many unhappy and unwell patients? I am fortunate at the moment, as my CCG still gives me Liothyronine plus Levothyroxine but this nonsense cannot go on leaving patients extremely unwell when the cure is there to be used.
If only Henderson!! It is a brick wall the thickness and strength of a banks vault so knocking through is no easy matter! Lol..... As the body of evidence grows it may take a legal case before they will apply whats sitting right under their noses!
As for the price of T3 meds.....well its nothing to do with shortages but everything to do with the NHS allowing themselves to be targeted by setting up flawed contracts. Effective procurement should stop this.
And there is an argument to be had that effective thyroid treatment means other medications are not required & adding a T3 componant can be actually more cost effective. Nevermind the QoL..sigh....lol.
They have known all along. This is the horror of it all. Wellness NEVER factored into this. I would imagine enough of the ‘old players’ who created this cluster £”&! Have dropped off the twig or retired to allow the situation to change- PLUS the biggy for us under the ‘care’ of NHS …….price.
When can we tattoo this on the foreheads of the UK Endos ? But seriously maybe if they started prescribing T3 more often the drug companies would reduce prices ..economy of scale etc .Then people would be healthier and more active thereby saving on heart meds and diabetis meds and blood pressure meds etc...
There is only so long they can ignore the elephant at the party ie the obvious tension between treatment regimes vs poor quality of life for many.
It was inevitable these studies would eventually emerge have to investigate this. - the only shame is on the establishment for creating an inertia that has drawn this for decades and hounded those brave enough to stick their heads above the parapets.
Thanks for posting this info. What a pity it only mentions those with Hashimotos. What about people like me who have had their thyroid destroyed by RAI and, like me, have no quality of life.
We already have a paper that acknowledges that RAI offers the worst QOL when compared to either a thyroidectomy or long term AT drugs irrespective of whatever thyroid hormone replacement is prescribed :
It's disgraceful that RAI is even still on the table as a treatment option:
I am sorry you are still symptomatic and I definitely agree that people should be offered options to levothyroxine if patient isn't improving.
Levo gave me intense palpitations and Interfered with my sleep all night long.
I tried alternatives but only T3 resolved symptoms.
Some people recovered on the original replacement i.e. NDT (natural dessicated thyroid hormones) given since 1892 without the need of blood tests but was withdrawn without notice by the BTA et al despite its long-proven use and caused panic amongst those who depended upon it.
I think the BTA et al need a reintroduction into why the 'thyroid gland' is very important' and a course of 'How to restore the health of those who have a dysfunctional thyroid gland',
I'm sure a good number on this forum would be willing to attend a Conference to put our 'points' over to the 'supposed to be' "Experts".
Thankyou so so much Diogenes for keeping us all so well informed on this. So glad these research papers are reflecting what we patients already know. Am keeping my fingers crossed that now there are more papers showing this that it will filter into practise. No more hounding of those who dare to prescribe Liothyronine or a NDT. 🙏🙏 The suffering has been immense for patients. Not helped by the ridiculously high TSH threshold....but thats another matter! Many thanks.....
🤣😂 Its the endos & local health authorities (CCGs?) you need to get to! Lol...
My GP over my request for b12 jabs threw her hands up in despair as she couldn't prescribe them unless I saw a nhs neurologist first despite horrific symptoms.....all because my B12 was still just in range! She looked soooo relieved when I said I will buy my own whilst I wait 6 months (pre covid era) before I see one as I dont want permenant damage. She knew I was right.There must be thousands of patients suffering & ending up being unnecessarily harmed. Sorry it makes me soooo angry! 😬😤 Sorry!
There's no need to apologise for printing the truth.
My mother had pernicious anaemia until GP told her she needed no more as her B12 was now optimum.
Due to this GP's comment my mother's quarterly injection was removed - Result! her stomach developed cancer due to GPs decision; When she was dying my sister and I had to request more injections for her pain relief as she was now unconcious but clearly in enormous pain.
Oh Shaws thats terrible. Your poor Mum, & poor you & your sister....what a horrific thing to have to watch. Its inhumane to leave a loved one suffering like that. Sending you the biggest of hugs. Xxx
Good morning diogenes and I thank you and all other researchers who strive to improve people's health and I hope that all of the scientific statements will be read and absorbed by those who are the 'overseers' who decide what is and what cannot be prescribed.
Your last sentence:-
"This finding supports the great value of FT3 in clinical decision-making on dose adequacy".
Why do the 'organisations' BTA etc ignore all of the scientific evidence and leave many patients symptomatic and unwell?
Let's turn them upside down on a horse and they will certainly lose face from another 'angle' that hypo patients need proper selection of replacement hormones that suit the patient and no messing about.
Does it say the dose level range of levothyroxine that the control group were on? My next door neighbour does well on levo but his dose is only 75mcg....maybe his body copes better because of this?
It seems that the way forward id via researchers in China or India who aren't welded to the orthodoxy to gather the evidence without the bias for T4 only treatment.Thanks again diogenes
Many thanks, Diogenes! Much appreciated! Looks like a promising development and a clear and concise conclusion! Hopefully it will help to add to the rising tide for a broad range of treatments adapted to the patients symptoms and underlying thyroid issues. For too long we have been grouped into a generic standardised L-t4 protocol based on TSH and fT4 blood tests, and “normal” ranges, irrespective of whether there may be residual symptoms and low fT3, which is rarely considered and even more rarely measured in the standard blood tests. I have also had situations where the fT3 blood tests have been taken by the more enlightened Endocrinologist clinic but rejected or not reported by the NHS labs due to “cost” considerations! I’ve seen some of the research on animals where fT3 levels are considered to be important factors in restoring thyroid balance but it’s now more encouraging to see research emerging on the potential importance of fT3 in “human” research trials. Sadly, we still have a more general reluctance in the Endocrinologist community to consider a potentially critical role of fT3 in thyroid “regulation” and control, as well as QoL parameters that are so important for Hashimotos, Thyroid and Hypothyroid patients with a more complex range of conditions that compromise the standardised treatment protocols! Muchas Gracias!
I think the basic reason is that the medical thyroid community have become lazy, in believing the subject of diagnosis and treatment was effectively concluded, A set protocol was thus enshrined in their understanding: easy, cost effective and freeing doctors up to have more time for the really difficult cases in other areas. This has been torpedoed. And I can imagine doctors' reluctance to revisit this as a problem as difficult to diagnose and treat . This cuts into the time for treatment diagnosis overall and they simply do not want to admit that this is a problem which if anything, is now very large and demanding of a sophisticated relationship between patient and doctor. Simply it adds to their load of work.
Thanks again for your great insights and reflections on both the research and medical practice. I’m sure you are right about the Doctor-Patient relationships! I’m lucky if I get more than ten minutes for appointments and if it goes beyond you can sense the frustration building up! There’s a clear bias in the endocrinology profession towards diabetes, which appears to be considered more in research, training and practice, although I would argue that the Thyroid - or the HPT axis - is perhaps equally as complex and dynamic. Sadly the pressures of time, resources and patient numbers per practice, as well as growing NHS backlogs condemn us to the lazy prevalence of the standardised TSH and fT4 tests and monotherapy with L-t4 titrated to TSH. In practice this is all too frequently considered in isolation based on TSH without reference to fT4 - and even less likely fT3 - despite the residual of patients whose symptoms prevail beyond the standardised L-t4 titrations and whose QoL indices are compromised by the inadequacies of the current paradigm!
I should add that there have been some very good Doctors or Endocrinologists willing to challenge these paradigms but in my experience they are a rare breed and tend to be from the older generation of medical practice, based on patient symptoms and extensive consultations and prior to the intrusion of standardised norms, quantitative biases and treatment protocols based on cost- effectiveness and value for money rather than individual patients health, symptoms and QoL. Although I appreciate this may be over-simplifying the increasing burden on our current system of healthcare, I would argue that they are key drivers behind the apparent reluctance to change medical practice in response to new research results and emerging evidence that L-t4 is ineffective for some patients. I am also concerned by the missing cohorts of patients who are overlooked by the current TSH ranges established for initial treatment? How many Central Hypothyroid cases are missed by the TSH only screening with no fT4 or fT3 tests that should be elements of a more comprehensive diagnostic system.
Well said Diogenes! On top of which GP knowledge is extremely poor & they struggle to manage it because they don't understand it.....and are not trained. That would mean the NHS would need more endocrinologist who are thyroid specialist NOT diabetes specialists. Alternatively training GPS so they are competent.
With regard to the cost of T3 medicine, a friend in Turkey pays the equivalent of £2.50 for 30 25 mcg tablets, how can the powers that be complain about the cost in the UK?
Because the “Wally” who signed the contract to buy T3 for the NHS was either really stupid or had shares in many pharmaceutical companies (Sorry if I’m not supposed to write that 🤐)
I wrote many years ago to my MP, complaining about the price of T3. I eventually received a response from someone in the NHS explaining that they had an agreement whereby branded drugs were at a very favourable price but generics such as Liothyronine could be any price the manufacturer wished. This is how the great T3 hike began.
I take Imigran for migraines(the original brand, sumatriptan). I can’t tolerate the generic. My GP at the time said “the original are £27 for 6 tablets (I generally take no more than 6 per month) and the generic £1.40 for 12 (or could have been more), so you need to take an anti sickness pill”.The generic caused me to throw up for 7hrs with a dreadful migraine. The anti sickness tablet worked for 2hrs then I threw up and it didn’t stop the migraine.
The pharmacist said they actually only paid 50p per pack of Imigran.
So I went back to a different doctor and told them (as above) and now my prescription always says Imigran.
So what they wrote to you was the opposite to what I saw in the medication price book my GP showed me with the Imigran/sumatriptan.
Not sure what to believe. Just know that we are being screwed by companies who are making a lot of money while we continue to struggle.
I think it is affected by demand. How many people use Imigran, compared with the possible number now wanting Liothyronine? As soon as a manufacturer sniffs profit, up goes the price. There are also probably other medications that might help patients with migraine but there was only one version of T3 in the U.K. when the price of Liothyronine started to rise. Things began slowly to improve when other manufacturers came along. Nevertheless it can only be called a total disaster of buying skills by the NHS. Any company wanting to buy in the numbers needed by the NHS should be skilled in negotiating a good price. Our wonderful NHS buyers must simply have rolled over and said “ Whatever you like. We’ll pay.”
A lovely image! Or perhaps not. It still makes me so angry that we are treated like fools. I once found an interesting website that listed by their names all MPs who have shares in pharmaceutical companies.
One who shall remain nameless had previously written to me after I queried the price hike of Liothyronine with my MP and explained it away by difficulty of manufacture and transport costs. Oh really??
Yes, think we were born yesterday.This forum is so helpful and informative. I’m on another place (which I should come off) and there are too many people with thyroid issues who are completely ignorant of what help and advice they should be getting from their GP. (Who are also too ignorant of our disease) And as for medication/blood tests………I can’t write any more as it would need another post.
With people like Diogenes, Tara (ITT) and other amazing friends we may make headway through this fog.
I’m having a good few days at the moment and it’s mostly down to the help and advice I’ve received from here 🤩
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