This post is to inform anyone interested that this book will become available either as a download paper or PDF, or a cloth book (expensive) Should be available soon.
Rethinking Hypothyroidism
Why Treatment Must Change and What Patients Can Do
Antonio C. Bianco, MD
In this primer for patients, their families, and their doctors, a leading physician and scientist explains why the standard treatment for hypothyroidism fails many—and offers an empowering call for change.
Hypothyroidism, also commonly referred to as Hashimoto’s disease, affects millions in the United States alone. It occurs when the thyroid—the butterfly-shaped gland that sits in your neck right above the front of your shirt collar—malfunctions or after thyroid surgery, causing thyroid hormone levels in circulation to drop below normal. Thus, treatment is aimed at bringing these hormone levels back to normal. This is done with daily tablets of thyroxine or T4. Because hypothyroidism is so common, we likely know someone who is on this type of medication. While most patients respond well to this standard treatment, about ten to twenty percent (some two to three million individuals in the United States) are far from living a typical life. They exhibit “foggy brain”—low energy, confusion, and poor memory. Many doctors have shrugged off their complaints, believing these symptoms to be unrelated to the thyroid disease. In Rethinking Hypothyroidism, Dr. Antonio C. Bianco, a physician and a scientist who has studied hypothyroidism and thyroid hormones for decades, offers an accessible overview of the disease’s treatment and the role of big pharma in shaping it, making the case that the current approach is failing many patients. But more than this, Bianco calls for alternatives to improve lives, and he equips patients and their families with the tools to advocate for other treatments.
Thanks again for posting this update. Is it worth spending money on a book telling us what we already know? Thanks to the tireless work you and your Colleagues have put in, I think we already know the answer.
Thank you Diogenes for keeping us updated. However I feel as I'm sure many of us would agree. That we wrote the book. Hopefully others will benefit from what we had to endure as thyroid patients and to fight for our well-being .
I believe the book is mainly for the medical professionals who diagnose/treat people who have a dysfunctional thyroid gland but there is many patients who do not recover their health and symptoms continue when they cannot get prescribed replacement hormones that restore their health.
I suspect that patients may be prescribed anti-depressants if they go to the surgery too often.
A book could also be put into libraries and we can borrow.
If patients have no relief. who can they turn to ? especially if they have no connection to the internet.
For instance there used to be NDTs (saved lives from 1892 but removed by the BTA without notice and no alternative). There was panic amongst those who felt well on this product.
Fortunately there is Thyroiduk who works behind the scenes and lynmynott has been the connection between us, the patients, and the doctors/endocrinologiists/scientists and MPs.
There is also the scientists who can delve into queries through research and resolve the problems that arise.
The BTA have withdrawn medications - one that has been used successfully from 1892 - without any explanation or forewarning and leaving patients shocked and worried as many have to work and that can be affected if not on the correct medication/dose.
They also did the same with T3 and many hypo patients rely upon this important thyroid hormone were left high and dry.
Thankfully it can again be prescribed but I believe only an Endocrologist can do so but it seems a number of them don't.
We cannot source T3 without prescriptions in the UK.
I fear that, if this book is mainly for the use of professionals, then it will sadly go unnoticed as with many of diogenes et al papers. They are too busy trying to ride their extremely high horses.
It's there....but being prescribed T3 is also a challenge that many of us have experienced, without successWe have been forced, by desperation, to self medicate.
We are advised, even lectured at, by medics who clearly lack the ability to treat us.
As a result we have no NHS "safety net" or any guarantee that we will be appropriately medicated if, for whatever reason, we lose our independence to self-source and self- medicate
Since optimal T3 level varies from person to person there needs to be greater flexibility in the amount that can be prescribed....and time allowed to titrate to a therapeutic dose.
I don't doubt this book is valuable....but will it be read by those who need to change their attitude about current treatments....and improve their knowledge.
I agree. But we have to hope.When some CCGs (ICSs) ration the amount of T3 you're 'allowed', eg 10mcg daily, it's pretty scary thinking how far there is to go.
I just take heart from the very existence of Bianco's book. Do not expect miracles. Though it decries TSH as an adequate test, it at least exposes the fact of patients being not adequately treated with T4 and their need for combination therapy. That simply conflicts with the inadequate trials of combination showing no improvement. Also I'm glad he's in the USA, because they will take on board this problem much more readily than eg the UK, and will I hope produce adequate trials to revisit the problem. But it will be slow, and the inadequacies will take time to be settled in their minds. No-one will move until adequate trials are done.
Diogenes medical academia ought to take your wonderful papers that you worked so hard for and teach future Dr's how thyroid patients ought to be treated to achieve the best thyroid patients want/should feel. *Optimal *.
But NDT was used successfully for a very long time - how much evidence do these people need to prove that combination therapy is effective and safe? They simply do not comprehend the area they are supposed to be expert in; if they did it would be obvious that combination therapy is a much better idea than T4 monotherapy if you want patients to feel well again. One wonders why they want patients to feel permanently ill and do all they can to perpetuate this, resorting to any vile nonsense they can to excuse themselves of any responsibility for the situation, the it’s all in your head brigade. It is this ignorance that’s the biggest barrier to much needed change.
The more books like this the better, the unforgivable complacency in endocrinology needs challenging and rootling out.
DD there is such a lack of understanding that Dr's just don't get it that it's not one size fits all. Dr need to understand listen to patients and think out of the *Box* what each thyroid patients needs are. To make thyroid patients feel the most *Optimal *as possible.
I agree with your comments. Sadly I fear we, patients, will not reap the benefits from this book because too many endocrinologists will probably not change their good old ways of (not) treating hypothyroidism as it deserves to be.
I wonder why so many doctors and researchers feel completely unable to use the phrase "brain fog"? Is it just because it was invented and used by patients?
It sounds so common whereas somatic sounds scientific, it was invented by them, and means you can ignore it and the patient, who’s now conveniently labelled as a mental case and can be shoved on antidepressants - job done.
I take on board the possible dismissal of his book as being superfluous because of alternative thinking by our group. But I fear there is something nasty that may come out. The thyroid medical world as a whole cannot or will not engage with the primary defect in their diagnosis/treatment regimen. In short, they will not countenance the absolutely crucial role for direct T3 production by the gland, as an exquisite control for keeping FT3 strictly guarded against pressures of changed state, because to do so would collapse their argument in front of their eyes. Now I may be jumping the gun here so I'll just surmise, that Bianco will not give our body of work the attention it deserves. He is much more a genetics advocate for different actions of the body's deiodinases to show the roots of this variation in response. I don't decry the genetics, but it isn't by a long chalk the answer. Just as an example, our latest paper linking healthy thyroid control and the change in non thyroidal illness has had virtually no response. It is both too mathematical for most medics and too controversial in its non-mathematical findings for them to swallow its message.
I follow Bianco online, and posted his book release details a few months back. Not everyone has negative views 😉.
Granted he investigates deiodinases and not essentially the cause of our hypo as it's all written out in thyroid enzymes, genetics, etc but he's genuine as writes about hypo brain fog, hypo depression, the persistently high cholesterol in Levo patients and heart issues that resolve with combo meds.
I believe his book is about evidencing the TSH as an unreliable measure for thyroid hormone levels which is much the same as our final cause, just from a different angle.
Thanks DippyDame I'm saving these links to read them in detail for my next 'physical' consult with my endo in October... Particularly ironic when she worked in the US and prescribes ERFA which is Canadian 😕 thank you 👍
It is now thought the thyroid gland converts (nearly) as much as the liver, and so if your gland is partially/fully absent, then you will most likely require medicated T3 in some form to compensate for this conversion loss. People tend to focus on the DIO2 mutation re low T3 but the loss of our thyroid gland is also a huge contributor.
Thank you Radd, I do take ERFA but still have my thyroid.. As I've recently been diagnosed with Lupus (taking topical steroid for scalp) I'm hoping that having gone back on DHEA will help improve my cortisol levels (extreme stress for last 9 months) increasing ERFA (despite endo's request to reduce) has seen both T3F and T4F slightly go up, needless to say TSH has gotten even lower..hence my reluctance to 'talk' to endo til I'm away from major stress trigger for at least 6 weeks. I was prescribed T3 years ago but they don't like /know how to prescribe it in France, so in an ideal world I'd like to stick with what I know worked before 🙏 hoping that I can keep things simple...but in the meantime want to have the 'data' to physically present to endo... (past experience has shown that raising 'logical' points in emails doesn't work!!) thank you for this information.. I can already see her freaking out with the current TSH and her argument (said in November) that I was hypo.
It is ignorance and pride holding it all back. Even I could get your paper and I’m a nobody. They are simply lazy in action and mind and very stupid.
I presume Bianco does not really get FT3 as the thing being protected, and is still stuck floundering in all that other daft obfuscation which I suppose deiodinases are also a facet.
“Hypothyroidism, also commonly referred to as Hashimoto’s disease, affects millions ... )This description needs to be challenged, primary, congenital or surgically/ chemically induced hypothyroidism are not the same as Hashimoto’s.
If there is no thyroid left at all, by whatever means, treatment will be the same. T4 0nly or T4/T3 combined as required. With secondary and tertiary hypothyroidism, replaement will need more care. But, normally, as the end result of athyreoticism, the basic treatment is the same. If any thyroid is left working, this doesn't apply, and the course of the illness has to be examined case by case.
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Dr Sarah Myhill has a new book on thyroid - see amazon or her website for details. 
