I'm sorry if I'm in danger of boring this site, but I thought as a last example I would show you a paper (as late as 2021) where the authors have no inkling of the 10 years of work that we (and others) have produced, and merely repeat the same old, fatally compromised tosh. In papers well before this (by almost half a decade) we have struck out against the kind of study such as this (mixing up combination asnd pure T4 doses) which show no effect of T3/T4 combination simply because the combination-responsive group are a minority. I'm afraid my normally (fairly) equable temperament is being sorely tried by this kind of work, logically and publically discredited by earlier work
My renewed apology: I won't do this again, but I want you all to know what a hill of ignorance there is to climb. It is one of a tedious number of studies that, doing the same mistake get the same (non) answer.
J Clin Medicine
Borson-Chazot, F.; Terra, J.-L.; Goichot, B.; Caron, P.
What Is the Quality of Life in Patients Treatedwith Levothyroxine forHypothyroidism and How Are We Measuring It? A Critical, Narrative Review.
You have brought so much to members of this forum, to thyroid sufferers everywhere and, in time it will be seen, to the management of thyroid in general.
Say it again and again. None of these things can be said, highlighted, criticised, sufficiently.
Regretfully,I have come to the conclusion of several years ago. It is simply: Usually, physiologists like us present things that are primarily science-based and not patient-based (we have to generalise somewhat so as to include everyone). The medical/diagosticians use the numerology from patient panels to advance their cause. Again they generalise but from a distortion of the use of statistics on an individual's case. So both sides deal with generalities coming from their use of data. But we know that the individual is both part of the data, but not the whole. This the medical side ignore.
Having seen a GP stumble over the most basic arithmetic of working out tablets to provide a dose, I have little faith in the statistical understanding of most medical people. Statistics is far more complicated and full of things to trip over.
No need to apologise, you are never boring. On the contrary, thank you for keeping on exposing the inefficient so-called scientists who are not interested in making any serious progress in the treatment of hypothyroidism. It is appalling…Do they actually receive grants for their poor work?May I ask you to keep on informing us all about such a shocking practice?
So thank you so much for helping us see through this quagmire of very bad scientific papers.
"Do they actually receive grants for their poor work?"
at the bottom of the paper in question ...... (Merck just happen to make levothyroxine)
"Funding
The present research was funded by a medical writing grant from Merck Serono SAS (Lyon, France), an affiliate of Merck KGaA (Darmstadt, Germany).
Conflicts of Interest
Françoise Borson-Chazot has received consulting fees, honoraria for lectures, and/or research funding from Merck Serono SAS (an affiliate of Merck KGaA (Darmstadt, Germany)), HAC Pharma and Sanofi-Genzyme.
Jean-Louis Terra has no conflicts of interest to declare.
Bernard Goichot has received consulting fees, honoraria for lectures and/or research funding from Merck Serono SAS and Unipharma (Kifissia, Greece).
Philippe Caron has received consulting fees, honoraria for lectures and/or research funding from Merck Serono SAS, HAC Pharma, Unipharma, and Laboratoires Genevrier (Antibes, France)."
Diogenes , it's precisely because you keep us informed about this mountain of poor work, (which is still being added to) , that we find the strength to stand up in spite of it ,rather than being beaten down and smothered by it .
And as for 'boring' .. the truth is often boring .. but it still needs saying.... so carry on., you'll hear no complaints about repetition from me.
Thank the universe you and your team are working on this and are you going to produce a paper directly challenging? When is the dust up going to start? I feel it is coming to a head…..
I'm flattered that you want me to carry on in this way - but I don't want to swamp posts by being too enthusiastic a poster. Our plans at the moment are 1) we have virtually written another paper to augment our last one. The first paper was a purely mathematical paper which explained a) how the body can be simultaneously robust to change and b) able to change when the need arises, and c) discovered the answer to the presently held incorrect paradigm which ignores T3's contribution to control - ie find the situation through mathematics where direct thyroid T3 plays an essential part and how. This was all theory. But 2) we are very near submitting another paper which (having found which model fits best from the first paper) is an augmentation of the first in that it asks the question: if you know the biological values of various parts of the process, does calculating from these in a focussed paper give, using these, results compatible with the first. Happy to say the papers agree, from different angles. It's essential to test against reality as well as theory to see if they match. The first model was a minimal model and the second a mechanistic one. We also have a clinical trial to analyse, but at the moment that awaits investigation. And I suppose as it's being hinted, to produce an allround review of all our findings in due course when the dust has settled. Books as such are no good as few read them nowadays.
This is an extremely robust and systematic approach! You are not simply building on others flawed science to push out scientific papers that reinforce the current ‘mind wash’. Once you have completed these various stages it will eclipse the questionable output from other sources. Truly commendable and good science. You will never over contribute . My only chagrin at this time is I haven’t got time to read more! Business closed, Sale of property in limbo phase and having to focus on packing with the outside chance it will all go !!!s up. Once we land in Wales a reading room is top priority!
But maybe I should apologise for another rant though!
The fact that I'm writing this now is in part testament to the research you have undertaken.
I said to my husband only yesterday that I feel as if I'm just a box of T3 tablets away from the edge!
It can be critical but..
"They just don't grasp it"
It is so very clear that "They", the powers-that-be neither want or, probably more significantly, are unable to pull their heads out of ancient sands where they are fixed.
Do they fear the bright light of change.
And a fall from "grace"
Since I first read Lorraine Cleaver's use of Ghandi's quote, I watch in hope!!
For those who don't know what I'm referring to -
When I despair, I remember that all through history the way of truth and love have always won. There have been tyrants and murderers, and for a time, they can seem invincible, but in the end, they always fall. Think of it–always.” ~ Mahatma Gandhi.
We see evidence of this need every day when we read the never ending stream of posts from members suffering at the hands of the incompetents.
Worthy petitions and the like have fallen on deaf ears....
they have elicited some understanding, fine words even, but the outcome is unconvincing or unproductive.
It beggars belief.
I was born before the NHS existed and I now fear for it's demise.
We are going full circle....my maternal grandmother had what she called her doctor's book.
I remember the thick tome....apparently the farm workers used to say....
Ask Mrs F...she has a book with answers!
Now, around 100 years later, instead of "Granny" we turn to the internet...
because medics don't have ( or use!) the answers
Sorry, I'm rambling again...
And I'm still despairing!
I can only imagine how you must have felt when you were faced with this drivel....
QoL appears to be influenced by a number of physiological, behavioral, cognitive and/or lifestyle factors that are not strictly related to thyroid hormone levels.
“It is so very clear that "They", the powers-that-be neither want or, probably more significantly, are unable to pull their heads out of ancient sands where they are fixed.”If only they were… seems to me the ‘ancients’ had far better ways of diagnosing and treating hypothyroidism by consulting with the patient and listening than most modern doctors do with all their scientific (mostly worthless TSH) tests and pharmaceutical concoctions which claim to reproduce the hormones we lack instead of the NDT that did the job of replacement therapy perfectly well for decades! 🙄
Maybe my wording was a little too poetic!!.....what I meant to imply was that medics today stick fast to their old, established and wrong ways of treating thyroid disease. I've edited it!
Totally agree.... in the late 1800s and moving forward they had a better grasp of the disease and how to treat it
They understood clinical evaluation
I need high dose T3-only to function
I once remarked to a GP at an annual review that it was pointless doing a thyroid test because FT3 would be high and FT4 and TSH possibly undetectable
She looked stunned and said...."but how do you monitor your T3 dose?"
Easy! I use what medics of old used....clinical evaluation. It's the only way on my dose.
All she said was "Oh...right!"
The GPs in my surgery are all very good now, after some discussion they leave me to self medicate
Perhaps my old notes reveal how ill I was before I discovered T3!!!
TSH testing was intended to diagnose hypothyroidism....nothing more!
Now they have muddied the waters by focusing on it....to the detriment of patients who are being wrongly diagnosed and medicated
Lazy diagnosis!
The fortunate ones arrive here but my heart goes out to the others who are left to struggle.
Sorry...I'm ranting again
I'd suggest that it"s medical neglect born of incompetence!
Totally agree DD! Perhaps if the current doctors were inclined to do a little more listening and apply clinical evaluation instead of clacking away on their keyboards and try looking at the patient instead of the computer screen, medical care might just get back to some semblance of actual care and not number crunching… I don’t take a supra-high dosage of T3, but I still take 55mcg/day with only 25mcg T4 and my readings are off the scale too. TSH is undetectable, my FT3 is slightly over range and my FT4 is way below the lower limit at around 4.2 and I feel fine, but nobody ever asks me that. They just look at me as though I should be dead… I try to explain to them how it works for me and sometimes they do listen, but for most their eyes just glaze over and they sign me off for another 12 months of T3 prescriptions… 😉
Thank you for this post. Please don't apologize, and please DO continue to post these. I would actually prefer to see more specific criticism of the paper. It helps to teach us to become critical and how to spot mistakes and errors in logic.
Diogenes It's always an honour and pleasure when you post. Please continue your very valuable and life enhancing *Spot On* papers. You are our Great advocate. Thank You.
Your expertise and perseverance is commendable and essential and absolutely NOT boring 🙂. It’s very reassuring to know you are chipping away at the ignorance and complacency around the treatment of thyroid issues. Thank you.
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Following on from my last post….. 
