The British Thyroid Association [7] and European Thyroid Association [8] provide clearer guidance. For patients not achieving adequate symptom control on L-thyroxine where other potential causes of the symptoms have been excluded, they suggest that Liothyronine in combination with L-thyroxine may be considered by a specialist Endocrinologist on a trial basis whilst maintaining the serum TSH in the reference range. The trial of liothyronine should be stopped after 3–4 months if there is no patient benefit.
Clearly TSH is the main criteria as the guidelines don’t mention anything about FT3 and FT4 levels.
My mums TSH has dropped just below the reference range whilst her FT3 and FT4 are less than half way through the range.
I think he will remove T3 from her treatment now as his clinical letter last time went on and on about the trial being judged by “TSH alone” - like he was paraphrasing the above guidelines.
From discussion on this forum it appears everyone knows TSH is suppressed by T3 therapy but if doctors’ own guidelines are refusing to acknowledge this then can we really blame doctors who are at risk of losing their jobs by going against these guidelines.
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Wired123
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I think we have to ask the question: are they seriously risking losing their jobs? Who's going to go round measuring every thyroid patient's TSH to find out if it's within range just so that they can 'victimise' a GP? Is this realistic? Does it happen? Who would do it? Other GPs? In my experience, they all stick together and cover each other's backs - unlike dentists and plumbers! lol How many doctors have actually been fired because a patient's TSH went below range?
Besides, there are just guidelines. Guidelines are not the same as rules.
Guidelines are not rules but the generally accepted principles a professional is supposed to follow, by going against this a doctor could be found to be in breach of guidelines or in other words what would a reasonable competent doctor do in the same situation.
If a patient had a problem later, the doctor could quite rightly be disciplined for not following guidelines.
How many doctors need that risk or hassle?
I suspect my mum will now be taken off T3 after a year long battle to even get on the trial.
It also says in the guidelines that they should use their discression.
The first paragraph in the NICE (NHS) Thyroid Disease,
Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
I am so sorry for you poor mother, caught up in the idiotic, impossible situation. It would seem that people's quality of life counts for nothing.
What are Ft4, Ft3, vitamin D, folate, ferritin and B12 results
If endocrinologist says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
Did the addition of T3 make a discernible difference to your Mum's health/ QOL?
Until medics get their heads round the fact that TSH is an inaccurate guide to dosing this nonsense will continue and patients will continue to suffer.
Research supports change but medics are unwilling to adopt change.....to change would be to admit mistakes!
Introducing T3 lowers both TSH and FT4 but this is generally overlook/ misunderstood by medics.
TSH is a pituitary, not a thyroid, hormone it reflects the level of thyroid hormone in the serum but it does not measure the individual levels of FT4 and FT3 which are the true markers...especially the active hormone T3!
I will never understand how they can dose a thyroid condition by way of a pituitary hormone, it makes no sense.....it is lazy diagnosing.
Any medic worth his stethoscope should be open minded and willing to appropriately treat their patient not only by lab results only but by clinical evaluation. With supportive evidence they can exercise their discretion
There is evidence to discredit the TSH fixation!
They must be aware that we do not roll off a factory production line....we are all different and that needs to be understood
I understand this problem only too well....I need high dose T3 only which almost had my GP running for the hills. I had done my homework and understood how T3 works and why I need this dose. I self medicate because the other option offered by an endo (who maintained I did not need T3) is levo... and a bed bound future ( like my maternal grandmother!).
My GP now accepts my right to patient autonomy/ self medication I have accepted responsibility for any outcome so she leaves me to it because she recognises the improvement T3 has made. It is a ridiculous situation.
I'd suggest you need to build a robust case for continued T3 treatment, if it has helped.....providing of course that the dose is appropriate. Medication has to be initiated by an endo and their knowledge should be such that they offer appropriate treatment....unlike GPs their hands should not be so tightly bound behind their backs.
Without flexibility how do they treat complicated cases.
If your Mum needs that T3 then she needs to have it continued....it's a challenge you may have to undertake.
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