This downloable paper shows that Irish doctors are quite ready to prescribe T4/T3 combination therapy and are not dissuaded from doing so:
Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society
December 2022
Irish Journal of Medical Science DOI: 10.1007/s11845-022-03235-z
Elsheikh Ali, Anne McGowan, Carla Moran et al
Background. Replacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs..
Methods The aim of the study was to examine the attitudes of Irish endocrinologists regarding the treatment of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society (IES) were invited to participate in an online survey.
Results Forty-eight invitations were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy (LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody positive women seeking pregnancy, 18% for goitre and 5% for unexplained fatigue. Many (38%) consider combination therapy in patients with persistent symptoms. Respondents reported seeing LT4 treated patients with persistent symptomatology more frequently and perceive psychosocial factors and comorbidities to be the most common reasons for such symptoms.
Conclusion. LT4 tablets are the treatment of choice for hypothyroidism in Ireland. Approximately a third of Irish endocrinologists either regularly use, or would consider, liothyronine for hypothyroid patients. A significant proportion would give TH to euthyroid individuals in specific circumstances. The prescription of TH amongst Irish endocrinologists was generally in keeping with recommended practice, and areas where practice deviated from guidance were typically where evidence was conflicting or insufficient.
Written by
diogenes
Remembering
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So though not explicit, some seem to be cottoning on to the fact there is blur in the extremities of ranges and there is uncertainty. Also does 'specific circumstances' mean symptoms play more of a part in diagnosis? With TSH having been the gold standard for so many years, missing and delaying diagnosis has to be a major problem. Looking back over my health records for more than 10 years every symptom I presented with to the doctor was resolved once adequate levothyroxine replacement therapy was attained..
However the T3 route may yet be my choice as I know I have no longer got the 'over drive' I relied upon in our business to the extent we are dialing it down and selling up. Could the T3 that is produced directly by the thyroid and not converted in the tissues be my missing overdrive I wonder? I do quite well pacing myself but I would like to 'pull it out of the hat' sometimes. 🙂
From other Irish contributors to the forum I have always had the impression that thyroid treatment there is just as bad as here - perhaps even worse. However this makes it look a bit more hopeful. Interesting - I am watching you specifically Charlie-Farley . I was pretty sure my ‘over drive’ contributed to my ‘state’. However, like you, I miss it terribly. I am far from OK, I know you have had great wins with your meds. I feel I am still scraping along. Reading now about how T3 levels/output is protected whilst the thyroid winds down is also enlightening. I wonder if my natural T3 at many points was actually running too high. My over drive was in over drive? It makes me now, not able to quite judge ‘normal’. Pretty sure it was not Hyperthyroidism but the symptoms?? OR was it simply the natural progression of hypothyroidism. Not everybody mentions it. It was key to how I got here. Periods where I could do anything. Cardiologist said my symptoms were like I was on cocaine - possibly the truest words she said (however that was twenty plus years ago). I would like to understand this a lot more. I feel it could have a bearing on my over reaction to the introduction of T3. I am somehow extra sensitive to something my body is yelling for. You will have been watching for similar posts yourself I think, maybe. I am pretty much fed up looking back but if there is something ‘key’ there that would help my future ……. OR maybe again this is ‘normal hypothyroidism’ and I have totally missed this in individual people’s explanations. We all join here at different points in our journey and maybe I am just describing something common to us all. Apologies to everyone right here but I have been wanting to bring this up before. Charlie-Farley just created an opportunity!
My early 20s were a period of limitless energy and I seemed to be able to do the work of two people. And yes I was skinny and it was nothing for me to do an early shift and then get home, change, do a 10 mile cycle ride, get back, shower and then go and meet my friend for coffee at 4:30 in the afternoon, followed by an evening out on the tiles.
On the late shift. I would get myself up early, go horseriding and rock up to work half an hour early to change out of my riding gear and then in the evening after work, I would jump in the shower and go out to a club getting back about 2 am before getting up at 4:30 to get ready to drive to work which was some distance away. I would grab the odd power nap, but suffice to say I lived on little sleep for about five years and felt no ill effects. Late 20’s a were bit more measured. The peaks and troughs came in my early 30’s and I can distinctly remember two fairly dramatic drops when I thought I was suffering depression (though never saw a doctor for this), it was more a profound lack of motivation and tiredness.
My 40”s were business and caring role and the gradual slide into ‘random-symptom’ ill health. It took a fellow sufferer to diagnose me at 52
There is much to learn from looking back. My father had diagnosed Hashimoto’s, but my mother was never diagnosed, so I suspect she did have an underactive, thyroid and complained of the family, ‘small swallow’. This was something we used to joke about with regard to my Nan, who also had this strange affliction.
It would be interesting to look at the health records of both of them to try and identify some markers, but I doubt anything would appear because they were no more aware than I was at the times and I doubt they would’ve even broached the issue with the doctor.
However, my mum’s side of the family does have cases of Hashimoto’s.
Thank you diogenes We shouldn't have to live in Ireland to receive more appropriate care. I wonder why the difference? What do Irish Doctors know that those in England are unaware of? Or have they not faced similar pressure to refuse/reduce T3 prescribing?
There must be a difference in training almost as if the knowledge of the oldest treatment using NDT was not completely consigned to the dustbin like it has been in the U.K.
I'm totally convinced that many people would be living longer, healthier, happier and more productive lives if only medics understood the importance of T3....and that it needs to enter the nuclei of the cells to become active.
I do not understand why this most vital of hormones is so badly understood....or why medics do not open their minds and learn.
The endo I saw refused to accept that I needed T3 or that I had a form of RTH. He was wrong on both counts despite seeing that I presented with all the clues....he couldn't join up the dots!
After I started to self medicate with a supraphysiological dose of T3 my GP became terrified that I was killing myself....conversely, her lack of knowledge could have killed me. Six years later she accepts that I understand what I'm about and now leaves me to self medicate without her input....and with a statement to hand, offered by me, that I take full responsibility for any outcome!
We must be treated on an individual basis ....not as a subject to be uncomfortably squashed, by medics, into a pre-formed tick box that causes misery.
Among the core principles of advanced practice in the NHS are clinical practice, leadership, management, education, and research.
It doesn't seem a big ask to have those applied to the use of T3!
The UK needs to take a leaf out of Ireland's ( thyroid disease) text book....but the will to learn and change needs to be there!
Well said. I tried and failed to educate my consultant. He told me (retrospectively) that I was 'Borderline' Hypothyroid. But I had a low/normal TSH at 2.9 and a BELOW range T4. How can someone like that treat someone like me? I also have faulty DIO1 and DIO2, but he insisted on focusing on TSH instead of seeing my falling T3 levels and returning symptoms. There must be exceptions, but we seem to lack good thyroid care in England and no one seems to care, except us patients.
they are ignorant and unwilling to learn from their patients or bother to keep up to date with latest research on the very common area of thyroid disorder. Brainwashed by the worship of TSH the man made false idol of endocrinology, I long for the day it’s finally toppled once and for all.
Maybe it’s just an English thing… Even though the endocrinologist who first prescribed me Liothyronine in combination with levothyroxine was based in England, I live in Wales and my GPs practice has never questioned or suggested the withdrawal of T3, even when the price was sky high. However, after my old endo retired, the new one was determined to remove it because of cost but, when I told him I lived in Wales, he backed down completely. I now only have an annual phone appointment with him so he can sign me off for another years’ prescriptions, which suits me fine!
I live in France and get Levo and T3 from my GP It is all free including any other treatment as I have a life long health issue which is no Thyroid. When I did pay it was only a few Euros per 30 tablets. No NDT here, so not so good it's illegal.
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