NICE and NHS Guidelines - Links to useful bits!

[Charlie-Farley]

NICE and NHS Guidelines

This is undoubtedly at some point going to be revised by NICE and the NHS, so if this post becomes out of date AND I haven't realised, please give me a BIG PROD and I will UPDATE - keep me on my toes 😁😘

Here are some very important links - They have latitude to treat symptoms.

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cks.nice.org.uk/topics/hypo...

Hypothyroidism:

How should I assess a person with suspected hypothyroidism?

Last revised in May 2021

Check the serum thyroid-stimulating hormone (TSH) level, using clinical judgement to interpret thryoid function test (TFT) results, especially if TFTs do not match the clinical presentation.

So the above is just a small excerpt, BUT! if you read the entire section there enough different possible issues listed that TSH might not agree but it is not OVERTLY stated. Clinical Judgement.....

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bnf.nice.org.uk/treatment-s...

Aims of treatment

The aims of treatment are to alleviate symptoms, align thyroid function tests within or close to the reference range, and to reduce the risk of long-term complications.

Management of primary hypothyroidism

Explain to patients, and their family or carers if appropriate, that: Some patients may feel well even when their thyroid function tests are outside the reference range; Even when they have no symptoms, treatment may be advised to reduce the risk of long-term complications; Symptoms may lag behind treatment changes for several weeks to months.

So they are acknowledging in this section that symptoms do not always agree with blood tests - thank you very much!

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This next link relates to prescribing and I used it to good effect when arguing to have my levothyroxine upped.

According to the doctor I spoke to, I was 'NORMAL' when on 75ug of levothyroxine (because I was in range). I was also 'NORMAL' at 100ug, 125ug and 150ug, though granted TSH was below range. However my Free T4 and T3 were unequivocally within range all the way so I used the "room in the range for a dose increase" rationale to get to my 150ug dose.

The guideline dosing by weight of 1.6ug per Kg allowed me to get to therapeutic dose. But a GUIDE is a guide - it is different for everyone.

cks.nice.org.uk/topics/hypo...

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And something they never talk about, because I don’t think half of them know about it is the concerns around hypothyroidism and statins which are in the guidelines. Statins can cause tissue damage in people with hypothyroidism. The sad part about it is, statins are generally already being prescribed to the patient before a hypothyroidism diagnosis, somewhat like the antidepressants. As an aside anyone coming to this post as a newbie depression is one of the most common symptoms of hypothyroidism and also people who have under medicated hypothyroidism.

nhs.uk/conditions/statins/c...

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There is plenty enough conflicting advice in all of the guidelines to realise that they haven’t really got a handle on what should be done and they cover themselves by saying go with symptoms (if all else fails), but sadly doctors do not feel confident enough to do so. The lack of confidence should not impinge on your treatment, and you can push and go by your symptoms to get to a therapeutic dose of levothyroxine.

There is nothing more satisfying than slowly reading the guidelines and seeing the opportunities. There is also a good deal of up to date research being posted regularly which may not fall on such deaf doctor ears if you first soften them up with the contradictions/latitude in their own Guidelines, written in, I believe, for a reason.😉👍