Why the Hesitancy in Recommending Combination T3/T4 Therapy?

[Zephyrbear]

Found this recent interview with Antonio Bianco MD PhD from 25 May 2023

medscape.com/viewarticle/98...

Disappointed that he still regards a "normal" TSH as the overriding consideration before all others...

[Serendipitously]

At least he seems to be listening to his patients though, which is more than I can say of the UK doctors I've experienced...!

"My bias is I respect what the patient wants. I heard my neighbor is on desiccated thyroid extract. That's fine. I'm not going to say no, no, don't do that, you have to go synthetic. I did this many years of my life. Every patient that came into my office on combination therapy, I said, forget about it. I'm going to put you on levothyroxine. We evolved from there. We need to hear what the patients are telling us. If they feel better on desiccated thyroid extract, it's fine as long as the TSH is normal."

[Zephyrbear in reply to Serendipitously]

Not very promising for us patients who tend to be on more T3 with no, or just a smidgen of T4 and whose TSH has been “suppressed” for many years though, is it? There’s no way our TSH is ever going to be raised again, even if we were to come off T3 altogether…

[Serendipitously in reply to Zephyrbear]

Ah! You should actually write to him and explain that.

Patients do know their bodies best, and due to medical neglect (case in point) have often been forced to become specialists in understanding their conditions.

I've just joined the forum, so I'm learning from you all too.

[Lovecake in reply to Zephyrbear]

I’m on 100mcg T4 and 12.5mcg T3 and my TSH rarely goes above 0.02

Unfortunately, some of us get a very low TSH even on a low dose of T3. I have to agree to have it on record that I know of the potential issues that a very low TSH can cause or I wouldn’t get my T3 from my private endo and my life would be just dreadful with no energy to do anything. It’s not great now, but at least I do get days where I can function well.

I probably should see Dr Bianco or he would make me reduce my T3 🙁

[Zephyrbear]

Welcome to the forum. You’ll find most of the answers you need here, you only have to ask the question. I’ve been here for 13 years now and in that time I have been able to educate myself well enough to be able to hold my own in a discussion with my endo. I’d suggest you join ThyroidUK as a member too. Not expensive and very helpful too!

[Serendipitously]

I'll definitely join thyroid uk - thanks for the tip!

I moved to the UK 3 years ago. I was on T4 and T3 combination therapy for years in the country I lived in before.

My T3 was always a problem... The first doctor who picked up my low T3 years ago said she had no idea how I was actually functioning, it was that low. She'd only tested my T3 because she was our family doc, and my mother has low T3 issues too. The combo dose worked well for me.

I last had T3 over 3 years ago, and I'm an absolute mess of fatigue and brain fog now. I've battled the ignorance in the NHS to try and get my T3 tested. They refuse. This T3 debacle in the NHS is an absolute scandal. I am fuming - it has seriously impacted many people's quality of life.

Anyway, I'm going to do a test this week. If anyone who reads this could PM a testing company they recommend, please do. I'm picking up on the forum that not all tests are created equal. Many thanks!

And a huge thank you to all of you who take the time to support this community.

[FancyPants54 in reply to Serendipitously]

you can find all the recommended tests listed on ThyroidUK web site. I’m just using Monitor My Health at the moment because I only need TSH, FT3 and FT4 and it is relatively cheap.

[Zephyrbear in reply to Serendipitously]

I tend to use Medichecks. They usually have special deals for thyroid tests on Thursdays, which helps. You’ll find a full list of private testing companies on the ThyroidUK website.

[Batty1]

I started my thyroid-less life on T4 only and my TSH plummeted and so did everything else add T3 into the mix and TSH still low but at least my other numbers have moved up. I personally believe doctors like seeing thyroid patients suffer, sadist.

[Serendipitously]

Awesome! Thanks for the recommendations.