This may look at first glance as rather esoteric to TUK readers. But what it shows in children, that a particular algorithm invented by Dr J Dietrich to monitor T3 production can detect differences in subclinical hypothyroidism that was obscured by classical number scrunching. For children, read the probable same outcome in adults. This again helps classification and treatment possibility. It also for a change quotes our work in several papers. Perhaps we're becoming respectable.
Characterization of thyroid function in euthyroid and children with subclinical hypothyroidism using a multivariate homeostatic model
August 2023
DOI: 10.1101/2023.08.26.23294665
Aristeidis Giannakopoulos, Alexandra Efthymiadou, Dimitra Kritikou, Dionisios Chrysis
Written by
diogenes
Remembering
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My friend’s son is a GP and is interested in finding out more about subclinical hypothyroidism. I did not quite understand the import of this summary. Would this be a good link to send him? Can anyone recommend anything else I can refer him to on this subject? I want to be sure he does not read the wrong stuff!
The massive problem with treatment of subclinical hypothyroidism is ‘they’ just won’t treat it. They don’t monitor it even although they are supposed to! Your GP friend, if he even took that one thing on board he could literally save lives and I mean this in the widest sense. Mostly we don’t seem to die in myxoedema comas but our lives without treatment can be very bad indeed.
You could ask for him to read as much as he can written by Midgely et al, Barry Durrant Peatfield, the new book by Bianco... etc. Ask him to look into the SPINA model.
The main thing is for him to have a balanced view. Take patients seriously, look at the history -see how inconsistent thinking has been. NO one can ever agree! But also be aware of the limitations and failings of trials and studies.
The NICE document of 2019, not sure if it remains the same with the recent update, but it stated something like: Do not treat SH because 50% might right itself within 6 months.
So, to me this means, if 50% ‘might right itself’ it also means it might not. The other 50% will be Overt Hypothyroidism. Therefore, potentially 100% of SH could be Overt and none of it being treated. What further damage is being done whilst these people wait?
Personally it took me over 10 years to get diagnosed, despite being tested at c18yrs old, by a thyroid surgeon, over c 2yrs, where there was something then there wasn’t, reoccurring. Intermittent, erratic. Dismissed with a flick of the wrist. I reckon I grew up hypothyroid, SH or whatever, never knowingly tested back then. Never saw Drs. Always cold, tired, couldn’t keep up with siblings. ‘The quiet one’.
I am seriously thinking of saying - Mixed bag of symptoms? First thought should be hypothyroidism. Not hypochondria. Not depression. Not fibromyalgia. Not CFS/ME. I could go on. The problem being right where we started on this post, ‘sub clinical’ for many and the ‘guidelines’. Over time I have realised that the endos (who write the guidelines) appear to distrust/hate GPs nearly as much as they hate hypothyroid patients. Such is our luck.
Not menopause - thats a popular diagnosis of what is actually thyroid disorder along with the ones you list and many more. It’s a sorry state of affairs
I did forget about that one. Maybe because I am 71. It feels like quite a long time ago but interestingly I refused to make contact with a medic about that - trying not to bother them……..
I felt very poorly a lot (shingles on optic nerve was one example) so had to see them, I kept suggesting the possibility it was thyroid related but I was just gaslighted and menopause was trotted out as the explanation for all my ailments - but they were wrong and I was right. I gave up going to the doctors who’d brainwashed me into thinking I was a hypochondriac menopausal fusspot but I was infact overtly hypothyroid with short periods of severe hyperthyroidism, but no one bothered to run a test! Even when I had terrible paranoia thinking I was being followed all the time, the worst depression imaginable, my shins itched so much I’d scratch them until they bled, the hideous mood swings and terrible insomnia etc etc I no longer sought medical help thinking it was all in my head or a normal part of menopausal suffering. I don’t think I was rational any more but it does that to you takes away your personality and makes you two dimensional like a ghost. Menopause my backside!
TSH110, unfortunately a thyroid issue never occurred to me. Embarrassingly, as I have always had an interest in ‘health issues’ this was a complete oversight on my part but in my defence, orthodox explanations of hypothyroidism never seem to contain the aspects of hyperthyroidism (Hashi flares).
I was told when I was about 15 or so, when my Mother asked “could it be her glands?”, that “no that would be extremely rare”. After that I never looked to “glands”.
Sometimes it seems to me medics use ‘good bedside manner’ to smother a questioning patient. When watching my parents die I became very aware of this type of interaction with doctors. You really had to be very specific in your questioning. They were very taken aback when I asked pertinent questions. However they obliged me with proper answers - even when the answer was “I don’t know”.
I have had some awful doctors, although many were OK. However the doctor I like best talked to me like we were equals. Clever but he let me go for twenty years post heart attack and only once was an endocrinologist mentioned. “Oh you don’t want to go down that road!” Everything clearer with that marvellous thing called hindsight.
IMHO For many years now, we have not been receiving the courtesy of a proper doctor/patient consultation. It’s a massive problem in medicine. It’s so much easier for them to just keep putting off the ‘evil hour’ until someone else eventually gets to bite the bullet because the patient is finally showing signs of being on their way ‘out’. By the time I was diagnosed, I had stopped complaining and resigned myself to the inevitable. I have become troublesome again. I think maybe that shows I am feeling better.
Particulary, (and I never thought of this before),
"Sometimes it seems to me medics use ‘good bedside manner’ to smother a questioning patient."
-It is shocking that your dr used that to neglect you for 20 years!
I have a dr, that while he has not directly refused me, on different occasions has been slyly spiteful and on other occasions, deliberately obtuse. -Most recent example was when my bloods showed overmedicating he said, "I never really knew if the thyroid medication worked". ??This, from a dr who's been in practice for at least 30 years!
And I still have to correct his prescribed blood tests when he keeps "omitting" the "F" in front of T3. Then, when he emends, he will write "free" in front of T3...as if he's humouring me.
-Oh, and he was also treating me with just a tinge of obvious disrespect during numerous past appointments while my health was declining until, the thyroid tests started showing problems. -Now he masks it somewhat.
Luckily, I have all the helpful people on here. Otherwise, I would never have known how to be tested correctly and then be diagnosed (despite suffering most of my life), and then, never known how to/what is the correct dosing.
Thankyou, diogenes for posting emerging studies.
And yes, like you state: "Perhaps we're becoming respectable."
Definitely, in my eyes, and I'm sure from everyone benefitting from enlightened scientists such as yourself.
I think another problem with it is it creeps up so gradually you kind of adapt to it and it becomes the new normal.
I think I began being hyperthyroid I just thought I was a high energy person. I used to exercise to excessive levels to try and dissipate the boundless energy I always seemed to have. I was as thin as a rake and had very little appetite, ate like bird and suffered with terrible insomnia 5 hours sleep in a night was a lie in for me - looking back it was highly abnormal but it felt normal to me then I got bouts of exhaustion which must have been hypothyroidism, the hyper began to be overtaken by the hypo and I started to yo-yo between them towards the end it was very horrendous like I had gone stark raving mad. I’d be flying off the handle over something quite trivial then I’d feel full of remorse for my absurd outburst and start weeping uncontrollably, then I’d calm down and think that’s was a bit odd, but I was so focused on just getting through each moment and whatever horrors might be thrown at me I had little or no capability for reflection, I wasn’t even consciously aware of how poorly I was, but deep down something in me knew it was heading towards curtains and I went to the doctors determined I was not leaving the consulting room until I was given a blood test for a full thyroid panel. I was very literal and just told him what I needed he asked me why I thought that was the problem so I told him the depression was like a big black cloud that would not lift, unfortunately he suggested antidepressants …. I must have given him the most withering look ever, I just said look this is really serious it’s beyond the reach of any antidepressants. He teased more details out of me and realised all was not well and there was a family history of it. He did the test and was really fantastic after that, he saved my life. It came back hyperthyroid but the next one a couple of weeks later was very overtly hypothyroid and my hyper/ hypo swings were really mega then it was eternal hypothyroidism cos my thyroid had atrophied away to a non functioning tiny crisp of a thing, god it tried it best to the very end!!
I did have awful heart pains but have been lucky they stopped once I took NDT and I escaped any heart attacks during the severe swings. I used to think I was going to drop dead at work the pains could be so bad and a few relatives have actually croaked in this manner at work, but none had thyroid issues to my knowledge. But I’m still here 🤣🤣🤣 my heart must be tough. I’m sorry you were not so lucky with the ticker.
In my case I already knew quite a bit about thyroid problems because of family members having various forms of it and I knew I had similar symptoms. But I believed the medics when they said oh it’s just the menopause.
I have atrophic autoimmune thyroiditis which is like a Graves/Hashi hybrid they rarely differentiate it from hashis but my endocrinologist did. He said it was an unusual form. In the old days they knew all these nuances but they dint even get taught it now except perhaps at Guys and St Thomas’s where I was seen. Do you think yours might have been that too? I never had a goitre and only put on weight on Levothyroxine, many of my symptoms were mixed hyper/hypo ones.
I dont bother with the gp for thyroid matters, I told them I self medicate on NDT and feel hugely better for it they just leave it be and help me with any other health issues not that my thyroid disorder is an issue now, so there’s nothing for them to bother with in that department.
I agree that pertinent questioning of medics often brings considerable clarity in the response. I theorise that most people do not ask because it’s too painful to know the facts. I guess they are in a tricky situation where disclosure is concerned how much to reveal and how much to keep back and keep schtum unless grilled.
I’m glad you’re feisty with them again I agree it’s a very good sign that your health has improved 👍🏽☺️👍🏽
Thank you, TSH110 for detailing your lived experience. You can't get knowledge like yours from medical text books/official websites.
Re people not asking: seems to be two groups of people on that subject -those who want to know and are stressed if they don't, and those who don't want to know -because they are afraid of knowing the worst.
Come to think of it, there may be a third group: those who, rightfully, expect their dr to inform them.
Maybe a forth or a sub group of the second: the in complete denial group. My dear mama was in that camp she was just a fraud despite being gravely ill in hospital undergoing chemotherapy for thyroid cancer - by a miracle she survived. They say this attitude is a good one for fighting off cancer but also a good one for allowing it get totally out of control in the first place.
Mostly I’m in the third group but do have a slight leaning towards in denial!
If most organs and tissues deteriorate as we age why not the thyroid ? We know many people middle aged and older who are SH but will never get treated until something significant happens eg an MI? Was it Broda Barnes Who said often the first noticeable symptom of low thyroid function is a heart attack.
The book by Mark Starr on Type II hypothyroidism (Ie non autoimmune) is also an interesting read.
Interesting how doctors like Dr Peatfield, Starr and Barnes who suffered from hypothyroidism went on to write books on how unrecognised a “disease” it is and how blood tests like TSH & T4 (even T3 to some extent) are not a definitive way to diagnose it.
Glad to hear you are finally being referenced in others work. Hurray!! I really hope this is a sign that finally things are starting to change. I couldn't find the paper. Is it available for public view?
Hopefully an investment for the future of people suffering from hypothyroidism - if anyone who is supposed to know pays any attention. Thank you for putting up this post.
Therefore, many of them would be likely to continue untreated for possibly ten or more years of childhood and likely to affect development that should be taking place.
I wonder what specific issues they are likely to suffer due to non-treatment?
Specifically, if their thyroid axis has been off for so long, we clearly cannot assume their thyroid axis will be typical of the population.
I wonder how many here were Subclinical Hypothyroid as children? Most probably have no idea and can only surmise from their experience rather than laboratory measurements.
It's a good point Helvella. And it re raises the whole question of how the ranges are set etc etc.... The average in the population does not have a TSH anywhere near the level required to diagnose. This must and does leave a whole cohort of the population being told their thyroid is fine when they are actually Hypothyroid. There's so little evidenced science behind it, surely any good scientist could blow the myth up.
I wonder what specific issues they are likely to suffer due to non-treatment?
I know with hindsight that I had plantar fasciitis before I reached school age (Edit: And it continued throughout life). It disappeared 50 years later when I got my first thyroid hormones.
I have no idea how hypothyroidism affects male fertility.
I suspect for women it increases the risks of dysmenorrhea, menorrhagia, dyspareunia, low libido, ovarian cysts of various kinds, ovarian torsion, endometriosis, adenomyosis, retroverted womb, fibroids, PCOS, adhesions, repeated miscarriage, and infertility.
Plantar fasciitis was the first symptom that I actually saw a doctor about. I'd done enough reading around to know thyroid could be implicated so asked for a TSH test - just over 2. And steadily, slowly, rose thereafter.
My 21 year old son’s was 3 but GP said there’s no way she could justify treating him. So we have no choice but to muddle along. No obvious symptoms except low mood & fairly frequent viral infections (but could be lifestyle related - student !) I’ve asked for annual checks which she kindly agreed to.
PF was why I went to my GP - and (after my request), they did TSH. Then several other things and I kept asking for a TSH test. Eventually, when it went over the local reference interval, and a graph showed it steadily rising over time, a GP did prescribe.
I think I’ve always had hypothyroidism. As a child I was always cold, always hungry, slow brain although quite academic, disinclined to run around, weak finger nails, problems with teeth and gums, wet the bed until I was 11, and suffered really badly with motion sickness.
Not diagnosed until my 60s when I was told my TSH had been borderline for several years.
humanbean, I could not agree more. I know I have always had a problem from childhood. I was always classed as the ''sickly' child. I have plantar fasciitis , alongside poor temperature regulation, had a hysterectomy for endometriosis at 39 years of age. The list is endless. Now, at the age of 65 and still struggling with a three tier wedding cake weight gain ( in spite of heathy eating ) intolerance to exercise and all manner of thyroid related maladies , the endocrinologist has requested a repeat T4 test as it has been low on a couple of occasions. Hoping for a change from the usual diagnosis of anxiety, hypochondria or my advancing age!
I was always classed as the lazy child. After all, none of my problems were visible so I must be choosing not to do stuff!
And doctors decided my pain from endometriosis was me drug-seeking and there was nothing wrong with me, so I never got any pain relief that actually helped despite being in excruciating pain.
Always cold, constipated (although I didn't realise it), puffy eyes, weak fingernails, very active in bursts with long recovery times, pain with physical activity (didn't realise it wasn't normal and developed a high pain tolerance).
Also wonder if multiple food/pollen/dust/dyes/perfumes/medication intolerances, being sick until tonsils out at 7 years and nearly dying as a baby due to malabsorption are/were connected.
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Subclinical hypothyroidism 
Subclinical Hypothyroidism 
Subclinical Hypothyroid 
hypothyroidism - Subclinical 
