Can you recommend good articles for a GP friend of mine to read on subclinical hypothyroidism?

[Annib1]

This post has been triggered by a previous summary of an article by Diogenes on childhood subclinical hypothyroidism. I am helping a friend whose blood tests show subclinical hypothyroidism. Her son is a GP and is interested in reading more about SH as he says he had little input about it in medical school. He lives and works in Edinburgh and I am anxious to point him to good sources of information rather than some of the feeds that doctors might normally have easy access to. I would welcome suggestions..

[Regenallotment Ambassador]

here is one rcpe.ac.uk/sites/default/fi...

I need to dig back and find the amazing collection of papers diogenes shared a while back. 🌱

[Regenallotment Ambassador]

Here you go, this one is more recent and specifically Sub clinical healthunlocked.com/thyroidu....

[Annib1 in reply to Regenallotment]

Many thanks. I have sent the Toft one but the other was about subclinical hypERthyroidism.

[Regenallotment Ambassador in reply to Annib1]

Ah sorry! There is another somewhere I’ll try and find it 🌱

[HealthStarDust]

There are articles and then there is lived experience. I would suggest to him to join a forum with patients sharing their experiences, so he can learn from patients experiences. That would complement any article 😉

[Annib1 in reply to HealthStarDust]

It would indeed but would he be allowed to join a forum such as this one?

[HealthStarDust in reply to Annib1]

I am not sure what you mean by allowed. Allowed by whom?

[helvella Administrator in reply to HealthStarDust]

Doctors are not allowed to join as doctors - HealthUnlocked have to approve any such professionals.

However, there is nothing to stop them joining as anonymous individuals not claiming any medical training.

I am sure we have several doctors as members who simply keep quiet. That is, they might never post or reply. Or any posts/replies they do make are not based on them being doctors.

Very obviously, some doctors might be here for their own thyroid issues. And that is fine - they are welcome.

As admins, we have no way of checking any claimed professional qualifications. Most obviously so if they do not reveal their real identities, but also if they are abroad - not everywhere is accessible as GMC. And we certainly do not want anyone falsely claiming to be a doctor.

Also GMC rules rather imply (or even state) that if they take part in social media as doctors, they must reveal their identities and abide by some specific guidance as to behaviour. (Newly revised rules coming into force very early 2024.)

[HealthStarDust in reply to helvella]

That’s what I would have thought. I suspect there are many a GP on this site since, hopefully with the intention of being better GPs.

I’d join if I was a medical professional for my own learning. Lived experience is too important to ignore and often leads to changes in official type of guidance, albeit slowly.

[Annib1 in reply to helvella]

I just want to thank everyone who has gone to the trouble of pointing me to these sources. I have read now extensively and will be passing this invaluable information on and really hope it gets taken on board by my lovely GP friend in his future work.

[tattybogle in reply to Annib1]

You're welcome . i like the idea of getting a GP to read and think about some of the better stuff instead of the oversimplistic and often incorrect stuff they are usually fed .

Hopefully you have done a service to many future thyroid patients.

[DippyDame]

I suggest he reads from this forum...the collective knowledge and experience of members exceeds that of most medics!

This article provides information and links to research

thyroiduk.org/if-you-are-hy...

He would also find the following books instructive and they will extend his thyroid knowledge which is generally poor in medical circles due to inadequate teaching!

Diagnosis and Management of Hypothyroidism’ by Gordon R B Skinner MD DSc FRCPath FRCO

‘The Thyroid Patient’s Manual’ by Paul Robinson

Your Thyroid and How to Keep it Healthy’ by Dr Barry Durrant-Peatfield

And as someone with a form of Thyroid Hormone Resistance I add this e-book available on Amazon for £3.56 or free if you have Amazon Prime. It is called "Impaired Sensitivity to Thyroid Hormone (Thyroid Hormone Resistance)" by Hugh A Hamilton

[tattybogle]

Hi Annib1

I would suggest that he should read more generally , not limit his reading to articles that are about 'sub-clinical' hypo.

'Sub clinical' hypothyroidism is an arbitrary numerical cut off, meaning 'TSH is over range, but fT4 is still within range' .....however in reality 'subclinical' includes a very wide range of situations for individual patients.

A lot of research mentioning 'subclinical' hypo will be referring to patients who had no symptoms of hypothyroidism ,just a slightly high TSH,.... but due to the high level of individuality of the thyroid hormone system , some 'subclinical 'patients have significant symptoms , while some have clinical 'signs' of hypothyroidism (such as high cholesterol), but no obvious 'symptoms'.

Therefore some patients need to be treated to alleviate signs and symptoms when still 'subclinical' , and others don't . Research that doesn't clearly differentiate between these groups and includes 'anyone with TSH a bit over range' can give a very misleading impression od 'subclinical' hypothyroidism.

Once patients are taking thyroid hormone replacement (regardless of whether 'subclinical' or 'overt' when treatment started) the knowledge needed to treat them optimally , and the problems the patient may face with treatment , are effectively the same as if they were 'overtly' hypo (TSH over range and fT4 under range)

So , if he is interested in learning about treating hypothyroidism (of any classification ) he should read about hypothyroidism in general.

This list contains some stuff written specifically for GP's treating hypothyroidism:

healthunlocked.com/thyroidu.... -list-of-references-recommending-gps-keep-tsh-lower-in-range-

Tell him he will find a whole heap of accurately referenced scientific information on the canadian thyroid patients site ThyroidPatientsCanada:

Full site list of all topics they have covered here: thyroidpatients.ca/home/sit...

eg . a couple of pages that may be a good place to start :

Publications: John E. Midgley, thyroid scientist thyroidpatients.ca/2019/03/...

(JEM Midgley is a scientific advisor to Thyroid UK and inventor of some of the fT4 / fT3 test methods .... i need to remind myself which of Midgleys papers are best to suggest).

EDIT ~ THIS ONE frontiersin.org/articles/10... Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment . Rudolf Hoermann ,John E. M. Midgley ,Rolf Larisch , Johannes W. Dietrich.

An article from Tania S .Smith.

thyroidpatients.ca/2018/10/... review-ineffectiveness-of-l-t4-monotherapy-in-subclinical-hypothyroidism/

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A list of evidence which should help keep any fears of overmedication in perspective :

healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk

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EDIT

p.s i would also suggest he has a mosey around in Helvella's blog: helvella.blogspot.com/2023/01/

.. and in particular , check out his impressive 'Made Vecum' document: helvella.blogspot.com/p/hel...

Both contain a huge amount of very useful technical information presented in an easy to find form.

[DippyDame in reply to tattybogle]

Agree tatty...thyroid disease isn't something that can be understood after a few lectures in med school.