At least this admits a lack of scientific knowledge on the subject. And it acknowledges the individuality of patients which would discourage a one-fits-all approach. Much work still has to be done.
"Lastly, substitution therapy may be complicated by interindividual variations of deiodination. The question, if monotherapy with T4 or a combination of T4 and T3 should be preferred, is for years subject of debate. Numerous trials [413–422] did not lead to a standard recommendation. Persons with abnormal sum activity of deiodinases, however, might benefit from additional treatment with liothyronine[414, 423], although this does not hold true for all polymorphisms of deiodinases [424]. Calculating GD or T3/T4 ratio might help to stratify patients for an individualised therapy, but the required trials are still to be designed."
This is good science by virtue of the fact it discusses uncertainty. When that is understood fully and unanimously - then, hopefully, then we will get treatment tailored to the individual and not a one size fits all (probably in reality fitting no one) approach.
When running our business we had so many people suffering from hypothyroidism through and they did not realise that they were being mismanaged, but they were dragging themselves about suffering with lots of symptoms, many on statins, with lots of symptoms 😱.
Obviously many doctors are still not cognisant of the issues around giving people with hypothyroidism statins and also not aware of the previously understood fact that when hypothyroidism is treated cholesterol levels drop and high cholesterol used to be an indicator of a potentially struggling thyroid. Actually it is briefly mentioned in the guidelines but when do they have the time to read all this?? NHS needs restructuring. There is too broad a remit and not enough support.
Also when we consider the efficacy of thyroid hormone replacement protocols, I think we have to acknowledge that most of the people receiving treatment are probably not aware that they could feel a lot better if they were optimised. Those of us, we lucky few who actually realise things are not right are the tip of the iceberg.
This is good science by virtue of the fact it discusses uncertainty.
That's what I liked about the publication as well. I would also prefer a doctor who admits to not knowing over one that throws the "evidence based medicine" card in my face (most likely without knowing what the evidence IS). In fact, I once had a doctor whom I referred to an information leaflet by the Crochane Institute (which he refused to look at) who then, while lecturing me on laypeople interpreting research, said that even he, as a medical professional, can not interpret research. Thank you, sir! That explains a lot. This attitude discourages even looking at research. But, then again, doctors don't have the time anyway.
...I think we have to acknowledge that most of the people receiving treatment are probably not aware that they could feel a lot better if they were optimised.
When you are so super hypo that you can barely stand up, slur your words and would rather die, even the smallest help feels like you hit the jackpot. And depending on how long that has been going on there is also no memory of how good you felt before. So it is very hard to know when you feel optimally well. But that's exactly where the medical system should make the extra effort and push the envelope a bit more. My impression is that they are absolutely horrified of thyrotoxicosis and not at all concerned about myxedema.
buddy99 . Totally on point especially your observation about fear of thyrotoxicosis and lack of concern for myxedema. Could that lack of concern stem from ignorance 🤔
So true that many people don’t realise they need optimal vitamins, and neither do drs, shockingly. Over the years I’ve been fobbed off and not once, until I requested it following advice on here, was I ever tested for vitamins.
And yes, creep under by 0.1 with TSH and your Levo is reduced, yet drs happily sign off as normal TSH of 13!
Johannes Dietrich is one of my heroes. He brought sophistication and rationality to a medical specialty which has all too often let down hypothyroidism sufferers, at least in my country (the U.S.) He has made great use of his mathematical knowledge, so rare in medicine today, to shed light on thyroid disease, perhaps the most neglected medical problem of all. This is a big challenge today because the elimination of screening for thyroid disease is threatening to cause doctors to lose touch with its clinical manifestations, and therefore its seriousness. I hope his work will reach as many people as possible.
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