Been awesome to welcome the legend that is @Bianco_Lab
in Cardiff and get the pleasure of some time with him and his wisdom and catch up with colleagues and previous legends a happy 24 hours (bar NHS pressures)
Today’s visit was brilliant. The warm hospitality and discussions around hypothyroidism made the trip truly special. I am grateful for the opportunity to discuss some of their unpublished work. Edrych ymlaen at ddarganfyddiadau nesaf y grŵp anhygoel hwn o glinigwyr-wyddonwyr.
I asked Thyroid Trust if it'd be recorded and they didn't know. I very much hope so, as this is a meeting many would want to be at. I'm desperately disappointed as I don't think I'm able to go after recent surgery.
It's difficult for people to get there from further away - 10.30am is too early to get there from Norfolk and the Midlands or further afield.
Yes - I can't believe the Thyroid Trust wouldn't arrange recording as this is likely a pivotal meeting to keep for their website - though he is still focused on there being a TSH in the range.
The questions are always illuminating and hope to watch it live - otherwise being stuck down in Cornwall I'll stay focused on the surf - something else I have very little control over - from a distance !!!
I don't know if it will be recorded. There is a recording of his earlier talk to the Thyroid Trust youtube.com/watch?v=_6T2lSI... .
I don't think it is being broadcast live. If you want to see it and live a long way away I guess you would have to stay nearby overnight. I live on the other side of London and not looking forward to getting up early!
I quote from Bianco's recent book " Rethinking Hypothyroidism"....see Chapter 11.
"Therefore, the diagnosis of hypothyroidism is traditionally made through the combination of low T4 and elevated TSH levels. Circulating T3 levels have no part in it"
He adds,
"I can't understand why the primary goal of treatment of hypothyroidism isn't the normalisation of T3 levels"
And goes on to explain his stance and offers reasons for his conclusion.
I suspect that basically they do not have the courage or confidence to risk sticking their heads above the parapet to explore outwith their existing toolbox, in case they find the proverbial spanner which throws their neatly set out guidelines into disarray.i
He continues,
" Alternatively (to T4)we could prescribe T3. However guidelines are historically against T3 to normalize T3 levels"
And ends...
Very few people in the academic world talk about this"
About time they did!
The will to improve thyroid disease by including T3 just doesn't seem to be there.
He refers to guidelines....guidelines can change!
Treating with T3 is admittedly more complicated than doing so with T4.....but for a cohort of patients ( 10 - 20% of T4 treated patients) it is the answer! In extremis, a life saver!
He refers to there being, "a relatively small number of patients" involved.....are they less deserving than the masses?
If I'm following him correctly, he does indicate that he agrees T3 may be needed! But maintains it should not be used because, "we have not been trained to consider T3 in hypothyroidism".
Sorry, that is not an argument!
Research....find the answers! Ah! But do the decision makers conclude it's worth spending millions on research that may help " a relatively small number of patients."
His focus remains on TSH but states, "It is assumed that if you normalise TSH you will eventually normalise T3, as well. But we know this is not true."
Thank you for that Professor Bianco!
I would suggest that for some patients it's not the serum T3 level of patients that needs to be optimised.....it's the cellular level. And that is a different challenge! There are no tests to measure cellular T3....only the patient's description of what treatments they have had and how they feel as a consequence. And, at best, a medic's knowledge of T3 and how it works
To tackle that, medics must hear and understand what patients are telling them since testing won't provide the answers. They need to learn new skills and to have the confidence to treat their symptoms rather than adhering to guidelines and numbers that do not apply to them.
Is that too much to ask?
But, in an increasingly litigious society they may fear that treating by knowledge and professional judgement is not enough.....they need something written in black and white that supports their actions. Guidelines!
We are human and we are all different, we all need different treatment and unlike machines we cannot be calbrated to specific set points on a scale ....as far as I can see that is what adherence to TSH does. And, it's not working!
I don't doubt for a minute that Bianco's heart is in the right place but I fear for the consequences of his conclusion that, "Circulating T3 levels have no part in it" despite the fact that he conversely states they should not be dismissed!
Will anyone pick up the baton and run with it towards the goal of changing thyroid treatment for suffering patients with a desperate need T3?
The aim of thyroid hormone therapy should be one thing alone: Making the individual patient as well as can be achieved.
FT4, FT3, TSH and all the rest are only tools which, in the best hands, can help to achieve the highest wellness. For example, by helping to ensure that a good level, having been reached, can be and is maintained. But not when used to create a series of artificial and poorly justified target values.
I agree Forestgarden. Considering levothyroxine accounts for the largest number of prescriptions in the UK (bar the useless statins) I think it’s fair to say 10-20% is not a relatively small number of patients. Contrarily I wonder about the so-called 80% who are presumed to be doing well. Many patients tend to put up and shut up. Many are on multiple medications. How would they know what’s working/not working? We can see how many patients on here are palmed off by medics. How many are vulnerable elderly who cannot/would not challenge their medics, even if they were pretty sure their treatment was not optimal. This figure comes directly from untrustworthy individuals. Is there any decent quality research on this so-called 80%?
However I would also like to say, for the number of people on this forum, there are disappointingly few signatures on Dr. Peter Taylor’s petition for funding research. What is the reason for that? Well hopefully it’s because people get the correct advice here GET WELL and move on getting on with their lives. Who can blame them?
I don't think I am in the group who need T3 monotherapy. But I do wonder, as I suspect many do, whether even tiny additions of T3 would make a difference?
The difficulties of adding small amounts of T3, starting with getting hold of a suitable dosage/form, then getting appropriately tested, and managing the dose, are too great for those doing reasonably OK on T4 monotherapy to choose.
Well I have had to wonder too whether I need/should take T3 but I fight for right for the people who do.
There is just so much ‘missing’ information because the NHS (and others) are doing nothing to unravel it. Roll on diogenes book.
I was interested in that debate with Dr. Peter Taylor and Professor Kristian Boelart (Thyroid Trust) where Taylor came up with the research that backed T4. It was thin. He was convincing in his take on it. There’s plenty of room for research in this area.
I know Bianco still toes the TSH line but I think he and Taylor are doing interesting research. One day they may actually move on from TSH. However it’s a massive move from the ‘party line’. I think they are fairly good bets. Neither are sitting on laurels, unlike many others.
One. and one only barrier (admission) is needed to be overcome! To accept, and understand, the absolutely key importance of thyroidal T3 production direct by the gland, and the changed needs for adequate dosing by T4 (or combination as needed) when the gland fails. Genetics is part, but only part of the answer,
Been awesome to welcome the legend that is @Bianco_Lab
in Cardiff and get the pleasure of some time with him and his wisdom and catch up with colleagues and previous legends a happy 24 hours (bar NHS pressures)
I'm just wondering who the "previous legends" were and how they might feel about being described that way. It's like the biggest demotion on the planet. I can just imagine the eulogy at a funeral :
He was a legend then he became a previous legend and died of a broken heart at being so downgraded, and all his achievements being binned.
Is it me? I find Bianco utterly confusing. He seems to say consideration of T3 is important and then seems to dismiss his own thinking. Until he can clarify his thoughts on T3 and lose his adherence to TSH, I shall quietly wait for the wisdom of ANother.
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Dr Eric interviews Proff Bianco
