Pub med article challenging traditional TSH-based approach

[woofa27]

Hope the web address works - interesting!

In a study evaluating tissue function tests before total thyroidectomy and at 1 year postoperatively when using LT4, it was found that peripheral tissue function tests indicated mild hyperthyroidism at TSH <0.03 mU/L and mild hypothyroidism at TSH 0.3 to 5.0 mU/L; the tissues were closest to euthyroidism at TSH 0.03 to 0.3 mU/L [48]. A normal serum TSH level consequently does not necessarily indicate a euthyroid state at the tissue level [49]. In accordance, a systematic review found that clinical parameters are associated with FT4 or FT3 significantly more often than with TSH levels (50% and 23% respectively, P<0.0001) [50]. The scientific basis of the “low tissue T3 hypothesis” is thus sound, and individualized therapy for hypothyroidism could be indicated, as LT4 monotherapy may provide dissatisfaction in a subset of patients [7].

ncbi.nlm.nih.gov/pmc/articl...

😃

[Hedgeree]

Hi woofa27,

Yes the link works; it does look interesting.

Hopefully some of the brains on the forum would have a read and explain further.

[waveylines]

I'm not sure.... I'm no scientist and definately not one of the clever brains. I've read further down and it says things like T4, does not improve the QofL for the elderly therefore no point treating; that in obesity a percentage have Subclinical hypothyroidism with a higherTSH but this is weight related not thyroid failure because if they were taken off treatment their TSH levels normalised.It seems to be discussing a raft of pieces of research.... I think you need to look up each piece of research to see how it was done as I fear this piece is making some rather grand assumptions.

It talks about managing patients expectations as with subclinical hypothyroidism patients think that adding T4 in will resolve their problems and the research demonstrates it won't.

I found it quite scary....

I've not got time to read more and more more thoroughly.. Will read more thoroughly later.

[woofa27 in reply to waveylines]

You're quite right Waveylines, the document does contain some disconcerting statements.

I should've been a bit more aware when I was posting the article.

Oh dear, I didn't mean to disconcert people.

I must admit it was the section I'd highlighted and the linked references re:TSH needing to be much lower than usually cited, to achieve full tissue euthyroidism, that I thought would be of particular interest to people.

I was simply attaching the entire piece to enable people to follow the links to the relevant original research references in relation to TSH needing to be lower to achieve full tissue euthyroidism.

Apologies Waveylines 🙁

[waveylines in reply to woofa27]

Hey no need to apologise at all woofa27!! Always good to see research coming out. It just the general leaning these days seems to be more and more heavily against thyroid treatment. If levothyroxine doesn't work then it's not their thyroid or patients need to learn to live with the reality of their condition.... Such a cop out!! Honestly it all seems bonkers to me.....

[Hedgeree in reply to waveylines]

I think it is a review of other research. Sadly I don't currently have the concentration to read further. But thanks waveylines you've definitely outlined some interesting points.