I am keen to find the Clinical Guidelines and Care pathways that Endocrinologist should use for the hypo/hyper patient... Thanks

[sorrel89]

[helvella Administrator]

That is an issue. NICE has never produced any. Some years ago worked went into producing Clinical Knowledge Summaries such as I link below (and there are other such summaries so do search for more). These are now, technically, under NICE, but they have been abandoned and are not maintained.

cks.nhs.uk/hypothyroidism

cks.nhs.uk/hyperthyroidism/...

Other guidelines have been produced by British Thyroid Association and have no actual force. You can find their views here:

british-thyroid-association...

Individual PCTs, departments, etc. may well have their own documents and searching within the NHS web site might help there. (In Google, you can add site:.nhs.uk to a search.)

Rod

[sorrel89 in reply to helvella]

Great...lots of pointers here...my printer will be working overtime.

Thanks

[poing]

I believe that CKS has been replaced by Prodigy, and is maintained under the new URL:

prodigy.clarity.co.uk/home

The guidelines for thyroid conditions are here:

prodigy.clarity.co.uk/hypot...

prodigy.clarity.co.uk/hyper...

I think the prescribing guidelines for levothyroxine aren't too bad: They are kind of hidden away - it always takes me a while to find them.

They mention that it's a good idea to keep TSH in the lower half of the reference range for pregnant women and people who still don't feel well with TSH in the upper half of the reference range. (Actually the guidelines contradict themselves on this one later on... sigh, but it's better than nothing). And they mention the need to look for coeliac disease in people who need high doses.

prodigy.clarity.co.uk/hypot...

[sorrel89 in reply to poing]

Ok ...thanks fot that will get on it!

Thanks again

[Hidden]

I came across these on NHS Choices (England only) which mention secondary hypothyroidism, tertiary and hormone resistant. Sadly I don't think many doctors have seen it or follow it. healthguides.mapofmedicine....

I find it bizarre that there are none on anything other than primary hypothyroidism on Nice/Royal College of Physicians

[sorrel89 in reply to Hidden]

Thanks for the info..much appreciated...my head is so full of cotton wool lets hope that I can retain the info.

[helvella Administrator in reply to sorrel89]

The Map of Medicine has a lot of promise - at least if used with some braincells. But as it stands, it is sorely lacking. For example, it suggests differentiating between autoimmune, medication induced and thyroiditis as forms of hypothyroidism. I don't get past that as I fit none of them - but there is no "unidentified cause" path through.

Still seems more complete than most GPs' understanding.

[Angel_of_the_North in reply to helvella]

They also have a tertiary hypothyroidism, which I've never heard of before for people with low TSH and hypo symptoms. But it doesn't say what they'd expect T4 and T3 to be. The instruction is just "refer to endo"

[helvella Administrator in reply to Angel_of_the_North]

Why do I want to put that to music?

Refer to endo, address unknown.

No such number, no such zone.

[nostoneunturned in reply to Hidden]

Yes, really bizarre, but never mind, laladrew! Why should we complain about anything when matters are so well run? Read this and compare it with reality.....

british-thyroid-association...

[Hidden in reply to nostoneunturned]

I can't' read it nostoneunturned, my blood pressure shoots up

It's a bad day when the RCP refer us to a charity for guidelines...

[nostoneunturned in reply to Hidden]

Mine too. How do they reconcile "UK endocrinologists....record in thyroid research, both clinical research investigating patient symptoms and signs..."

with

"specific blood tests as the only method for the precise diagnosis of thyroid dysfunction" ?

Disgraceful doublespeak.

[Barbaraj]

If you pm me I can send the European Thyroid Guidelines in pdf format along with one of studies that demonstrates the combination T4/T3 replacement therapy is effective in many instances where T4 alone has not brought about resolution of symptoms. I would be really happy for you to pass this information on to wherever you think it may be useful. The link to them is below. I can also send a study that was done on the subject by the same eminent endos that drew up the guidelines. Barbaraj

content.karger.com/Produkte...

[LouiseRoberts in reply to Barbaraj]

Hi Barbara

That link is incomplete.

Louise

x

[Barbaraj]

I will pm you with my email address - if you send a blank one I'll send the info to you. This site doesn';t have an attachment facility so can only end it by email. x