Thyroid UK
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GP's behaviour?

Just wanted to say that after reading this document no wonder my GP is painstakingly, and at my cost, avoiding any further function tests on Thyroid. He won't refer me to a specialist although I can pay or claim on insurance. They have come up with 3 other conditions that might be causing my symptoms. I understand it's a costly process and he needs to rule out other conditions, but whilst all this is going on I'm living in a miserable state! My medication can not be increased either as he believe it won't make any difference apart fro a placebo affect. I understand he's' playing safe' now.

Table 1.2 makes interesting reading too although it is just a list of questions. But it give an indication of barrier for us patients.

Also how can the BTA agree with the high ranges the document suggests when so many people are struggling with TSH above 2?! Not to mention not knowing what the other readings might be.

Still waiting for the last set of bloods - this one is for Oestrogen and Anemia & Kidney function.


4 Replies

Those guidelines were published in 2006 with the following statement within them:

The guidelines were completed in June 2006. Comments on their accuracy and

relevance are invited during the first year after publication and should be directed to It is intended that a full review will take place after

three years

Dr Beastall has retired and the email address is no longer valid.

Nothing has been done to update them.

I believe that these guidelines should be regarded as out-of-date and no longer valid. There is a known error within them and there is no mechanism for correcting that error. I know that because I have reported the error to the ACB, who passed it on to Dr Beastall, who asked ACB to get it corrected. Nothing has happened. I believe that proves that the guidelines are not being and will not be maintained.

If your doctor insists on trying to use them, I believe he is profoundly mistaken in doing so. Further, it could be regarded as negligent to use out-of-date documents.

The error I found is a simple typographic mistake:

Therefore, typical serum reference ranges in adults are:

TSH 0.4 – 4.5 mU/L

FT4 9.0 – 25 pmol/L TT4 60 – 160 nmol/L

FT3 3.5 – 7.8 nmol/L TT3 1.2 – 2.6 nmol/L

The units of the FT3 test should be in pmol/L not, as they are, in nmol/L.

And yes, Dr Beastall was astonished that the error had been in the document despite care and attention and despite towards seven years of clinical use not one other person had reported it.

Apparently the BTA and BTF have made no obvious efforts towards getting these guidelines updated. The Department of Health are unwilling to get NICE to produce guidelines. So doctors (and in this aspect, I pity them) are really on their own.



Thanks Rod for putting me in the picture. I was puzzled why the document was so dated and rechecked to see if I missed one more recent, so that explains that. I can only presume he/they are following these guidelines as it's what's coming across in my appointments. So maybe I should be more understanding with them but still not give up!

How sloppy for them NOT to update AND correct any errors yet have it readily available. Do you know why the D of H are unwilling to work with NICE on new guidelines? I might contact BTF/BTA about more updated guidelines to see what they say.




Dr Beastall wrote to me that BTA and BTF have made no moves whatsoever to getting these guidelines updated. Reading between the lines (I hope correctly), doing them in the first place was a major exercise and they do not have the impetus to do it again.

As I say, I believe that these guidelines should be treated as "expired". And only now of historical interest.

I do not know why DoH are so minded - I can only guess, on the basis of no information whatsoever, that they believe the cost implications to be significant. I suspect that would be true in the sense of how much money appears to be spent on thyroid, but if you add in all the related issues which people suffer from, treating thyroid much better might actually save money.


Yes helvella I would agree with your last comments in your last paragraph, I believe it would save money, marriages, family relationships, preventing taking unecessary medication or other conditions (that's what I'm afraid of too) loss of employment etc....



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