Hypothyroidism Urgent Public Enquiry Called For
If the RCP and BTA began listening to patients with hypothyroid symptoms, millions of pounds could be saved. This could ONLY be achieved by the Government calling for a Public Enquiry to investigate why sufferers are being refused a proper diagnosis and/or a choice of thyroid hormone replacement.
The problem is a political and/or legal problem. It is not merely a medical problem. There are patients who are counterexamples that negate the dictates promulgated by the RCP, BTA et al. Adherence to these dictates by doctors results in patient abuse. Sufferers are being denied a proper diagnosis because of the excessive normal reference range of serum thyroid stimulating hormone (TSH). They are suffering because of the seriously flawed ‘Guidance on the Diagnosis and Management of Primary Hypothyroidism’ that tells doctors they should not give a diagnosis of hypothyroidism if a patients’ serum TSH is within the reference range of 0.5 to 10.0uM/L.
This reference range is so wide as to be unmatched by every other country. Many countries have realised their previous TSH range was overlooking patients and agreed it should be narrowed. The AACE recommended TSH range be lowed from 0.5 to 5.0 mU/L to 0.3 to 3.0mU/L. In Germany, Belgium and now Sweden, it has been lowered to 0.3 to 2.5mU/L., with a recommendation by Belgium that the upper limit be dropped still further to 1.5mU/L. Since America dropped the upper level of their range from 5.0mU/L to 3.0 in 2003, in 2005 over 13 million additional sufferers had been given a diagnosis of hypothyroidism.
For those given a diagnosis, the RCP guidance (effectively mandatory) recommend treatment with levothyroxine (T4) ONLY and that triiodothyronine (T3), (the ACTIVE thyroid hormone), synthetic or natural, should not be used. T4 is a pro-hormone that must convert to T3.T4 appears to work for many, but for a large minority, they are unable to convert T4 to T3. It is Every cell in the body and brain needs T3 to make them function NOT T4.
The BTA, RCP are boycotting all T3 products. T3 is vital for life. Medical science showed this over 40 years ago, yet they refuse to acknowledge this fact.
There are many patient counterexamples to the T4-only therapy. Patient counterexamples are those who fare poorly under the medical prescriptions (T4 only) and fare well under the medical proscriptions (T3). These counterexamples demonstrate that there is no medical problem only a political or legal problem. Consequently, the endocrinologists are WRONG. Without T3, we die. The proscription of T4 -only is illogical and unethical. It has counterexamples amongst testifying patients and in peer-reviewed medical science journals.
I MUST stress the pernicious involvement of the RCP, BTA et al. as to the serious harm they cause through many misleading statements, e.g. “the British Thyroid Association recommend the use of sensitive and specific blood tests as the only method for the precise diagnosis of thyroid dysfunction and for the monitoring of treatment with approved medications” and “Overwhelming evidence supports the use of Thyroxine (T4) alone in the treatment of hypothyroidism. We do not recommend the prescribing of additional Tri-iodothyronine (T3) in any presently available formulation, including Armour thyroid, as it is inconsistent with normal physiology, has not been scientifically proven to be of any benefit to patients, and may be harmful”. To date, the BTA have NOT produced any overwhelming evidence their statements are merely opinion. Their opinion is harming patients.
The above statements are scientifically incorrect, yet they refuse to accept available medical evidence or to amend their guidance when presented with references to relevant scientific studies. TPA, in refuting their claims, has adduced hundreds of references to which their attention has been drawn, to no avail.
The President of the Royal College has asserted that the RCP will not be entering into further correspondence regarding this matter. For the 250,000 sufferers who are being left without a proper diagnosis and correct treatment, this is an appalling statement.
Doctors are afraid to go against such guidance as they rightly fear being arraigned before the GMC so refuse to prescribe any form of T3, even though this is indicated for specific patients. Instead, as a consequence, they are prescribing many and varied
Whilst taking into account the costs of these medications, consideration must also be given to the massive cost to the NHS and also, the cost of other medicines prescribed when T4 alone does not fully resolve the patients symptoms.
Many patients end up on antidepressants. Many sufferers have confirmed this to be the case. Irving Kirschs study, 2008, is the first to examine both published and unpublished evidence of the effectiveness of SSRIs, which account for 16 million NHS prescriptions a year. The largest study of its kind concluded that antidepressant drugs do not work. More than 291 million was spent on antidepressants in 2006, including nearly 120 million on SSRIs. Depression, anxiety, memory loss and Alzheimers disease all have an association with lower thyroid hormone levels and research has shown that improvement can be achieved with thyroid hormone replacement.
Further, those suffering the symptoms of hypothyroidism chronically use more prescription drugs, especially for diabetes, cardiovascular disease and gastrointestinal conditions, adding further financial strain on the NHS and an overwhelming burden to the quality of life of the 250,000 citizens who are not being given the thyroid hormone replacement they need.
How the idea could be implemented
If sufferers were diagnosed and treated correctly, under a properly revised protocol for the diagnosis and treatment, considerable financial savings would accrue to the Health Service. However, the authors of such a guideline should be drawn from Patients diagnosed with hypothyroidism are given free prescriptions for life, whether their symptoms are connected with hypothyroidism or not. This should be abolished leaving free prescriptions for thyroid hormone replacement(s) only.
If doctors were allowed to prescribe T3 containing drugs for those with peripheral thyroid hormone deficiencies, they would not require other prescriptions for their remaining symptoms. Many diagnosed claim many drugs by free prescription, which may, or may not be relevant to their thyroid problem.
Two other very serious problems are the two completely physiologically different definitions of ‘hypothyroidism’ given by the BTA and the RCP which cause concern and confusion.
The RCP (London) defines hypothyroidism as “the clinical consequences of insufficient secretion by the thyroid gland” meaning ‘hypothyroidism’ is ONLY associated with the THYROID GLAND. This definition is the correct and narrow definition.
The BTA define hypothyroidism as “the clinical consequences of insufficient levels of thyroid hormones in the body”. This broad definition is associated with peripheral metabolism and peripheral cellular hormone reception, which produces insufficient thyroid hormones in the body.
If the first definition is correctly called “hypothyroidism”, this should be treated with levothyroxine. Therefore, the second definition should not be called hypothyroidism. This should be defined as Clinical Euthyroidism, Type 2 Hypothyroidism or Euthyroid Hypometabolism and peripheral thyroid hormone deficiencies would be treated with T3 and NOT T4.
It does appear, that to avoid suggesting that T3 is needed, the diagnostics recommended for the symptoms of hypothyroidism focus only on the thyroid gland. When these symptoms continue, because they are caused elsewhere, i.e. peripheral thyroid hormone deficiencies at cellular level, they are not treated. Instead, if a patient continues to complain of symptoms, s/he is given the bogus excuse of you are suffering from a functional somatoform disorder your symptoms are non-specific or its old age.
The result of these continuing symptoms is a reduction in the patient’s ability to function, or to resist the dangerous consequences of low thyroid.
Last year, Anne Milton MP asked a Question in the House on behalf of TPA, in order to obtain clarification of the correct definition of hypothyroidism, but the response from Ann Keen, MP was not satisfactory. This matter MUST be resolved.
We have made repeated approaches to the DoH over the past 6 years, but these have been systematically ignored.
The diagnostic and treatment protocol for those suffering the symptoms of hypothyroidism must be thoroughly investigated without delay. The confusion in the definition is one of the main causes for over 250,000 patients being improperly diagnosed and improperly treated. If this issue were fixed, the NHS would save millions of pounds.
TPA is unable to progress our campaign for a better diagnostic and treatment protocol in this matter, because of the intransigent opposition from the RCP and the BTA to any suggestion that they should change their policy stance in their Guidance on the Diagnosis and Management of Primary Hypothyroidism, in the face of a great deal of scientific evidence adduced to support this demand for change.
In short, the RCP, as a setter of medical standards to improve medical practice through self-regulation, are “above the law” and a ‘closed shop’. Their standards and quality are seen as implicit rather than explicit, with government and society trusting them to protect the public, and granting the profession considerable autonomy in the process.
A Public Enquiry is called for to put an end to this appalling situation.