Two physiologically different definitions for HypoT!

This is the forum to discuss thyroid issues when talking with doctors.

Moderator: talkhealth

Locked
2 posts
Mireille
Posts: 23
Joined: Thu Jan 26, 2012 4:14 pm
Quote

by Mireille on Mon Jan 30, 2012 5:36 pm

Two physiologically different definitions for HypoT!

First, thank you for organising this Thyroid 'talkhealth forum' and giving us the opportunity to ask the expert panel questions.

I would draw the attention of the panel to a very serious problem that exists, but is not being recognised. My question is, why are those suffering with peripheral metabolism and peripheral hormone reception being denied a correct diagnosis and prescribed the active thyroid hormone T3? Doctors failing to recognise this problem are causing harm to patients.

The problem is that there are two completely physiologically different definitions of 'hypothyroidism', which is a cause for great concern.

The Royal College of Physicians define ‘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. If this first definition is correctly called "hypothyroidism", this can, hopefully, be treated with levothyroxine sodium-only.

The British Thyroid Association however, 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 hormone in the body. This should NOT, therefore be called ‘hypothyroidism’. It should be given a diagnosis of 'Clinical Euthyroidism’, ‘Type 2 Hypothyroidism’, ‘Euthyroid Hypometabolism’ or perhaps even the more wordy ‘Impaired Cellular Response to Thyroid Hormone' - and peripheral thyroid hormone deficiencies would be treated with the active thyroid hormone replacement 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 come from elsewhere, i.e. peripheral thyroid hormone deficiencies at cellular level, they are not treated by medicine. Instead, if a patient continues to complain of the symptoms of hypothyroidism, and has normal thyroid function test results, and given T4-only, 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, which can be many, and they continue to be a drain on the NHS.

The diagnostic and treatment protocol for those suffering the symptoms of hypothyroidism must be thoroughly investigated without delay. Such confusion in the definition is one of the main causes for over a quarter of a million patients in the UK alone, being improperly diagnosed and improperly treated. If this issue were fixed, then the NHS would save millions of pounds and the quarter of a million suffering the symptoms of hypothyroidism would no longer be ignored. See http://www.tpa-uk.org.uk/pritchard1.pdf

Please will one of the Panel Experts be kind enough to respond to this request, for the sake of all those being left to suffer so unnecessarily on T4-only therapy?

Mireille

User avatar
Dr Graham Beastall
Posts: 21
Joined: Wed Jan 18, 2012 5:36 pm
Quote

by Dr Graham Beastall on Fri Feb 03, 2012 8:23 pm

Re: Two physiologically different definitions for HypoT!

Mirielle,

I will reply but I suspect that I may not be able to answer your query to your satisfaction.

I hear a lot of cases in which patients claim to be suffering from poor peripheral conversion of T4 into T3. Usually there is no supporting evidence and it is a diagnosis of exclusion in someone who has symptoms of hypothyroidism but with normal thyroid function tests.

A primary cause of poor conversion of T4 into T3 is extremely rare and not difficult to diagnose. What is much more common is a relative shift in the conversion of T4 into T3 in the presence of intercurrent illness. This very common condition is known as non-thyroidal illness or (as it used to be called) the sick euthyroid syndrome. A wide range of acute and chronic illnesses can bring about subtle changes in the conversion of T4 into T3. It is generally regarded as a normal and necessary physiological response to slow down the metabolic rate in the presence of a non-thyroidal illness.

It is clear that when the intercurrent illness can be identified and treated then the conversion of T4 into T3 is altered back to the healthy situation. This is most easily illustrated in an elective surgery situation where thyroid hormone metabolism normalises in a few days. In chronic disease it is much more challenging, especially when the primary source of the chronic disease is not easily identified and treated. It may seem obvious that in such circumstances T3 therapy should be considered. However, there are precious few bona fide clinical trials of T3 replacement in situations like this and the results of those that have been performed are not clear cut. Most doctors are cautious and in the absence of evidence to the contrary they are reluctant to treat what is seen as a normal physiological response to another condition.

You can read a bit more about this in Chapter 5b of The Thyroid Manager (http://www.thyroidmanager.org)
Dr Graham Beastall
President of the International Federation of Clinical Chemistry and Laboratory Medicine

Locked
2 posts