| Diagnosis & Treatment of Thyroid Disease In The | | | | It is very difficult to begin here. |
| UK Limited By Restrictive Guidelines. | | | | But here goes, there isn't any peer-reviewed research |
| Thyroid Disease although perhaps more widely known | | | | proving synthetic T4 therapy is safer or even any |
| is the US also affects many patients in the United | | | | more effective than the combination T4/T3 synthetic |
| Kingdom and unfortunately it seems the British medical | | | | treatment, or natural desiccated thyroid drugs like |
| establishment is making things even harder for UK | | | | Armour often prescribed in the US. Nor is there |
| sufferers to access the treatment they deserve, they | | | | peer-reviewed research that proves that proper |
| may well be making it even harder for those same | | | | management of hypothyroidism with thyroid |
| people to get a correct diagnosis in the first place. | | | | medications that include T3 is dangerous to bone or |
| Diagnosis is often not as quick as perhaps it should be | | | | heart health. |
| due to the nature of many of the symptoms and the | | | | Restricted from relying on knowledge and experience |
| fact that they replicate many other conditions if | | | | However without the benefit of conclusive research, |
| considered individually. | | | | the RCP and its fellow thyroid organizations have |
| My own experience with the diagnosis of my Thyroid | | | | opted to restrict the methods of treatment |
| condition led to me being misdiagnosed and treated | | | | practitioners are able to offer despite the fact many |
| incorrectly for several weeks prior to even being | | | | want to use these medications primarily based on their |
| tested for the possibility of my having a thyroid | | | | own previous experiences of treating this condition. |
| disorder. | | | | It is not however only a restriction on practitioners they |
| The fact that British Thyroid bodies are now making | | | | are also drastically reducing the choices options open |
| the diagnosis and treatment of Thyroid Disease harder | | | | to patients, may of whom have been safely using |
| seems to be unfathomable. | | | | these medications for years, or who given the |
| Within the profession this is the very same medical | | | | opportunity to try might benefit from their use as their |
| body, which already has a reputation for operating a | | | | treatment progresses. |
| seemingly intolerant and very outdated approach to | | | | These new guidelines have also stated the diagnosis |
| thyroid disease. | | | | of thyroid disorders should be based purely on TSH |
| Only ONE course of medication | | | | and Free T4 tests only. The exclusion of thyroid |
| This latest setback comes about following the release | | | | antibody tests, does nothing but prevent practitioners |
| of guidelines from the Royal College of Physicians | | | | from diagnosing symptomatic Hashimoto's disease. In |
| (RCP), in which they state that "thyroxine is the only | | | | some cases, symptoms develop when antibodies are |
| treatment that should be given" for hypothyroidism. | | | | elevated, without TSH reflecting the damage being |
| These latest guidelines are considered a backward | | | | done to the thyroid gland. Hypothyroidism treatment |
| step in the level and effectiveness of Thyroid | | | | can relieve symptoms in such patients, and can in |
| diagnosis and treatment for patients in the UK. | | | | some cases stop the development of their condition to |
| Unfortunately it appears that they've gained the | | | | that of overt hypothyroidism. The guidelines offered |
| support of many of the big players currently operating | | | | here, as a result exclude treatment for the entire |
| in the field of thyroid care in the UK. | | | | spectrum of Hashimoto's sufferers who have a TSH |
| These include the Society for Endocrinology, the British | | | | level under 10. |
| Thyroid Association, the British Thyroid Foundation | | | | What is the reference range for testing, diagnosis and |
| Patient Support Group, and the British Society of | | | | treatment |
| Paediatric Endocrinology and Diabetes. | | | | This brings us then to the subject of the "reference |
| These new guidelines quite simply state and in-doing | | | | range" that the guidelines are based on. As noted, TSH |
| so restrict patients to just one kind of treatment when | | | | levels under 4.5 are considered normal and within the |
| they say... | | | | reference range. Only TSH levels above 10.0 are |
| Hypothyroid Patients Will Be Limited to Synthetic T4 | | | | considered overtly hypothyroid. Levels within 4.5 and |
| Only | | | | 10.0 are, if Free T4 is normal -- considered "subclinical" |
| It appears that Doctors on the NHS will be prevented | | | | and for patients that fall into that category, the decision |
| from or at the very least limited in their ability to | | | | to treat is left to the practitioner's discretion. Research |
| prescribe Armour Thyroid, Cytomel (T3), or any drug | | | | experts in the U.S. are still discussing and exploring the |
| except for thyroxine (synthetic T4). Synthetic T4, | | | | following, however it seems to be widely accepted |
| Levothyroxine or Synthyroid becoming the only | | | | now that a TSH test indicating levels over 3.0 are in |
| prescribed hormone replacement permitted for use in | | | | fact proof of hypothyroidism. |
| treating Thyroid disease. According to research and | | | | Until November 2002, doctors had relied on a normal |
| hence these guidelines, the following has been stated: | | | | TSH level ranging from 0.5 to 5.0 to diagnose and treat |
| There appears to be mounting evidence to support | | | | patients with a thyroid disorder who tested outside the |
| the use of Thyroxine (T4) alone in the treatment of | | | | boundaries of that range. Now AACE encourages |
| hypothyroidism. Thyroxine is usually prescribed as | | | | doctors to consider treatment for patients who test |
| levothyroxine. | | | | outside the boundaries of a narrower margin based on |
| The prescribing of additional Triiodothyronine (T3) in | | | | a target TSH level of 0.3 to 3.0. AACE believes the |
| any presently available formulation, including Armour | | | | new range will result in proper diagnosis for millions of |
| thyroid is not recommended, as it is inconsistent with | | | | Americans who suffer from a mild thyroid disorder, but |
| normal physiology, has not been scientifically proven to | | | | have gone untreated until now. (Source: AACE |
| be of any benefit to patients, and may be harmful. | | | | Thyroid Awareness 2003) |
| There are potential risks from T3 therapy, using | | | | It is also accepted that untreated subclinical |
| current preparations, on bone (eg osteoporosis) and | | | | hypothyroidism is a contributing factor in the increased |
| the heart (eg arrhythmia). | | | | risk of heart disease, obesity, infertility, miscarriage, and |
| It is noted that the extract marketed as Armour | | | | a host of other health problems. |
| thyroid contains an excessive amount of T3 in relation | | | | A Backward Step |
| to T4. Over-treatment with T4, when given alone, has | | | | It seems then the United Kingdom is taking a |
| similar risks... The College does not support the use of | | | | backwards step, and seems to be determined to |
| thyroid extracts or thyroxine and T3 combinations | | | | reduce the capabilities of its own physicians to practice |
| without further validated research published in | | | | medicine in the way they were initially trained. |
| peer-reviewed journals. Therefore, the inclusion of T3 | | | | These guidelines make diagnosing and treating thyroid |
| in the treatment of hypothyroidism should be reserved | | | | disease a very precise if incorrect process not |
| for use by accredited endocrinologists in individual | | | | allowing for anything other than the results dictated in |
| patients. | | | | the guidelines be viewed as warranting treatment |
| Just one test - Diagnosis of Hypothyroidism Relies | | | | even if the practitioner feels differently. |
| Only on TSH and Free Thyroxine (Free T4) | | | | Doctors who have until now used years of experience |
| "The only validated method of testing thyroid function | | | | and practice to make there are now being expected |
| is on blood, which must include serum TSH and a | | | | to disregard all that knowledge and blindly follow these |
| measure of free thyroxine (T4)... There is no indication | | | | insanely restrictive guidelines. |
| for the prescription of T4 or any preparation containing | | | | It now seems more and more thyroid patients in the |
| thyroid hormones to patients with thyroid blood tests | | | | U.K. will be forced to go outside the National Health |
| within the reference ranges. In patients with suspected | | | | Service to seek private medical care in order to have |
| primary hypothyroidism there is no indication for the | | | | their Thyroid conditions treated in a way, which |
| prescription of T4 or any preparation containing thyroid | | | | provides a more balanced approach. |
| hormones to patients with thyroid blood tests initially | | | | Even for Private Practitioners there is mounting |
| within the normal range. | | | | pressure to comply with the guidelines specified, those |
| Thus patients with normal T4 and TSH do not have | | | | who are not endocrinologists especially will face |
| primary hypothyroidism and even if they have | | | | increased scrutiny and limitations in their ability to |
| symptoms which might suggest this should not be | | | | prescribe T3 medications to their patients. |
| given thyroid hormone replacement therapy." In the UK, | | | | It seems that once again medical science is refusing to |
| the reference range for the TSH test is .4 to 4.5, and | | | | look beyond what they first identify as the best and |
| TSH levels between 4.5 and 10.0 -- with Free T4 | | | | only treatment for a particular condition, refusing to |
| levels within the reference range -- are considered | | | | accept other alternative and often-complimentary |
| subclinical hypothyroidism. In the UK, only at levels | | | | medicines are available. |
| above a 10.0 is a patient considered overtly | | | | This seems to be something, which is going to affect |
| hypothyroid. The decision to treat patients with a TSH | | | | the Thyroid sufferers of the UK much more than |
| under 10.0, therefore, is left to the practitioner. | | | | those it would seem now luckily living elsewhere in the |
| Why is are these Guidelines wrong - No Proof | | | | world. |