by Denise Roguz
ThyroidChange Co-Founder and Hashimoto's Patient
A recent study is confirming thyroid testing beyond TSH and the revisitation of treatment options beyond the gold-standard T4-only. The work of Thyroid UK advisors Rudolf Hoermann, John E.M. Midgley and Johannes W. Dietrich was recently demonstrated in a research paper published in the Clinical Endocrinology Journal.
ThyroidChange Co-Founder and Hashimoto's Patient
A recent study is confirming thyroid testing beyond TSH and the revisitation of treatment options beyond the gold-standard T4-only. The work of Thyroid UK advisors Rudolf Hoermann, John E.M. Midgley and Johannes W. Dietrich was recently demonstrated in a research paper published in the Clinical Endocrinology Journal.
Dr. John E.M. Midgley, one of the study's researchers, was interviewed by Thyroid UK stated that testing needs revaluation and that treatment should be individualized:
"What it proves is that there is no such thing as a TSH range that is suitable for everyone, and that the range is different according to the effect of independent influences such as age, body mass, size of working thyroid volume and whether someone is on T4 or not."
He goes on to say that "the T4 therapy range is very much lower than the "normal" untreated and sits around the 1 or lower mark. The 3-4 upper level that works for the normal person is not satisfactory and can indicate under-treatment."
He continues, "we're finding that people with no thyroid working at all cannot easily regain normal FT3 with T4 alone and that TSH suppression often has to happen, and in some people no amount of T4 will regain normal FT3 levels. Recent reviews by the gurus now admit that some people cannot handle T4 only and regain health."
The study's findings are listed below and were originally reported here. To download the full paper in PDF format, please click here.
Homeostatic equilibria between free thyroid hormones and pituitary thyrotropin are modulated by various influences including age, body mass index and treatment
Rudolf Hoermann*, John E.M. Midgley†, Adrienne Giacobino*, Walter A. Eckl*, Hans G€unther Wahl‡,Johannes W. Dietrich§ and Rolf Larisch
Article first published online: 7 JUL 2014
Summary Objective
We examined the interrelationships of pituitary thyrotropin (TSH) with circulating thyroid hormones to determine whether they were expressed either invariably or conditionally and distinctively related to influences such as levothyroxine (L-T4) treatment.
Design and Methods
This prospective study employing 1912 consecutive patients analyses the interacting equilibria of TSH and free triiodothyronine (FT3) and free thyroxine (FT4) in the circulation.
Conclusions
TSH, FT4 and FT3 each have their individual, but also interlocking roles to play in defining the overall patterns of thyroidal expression, regulation and metabolic activity. Equilibria typical of the healthy state are not invariant, but profoundly altered, for example, by L-T4 treatment. Consequently, this suggests the revisitation of strategies for treatment optimization.
What does this mean for thyroid patients and doctors?
Both patients and doctors need to know that a full thyroid panel is needed to obtain the larger picture of their thyroid hormone status, including how well they are converting T4 to T3. The thyroid stimulating hormone test (TSH test) is only a measure of the signal between the pituitary gland and the thyroid gland. It does not measure what is available for storage or what is available for our cells to use.
Treatment is also individualized. The gold-standard T4-medication (levothyroxine) leaves many patients symptomatic if the patient does not convert T4 to T3 well. Options are available including natural desiccated thyroid extract, T3/T4 combination methods (including compounded T3/T4), and T3-only.
Patients deserve better. Optimal health is obtainable if patients are properly diagnosed and if individualized treatment is employed. Please peruse this website for additional information regarding how to find a good doctor, what lab tests you should request, and what treatment options are available. We need change.
"What it proves is that there is no such thing as a TSH range that is suitable for everyone, and that the range is different according to the effect of independent influences such as age, body mass, size of working thyroid volume and whether someone is on T4 or not."
He goes on to say that "the T4 therapy range is very much lower than the "normal" untreated and sits around the 1 or lower mark. The 3-4 upper level that works for the normal person is not satisfactory and can indicate under-treatment."
He continues, "we're finding that people with no thyroid working at all cannot easily regain normal FT3 with T4 alone and that TSH suppression often has to happen, and in some people no amount of T4 will regain normal FT3 levels. Recent reviews by the gurus now admit that some people cannot handle T4 only and regain health."
The study's findings are listed below and were originally reported here. To download the full paper in PDF format, please click here.
Homeostatic equilibria between free thyroid hormones and pituitary thyrotropin are modulated by various influences including age, body mass index and treatment
Rudolf Hoermann*, John E.M. Midgley†, Adrienne Giacobino*, Walter A. Eckl*, Hans G€unther Wahl‡,Johannes W. Dietrich§ and Rolf Larisch
Article first published online: 7 JUL 2014
Summary Objective
We examined the interrelationships of pituitary thyrotropin (TSH) with circulating thyroid hormones to determine whether they were expressed either invariably or conditionally and distinctively related to influences such as levothyroxine (L-T4) treatment.
Design and Methods
This prospective study employing 1912 consecutive patients analyses the interacting equilibria of TSH and free triiodothyronine (FT3) and free thyroxine (FT4) in the circulation.
Conclusions
TSH, FT4 and FT3 each have their individual, but also interlocking roles to play in defining the overall patterns of thyroidal expression, regulation and metabolic activity. Equilibria typical of the healthy state are not invariant, but profoundly altered, for example, by L-T4 treatment. Consequently, this suggests the revisitation of strategies for treatment optimization.
What does this mean for thyroid patients and doctors?
Both patients and doctors need to know that a full thyroid panel is needed to obtain the larger picture of their thyroid hormone status, including how well they are converting T4 to T3. The thyroid stimulating hormone test (TSH test) is only a measure of the signal between the pituitary gland and the thyroid gland. It does not measure what is available for storage or what is available for our cells to use.
Treatment is also individualized. The gold-standard T4-medication (levothyroxine) leaves many patients symptomatic if the patient does not convert T4 to T3 well. Options are available including natural desiccated thyroid extract, T3/T4 combination methods (including compounded T3/T4), and T3-only.
Patients deserve better. Optimal health is obtainable if patients are properly diagnosed and if individualized treatment is employed. Please peruse this website for additional information regarding how to find a good doctor, what lab tests you should request, and what treatment options are available. We need change.
About the Author
Denise Roguz is the co-founder of ThyroidChange and is a Hashimoto's and Lyme disease patient. As an experienced artist and education professional, Denise invests her passions in her advocacy work to inspire other thyroid patients and to advocate for change. Her background in higher education administration, organizational policy, and fine art, Denise brings creative designs and innovative strategies to ThyroidChange. Unite with us and transform your health with access to the latest thyroid care information.
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