Category Archives: Diagnosis & Treatment of Thyroid Problems

The reasons your doctor may miss your thyroid issues

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This article describes two studies which, yet again, show that thyroid blood tests may not accurately reflect what is going on in the body.

Taken with permission from “Easy Health Options”,  1 November 2014 (bolding by HCS).

http://easyhealthoptions.com/reasons-doctor-may-miss-thyroid-issues/

 

When your thyroid functions properly, your health blossoms. But you have to know what to do if it falters or it becomes too active.

Otherwise, serious illness can complicate your life.

Ironically, as you age and become a senior citizen, it may benefit your health to have your thyroid slow down a bit.

Aging thyroid

Research shows that an active thyroid in older people can lead to depression. And just because a blood test seems to show that your thyroid is operating normally, your thyroid can still malfunction and leave you vulnerable to emotional turmoil.

A study at Erasmus Medical Center in Rotterdam, the Netherlands, shows that if you are in your late 70s or in your 80s, a very active thyroid that, according to blood tests, is still at the upper limit of what is considered normal can increase your risk of diminished emotional well-being.

“We found that older individuals with thyroid activity at the high end of the normal range had a substantially increased risk of developing depression over the course of an eight-year period compared to individuals who had less thyroid activity within the normal range,” says researcher Marco Medici. “This suggests that people with even minor changes in thyroid function may experience similar mental health effects as those with overt thyroid disorders, including hypothyroidism and hyperthyroidism.”

The research looked at health data from about 1,500 people with an average age of 70. At the beginning of the research, the scientists measured their TSH (thyroid stimulating hormone) levels and then periodically evaluated their emotional health with a detailed questionnaire.

When the 8-year study started, no one in the research had symptoms of depression. But as the research wore on, the scientists found that people with more active thyroids endured more incidences of depression.

“These results provide insight into the powerful effects thyroid activity can have on emotions and mental health,” Medici says. “This information could influence the process of diagnosing and treating depression, as well as treatments for individuals with thyroid conditions.”

Your thyroid and your heart

If you’re overweight and you have diabetes, a poorly operating thyroid means trouble for your heart. Research at the New York Institute of Technology (NYIT) College of Osteopathic Medicine shows that for a growing number of people, a low level of thyroid hormone in your heart can impair the function of the cardiac muscle and possibly lead to heart failure.

In lab tests, the NYIT scientists found that the administration of low doses of the thyroid hormone T3, stopped heart disease in the presence of diabetes.

“This treatment prevented the abnormal changes in gene expression, tissue pathology, and heart function,” says researcher A. Martin Gerdes.

Other studies have shown that high blood pressure and heart attacks are linked to lower thyroid hormone in the heart muscle and can increase the risk of serious heart complications.

“The clinical implications are profound and far-reaching because it suggests that the heart disease associated with diabetes may be easily preventable,” says Gerdes. “And importantly, the dose we gave of T3 hormone did not significantly change the serum (blood) thyroid hormone levels but it was enough to make all the difference in the heart tissue.”

Measuring thyroid

Your thyroid level is usually determined with a blood test. But the NYIT study showed that the level of thyroid in heart cells doesn’t always reflect what a blood tests shows. In other words, while your blood test for thyroid function can look fine, you can still be suffering from heart problems caused by a lack of thyroid hormone in cardiac tissue.

Gerdes points out that when blood leaves the heart’s chambers and mixes with the rest of the circulating blood it is severely diluted as it mingles with the body’s entire supply of plasma (It’s about a 20 fold dilution.)  That dilution can keep thyroid hormone from reaching the heart’s tissues. Consequently, his studies have shown that low-dose thyroid hormone replacement can effectively and safely protect diabetics from heart disease.

“A low thyroid condition can cause heart failure by itself,” he says. “The fundamental question we should be asking about patients with heart failure is: how much is due to the diagnosed disease and how much is due to low thyroid levels in the heart? There clearly needs to be more awareness with regard to research examining the impact of low thyroid hormone levels in the heart and the role this condition plays in acceleration of heart failure.”

Gerdes is still doing experiments to further understand precise methods to track low thyroid hormone levels in the heart muscle. But he has come up with a dependable way to use thyroid hormone to protect your heart.

“There’s so much fear of overtreatment (with hormones) and inducing arrhythmias that physicians in general completely avoid treating heart patients with thyroid hormones,” Gerdes says. “But we have established a clear treatment and monitoring program in this study that is safe and can be used in people.”

So if you have diabetes and heart issues, you need to find a healthcare practitioner who is familiar with this research and protocol. Or is at least willing to learn.

Our Holy Miracle of the Infallible TSH Test

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A beautiful video which sums up the ‘approved’ approach to thyroid treatment.

The Ministry Of Health insists that the Thyroid Stimulating Hormone (TSH) test is the be all and end all and punishes those doctors who question it. Meanwhile, many patients with normal TSH levels continue to feel unwell.

 

Mother Jailed for Getting Her Sick Daughter Hormone Therapy, Later Cleared. Her Lawyer’s Statement. A Letter from Dr Thierry Hertoghe.

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If it was “their” daughter surely “they” would want the help this British mother got from world renowned Dr Thierry Hertoghe, a Belgian physician and expert in hormone therapy, President of the International Hormone Society, which has 3000 physician members worldwide.

 

Mother jailed

Mail Online, 1 November 2014, Poison my daughter? No, I was trying to CURE her: Mother jailed for child cruelty after rejecting NHS care to seek treatment at foreign clinic for teenager’s hormone therapy http://www.dailymail.co.uk/femail/article-2817084/Poison-daughter-No-trying-CURE-Mother-jailed-child-cruelty-rejecting-NHS-care-seek-treatment-foreign-clinic-teenager-s-hormone-therapy.html

Mail Online, 3 November 2014, A cure for thyroid problems the NHS ignores – or quack doctor’s poison? Mary gave her daughter hormones prescribed for crippling tiredness. Then police arrested her for child cruelty  http://www.dailymail.co.uk/health/article-2819347/A-cure-thyroid-problems-NHS-ignores-quack-doctor-s-poison-Mary-gave-daughter-hormones-prescribed-crippling-tiredness-police-arrested-child-cruelty.html

 

Mother cleared

Thankfully the mother was cleared. Dr Thierry Hertoghe gave evidence at her trial. He described the British National Health Service as 40 years behind in this area of treatment. He commented that the NHS only treats patients when they are 70% hormone deficient, where he and his colleagues treat when the patient is 25-30% deficient.

The Independent, 30 October 2014, Mother cleared of poisoning teenager daughter with hormones supplied by Belgian doctor says case should be landmark for parents’ rights http://www.independent.co.uk/news/uk/crime/mother-cleared-of-poisoning-teenager-daughter-with-hormones-supplied-by-belgian-doctor-9829226.htm

 

Mary Kidson’s lawyer comments

From the website of Ken Hind CBE, one of Mary Kidson’s Lawyers, November 9, 2014 (bolding by HCS): http://kenhindbarrister.co.uk/press/

Lancashire Counsel and Solicitors secure acquittal for mother charged with poisoning her daughter in land mark case

Lancashire Barrister Ken Hind and Blackburn Solicitors Simon Farnsworth, Deborah Morgan of  FMB  took on the case of Mary Kidson a local woman from Nelson, who had moved to live in Herefordshire and secured her acquittal in a landmark case that could have long term  impacts on suffers from thyroid and cortisol hormone deficiencies throughout the NHS .

Ken Hind commented “We were initially approached by Mary Kidson’s family to take this case and we undertook it as this was the kind of case which we came into this profession to deal with and protect the man and woman in the street where we see the state has got things wrong. FMB is a medium sized 3 partner firm of solicitors who instructed me as an independent member of the bar”.

Mary Kidson’s daughter suffered with a number of physical problems , primarily she was constantly fatigued, had low blood pressure , lack of energy, pain in muscles and joints plus other problems. She was seen by 5 endocrine paediatric consultants in the (National Health Service) NHS – 4 of whom discharged her saying there was nothing wrong with her as it was all in the mind . Mary did not believe this , she researched on the internet , read books on hormone deficiency and accessed the web sites of Thyroid UK and the Thyroid Patients Advocacy Forum . She was convinced her daughter had deficiencies in cortisol, thyroid and oestrogen.

Taking advantage of section 13 in the Medicines Act 1968 she ordered hormones from  accredited pharmacies on the internet . She consulted Dr Durrant Peatfield an unregistered physician who had been criticised by the (General Medical Council) GMC for his views expressed in his book on the Thyroid Gland (can be downloaded off Amazon) who approved her treatments . She was still concerned to have a registered physician directing her daughter’s treatment and was recommended to Dr Thierry Hertoghe , the President of the  International Hormone Society with 3000 physician members worldwide. Dr Hertoghe has written 7 books including the Hormone Manual , one of the leading text books for physicians practising abroad in this field.

Mary took her daughter to Brussels where Dr Hertoghe carried out tests on 40 hormones and minerals , far more than carried out by the NHS and diagnosed chronic fatigue syndrome caused by hormone deficiencies. He prescribed hormones and nutrients and treated her for  5 months .

On the 5th March 2013 without having spoken to Mary, social workers and police officers turned up at her home & arrested her, took her daughter into interim care where she was placed with foster carers whom she did not know her for 2 months. Doctors examined Mary’s daughter who they said had nothing wrong with her, made no contact with Dr Hertoghe to ask about diagnosis and treatments , despite the fact he wrote to the police , doctors in the case and social services 3 times. NHS doctors ended all the hormone treatments. Mary’s daughter was interviewed on videotape by the police and said she felt better as a consequence of the treatments.

9 months later in January 2014, the police charged Mary Kidson with poisoning her daughter unlawfully and maliciously causing grievous bodily harm or endangering her life. Mary was only able to see her daughter for 2 hours a fortnight and that was under the supervision of a social worker until April 2014 . In breach of her bail conditions  Mary was phoning and texting her daughter in response to requests  for help and reassurance. Mary was remanded in custody to prison  for 6 months for a breach of this  bail condition, her daughter was certified under the Mental Health Act and sent to a psychiatric hospital where she remains.

The case came to Worcester Crown Court for trial for 3 weeks. Deborah Morgan who prepared the case for trial commented ‘One of our first requirements was to speak to Mary’s 16 year old daughter as the prosecution declined to call her but Hereford Social Services blocked it at every turn. Eventually a psychiatrist appointed by the defence was allowed into the hospital to speak to her, he found she was fit to give evidence and wanted to do so on behalf of her mother as she was within 2 weeks of being discharged by her psychiatrist. I turned up at the hospital to see her and was told I could not do so because Herefordshire Social Services blocked it. Eventually I was allowed in after application to the trial Judge which Herefordshire Social Services fiercely resisted in court.

Ken Hind stated  “Mary Kidson’s defence was that as a loving  caring mother who had struggled for years with her daughter’s ill health  she only wanted to see her get well, develop normally and have a happy, fulfilled adult life.  After 11 days in court, evidence from 5 consultants, 2 social workers , a forensic scientist and police officers,  the Judge directed the jury to acquit Mary Kidson as there was no evidence of grievous bodily harm (accepted by the prosecution) and that the alleged victim’s life had not been endangered”.

At the centre of the case was the treatment of NHS doctors for thyroid hormone deficiency. Dr Hertoghe from Brussels who gave evidence described the NHS as 40 years behind in this area of treatment. He commented that the NHS only treats patients when they are 70% hormone deficient, where he and his colleagues treat when the patient is 25-30% deficient . A major point of argument was the use of natural dessicated thyroid or liothyronine  a drug prescribed by Dr Hertoghe. The Royal College of Physicians directive for treatment of thyroid deficiency is the prescribing of levythyroxine which is an artificial type of thyroid hormone T4. This is converted by the body into T3 the main active ingredient of thyroid production and very necessary to sustain quality life. Doctors are disciplined by the GMC for stepping outside the dictat. There are estimated to be 1.3 million NHS patients who are thryroid deficient. For about a million of these patients levythyroxine works. For the remaining 300,000 their problems are different as their bodies cannot convert T4 to T3 in sufficient quantities.

Sheila Turner the Chairman of the Thyroid Patient Advocacy Forum commented thus “I suffered symptoms similar to Mary’s daughter, I found a doctor who diagnosed my problem and prescribed T3. My life was revolutionised – I felt normal again. The Forum had 1.25 million hits on its web site in just the months April and May this year to give some idea of the extent of the problem. We have seen 10,500 people who have come to seek meaningful information and guidance”.

“The defence team , Deborah Morgan , Sue Hind (researcher) and me are actually all strong supporters of the NHS , believing health care should be available tax funded at the point of delivery. To quote Dr Fraser however, the leading paediatrician for the prosecution in the witness box , ‘The NHS does not always get it right’.

“Thyroid UK one of the 2 major organisations campaigning for change have called for the government to fund research on the use of T3 in the NHS. They have placed on the Parliamentary web site an e petition , currently signed by 7130 people. We ask you to sign this petition as if  100,000 sign  there will be a parliamentary debate on this very subject and some positive good will come out of the tragic case of Mary Kidson. If the politicians listen to the views of many doctors throughout the world the whole issue can be is resolved by properly funded research for the benefit of many NHS patients” .

“Meanwhile Mary Kidson will fight in the courts for the return of her daughter. During our conduct of the case we have discovered that this is not an isolated tragedy which are mainly dealt with in Family Courts where anxious parents have been threatened with removal of their children into care . This has also been true in the case of ME sufferers, a condition very similar in some respects to chronic fatigue syndrome”.

Fund research into T3 and/or natural desiccated thyroid treatment for hypothyroidism

Responsible department: Department of Health

Many patients with hypothyroidism continue to have symptoms on levothyroxine (T4) but find that their symptoms are often greatly reduced when they take liothyronine (T3) or natural desiccated thyroid.

Natural desiccated thyroid is only manufactured in the US and Canada but can be prescribed in the UK on a “named patient” basis. Many doctors will not prescribe it because there are no randomised controlled trials as it was manufactured before licensing of medicines came into being.

Research has shown that some patients have benefited from natural desiccated thyroid but there needs to be more research done to investigate whether this would be a better treatment for patients.

More research also needs to be done on the addition of T3 to T4 because previous research has been inconclusive.

Note:

1.  Herefordshire Social Services Department was reviewed by Ofsted and found to inadequate on all 4 of the main categories and given a 6 month timetable to improve services .During this 6 month period they took Mary Kidson’s daughter way from her without speaking either to her or her physician.

2.  On the first day of the trial the Wye Valley Health Trust, from which 3 of the paediatric consultants called for the prosecution came, was put into special measures by the Department of Health.

 

Letter from Dr Thierry Hertoghe     (Bolding by HCS)

From: “Dr Thierry Hertoghe” <dr.hertoghe@hertoghe.eu>

Date: November 6, 2014 at 9:53:07 PM GMT+8

To:

Subject: SUCESS : the mother of the hormone-treated child, is CLEARED OF ALL CHARGES AND FREE, OUT OF PRISON – HORMONE RIGHTS INTERNATIONAL

Reply-To: office@hertoghe.eu

Dear Dr,

Many thanks for your testimonies and petitions.

MARY KIDSON, the mother of the hormone-treated child, is CLEARED OF ALL CHARGES AND FREE, OUT OF PRISON. Your testimonies and petitions were included in my medical report and have contributed to the success.

Mary Kidson is the mother who was imprisoned because she brought her daughter with six years of severe chronic fatigue syndrome (making it impossible for her to go to school) to my consultation and applied the hormone and nutritional treatments, which substantially improved her daughter’s health.

After two and a half weeks of a court trial with extensive media coverage the prosecution claims collapsed before defense witnesses would even provide their evidence.  I did however give evidence as an expert witness during the trial.

None of the absurd claims of potentially or actually harming the child made by the prosecution and the NHS were shown to have any grounds in reality.  In fact, the prosecution, child protection and NHS doctors have themselves severely traumatized child and mother, the child being now in a psychiatric institute with heavy psychotropic medication.

Links to the BBC: http://www.bbc.com/news/uk-england-hereford-worcester-29829946

Links to the Daily Mail: Lynne Wallis For The Mail On Sunday or: http://www.dailymail.co.uk/home/search.html?S=&authornamef=Lynne+Wallis+For+The+Mail+On+Sunday; http://www.dailymail.co.uk/health/article-2819347/A-cure-thyroid-problems-NHS-ignores-quack-doctor-s-poison-Mary-gave-daughter-hormones-prescribed-crippling-tiredness-police-arrested-child-cruelty.html

Links to the Independent: http://www.independent.co.uk/news/uk/crime/mother-cleared-of-poisoning-teenager-daughter-with-hormones-supplied-by-belgian-doctor-9829226.html

 

HORMONE RIGHTS INTERNATIONAL: Let’s make that this will not happen again. Your personal testimonies have shown that this is an international problem, not only limited to the UK. We are building an internet organization similar to Amnesty International called “HORMONE RIGHTS INTERNATIONAL”, organization of patients, physicians and other health professionals, to defend people’s right throughout the world for them and their family members to receive hormone therapy if they have hormone deficiencies.

Any attack against this right will put HORMONE RIGHTS INTERNATIONAL in action, launching internet news, emails and (post)mails from HORMONE RIGHTS INTERNATIONAL members to the institution that intervenes wrongly.  Patients should be free to attend a doctor of their choice without suffering interference by other medics or institutions.

Hormone deficiencies are as frequent as eye problems. Many of us are born hormone-deficient to some degree, and we all become more hormone-deficient with advancing age. Correcting these deficiencies with safe hormone doses gives to people their life and health back.

Become a free member by signing the membership form here below and sending it back to ihs@intlhormonesociety.org

I (fill in what fits):

O      become member of HORMONE RIGHTS INTERNATIONAL and engage once or more per year to send a testimony or sign a petition by email or post mail to any institution who attacks patients, parents of patients or their physicians or other health professionals, and tries to limit their right to hormone therapy.

O      wish to additionally participate more actively in the organization as active member preparing papers and actions, finding journalists, etc.

O      accept that my testimony(ies) is (are) published on websites or in books

First Name: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I__

Family Name: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

Healthcare  profession: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I__

Address

Street: I___I___I___I___I___I___I___I___I___I___I___I___I___I_

n°: I_ __I___I___I       Zip code: I___I___I___I___I___I___I

City: I___I___I___I___I___I___I___I___I___I___I

Country: I___I___I___I___I___I____I___I___I___I__

E-MAIL: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

Phone
Office: I___I___I___I___I___I___I___I___I___I___I___I___I__I___I___I_

Mobile: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

FAX: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

 

Signature: __________________________________

 

Thanks for all your wonderful input,

Warm regards,

Dr Thierry Hertoghe

President of the World Society of Anti-Aging Medicine

President of the International Hormone Society

Discover www.lifespan-journal.com and enjoy the latest breakthroughs in Lifespan Medicine.

7 Avenue Van Bever

1180 Brussels – Belgium

Phone +32 2 379 34 43 fax +32 2 732 57 43 office@hertoghe.eu www.hertoghe.eu  

Living healthier with hormone and nutritional therapies. Training for physicians

Dr. Mehmet Oz Got It Right About Thyroid Disease on ABC’s Good Morning America

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Thyroid patient advocate Mary Shoman, who has  previously criticised Dr Oz for lack of clarity on thyroid issues, now feels he deserves some credit.

http://thyroid.about.com/b/2010/03/15/mehmet-oz-doctor-oz-thyroid-abc.htm

One of the valid statements he made, so often overlooked by doctors confronted with hypothyroidism but understood by every hypothyroid patient, is that, “When we tell you your thyroid hormone is normal, we’re really misleading you. Because what we really need to do is find out if you have any of the symptoms I mentioned. If you’ve got symptoms, even if the blood tests come back looking like you’re borderline okay, we still might want to treat you more aggressively. It’s a very important point to make. Unlike other blood tests, it’s a matter of symptom management, not about getting the right blood tests.”

(Bolding by HCS)

Hopefully such thinking will become de rigeur in Singapore, though, sadly, it does not seem promising at the moment.

Adrenal Exhaustion

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Many people being treated for low thyroid continue to have symptoms. This may be because they have concurrent low adrenal function, an issue frequently overlooked by doctors who are not aware of this connection. Indeed adrenal fatigue is perhaps the commonest cause of secondary low thyroid function,  hypothyroidism caused by a malfunction elsewhere in the body.

Treating low thyroid without treating adrenal fatigue can be dangerous. The weak adrenal system will not be able to cope with the extra energy output of the thyroid and this situation may lead to a complete break down of the adrenal system. Thus when treating the thyroid it is vital to ensure that the adrenal hormones are also balanced. Many bioidentical hormone options are available for this.

See The Adrenal Fatigue Solution, Fawne Hansen, Bioidentical Hormone Replacement

http://adrenalfatiguesolution.com/hormone-replacement/

The following article is an informative account of adrenal exhaustion.

The Mail Online, Wellbeing, 30 November 2014, Lucy Fry, Don’t go for the crash and burn 

http://www.dailymail.co.uk/home/you/article-2850605/Wellbeing-Don-t-crash-burn.html

 

 

OECD calls for progress on thyroid disruptor testing

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The mission of the Organisation for Economic Co-operation and Development (OECD) is “to promote policies that will improve the economic and social well-being of people around the world”. Recently, 16-17 October 2014, the OECD Advisory Group on Endocrine Disrupters Testing and Assessment met to discuss the development and update of Test Guidelines and related documents for the testing and assessment of endocrine disrupters.

Member countries are being encouraged to develop non-animal test methods for the detection of thyroid disruptors. Highlighting the fact that the thyroid pathway is an important endocrine system, OECD believes that more efficient methods of testing are required and that advancements in such testing should be “very high priority” in order for accurate screening and assessment of endocrine disruption in humans and wildlife to be detected.

See Chemical Watch, 22 October 2014, OECD calls for progress on thyroid disruptor testing

https://chemicalwatch.com/21599/oecd-calls-for-progress-on-thyroid-disruptor-testing

History of Thyroid Testing – Dr John Midgley

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 Transcript of the talk by Dr John Midgley at the Thyroid UK 2014 Conference 18/10/2014

History of Thyroid Testing 

There have been long, sad and unsatisfactory developments in thyroid function testing, including up to the present day.

The first thyroid function test, in the form such tests are used today, appeared in 1960. This measured total thyroxine (T4). Before this, convenient measurement of thyroid hormones was not possible. However, breakthrough though this was, it was immediately realised that this was insufficient for accurate estimation of thyroid function.

Thyroid hormones (T4 and T3) leave the thyroid gland and in the bloodstream are bound onto transport proteins that convey the hormones to the tissues. There are three of these transport proteins: thyroxine-binding globulin (TBG), transthyretin and albumin. Of these TBG is the most important in the average person. It transports about 70% of T4 and 60% of T3.

As the transport proteins and their T4/T3 load pass by the tissues in the bloodstream, very small amounts of hormone are freed as required. These are the free T4 and free T3 fractions. As the tissues remove T4 and T3 for their own use, more is released by the transport proteins for the next tissues to use. The free T4 (FT4) and free T3 (FT3) fractions are a very small percentage of the total circulating hormones. In the case of FT4 in the average person it is about 2/100 of 1% of the total T4 and for FT3 2/10 of 1% of the total T3. Therefore, it is necessary to measure FT4 and FT3 rather than total T4 or total T3.

The problem is that we are all unique in the makeup and amounts of our transport proteins. In the vast majority of people, the TBG levels can be different by at least a factor of 2; and the same (independently) for the other two proteins. There are people with either no TBG at all, or 4 times the normal amount. Their reservoirs of T4 and T3 are therefore hugely different for the same FT4 and FT3. Also, the pregnant woman has twice the TBG and ¾ the amount of albumin she had when not pregnant. We also lose transthyretin and albumin when critically ill or with trauma like burns or septicaemia.

To try to get a measure of FT4, a test was developed in 1963-65 to try to convert the total T4 result to a FT4 result. This was the thyroid hormone uptake test. In conjunction with a total T4 result, the two tests could be amalgamated to produce what was claimed was an estimate of FT4. The test method is still used today; e.g. in certain American private labs and elsewhere. However, it is not based on sound principles and does not work properly, especially for people with extreme differences in TBG from the average. Even the pregnant woman’s results are compromised.

In the remainder of the 1960’s, commercial firms were set up to provide ready made tests for the clinical chemistry labs to use.

In about 1975, commercial TSH and T3 tests were developed and sold. The TSH test was first generation – that is, it could only measure and detect hypothyroidism (the depressed levels in hyperthyroidism were too low to be measured directly). Such was the growing demand for tests that the various companies competed with one another for business in the labs. Since the method of measurement (radioactivity) was the same in all tests, competition was such that no company would have a monopoly of business in the labs. This competition produced faster and slicker tests with shorter and shorter times – giving quicker turnover and more tests done in a given time.

In the late 1970’s the shortcomings of the thyroid hormone uptake test, arising from the variation in TBG levels in patients, were very apparent. The demand for properly formulated and soundly developed FT4 and FT3 tests was very great.

As a response, companies and individuals produced various forms of tests claiming to measure these fractions. Many of the offerings were not soundly based, and  slowly disappeared into obscurity and obsolescence. Two methods did however prevail and form the basis of FT4 and FT3 testing today.

The London researcher (now a distinguished professor – Nobel Laureate just failed), who had developed the pioneering total test 20 years earlier invented a validly based test for FT4. At the same time, I invented and my company developed and offered a method based on a different principle, but also soundly based.

My method as initially developed was not perfect – there were obscure areas of thyroidology where there were problems but we’d identified them and given advice to circumvent.

The professor’s method was sound but suffered from the fact that there were several steps to take before you got an answer, which took time and cost precision – the more handling, the more progressive errors creep in.

On the other hand, the test I had invented was, in the hands of the lab technician exactly the same in handling as the existing total T4 test – a big time/turnover/precision advantage for the busy lab.

The London professor and his group decided to try to destroy the validity and reputation of the rival test and those who had developed it. So began a long series of aggressive, long and detailed theoretical arguments as to why the test I had invented was, in its present form, unfit for purpose and could not and did not work.

In vain did we show that the practical working of our test bore no resemblance whatever to his theoretical predictions – this only invited more and more vituperative denunciation. This aggressive, acrimonious and almost libellous controversy (the worst in the history of any discipline in clinical chemistry) continued for almost 20 years before dying out in the futility with which it had started.

During this time, the average clinical chemistry worker in the average hospital was totally oblivious to all this rarefied argument and was happy that at last a reliable FT4/FT3 test was available. For example it brought into the diagnostic fold even the most TBG-extreme people mentioned earlier. For a while, there was a golden age in thyroid diagnosis where all tests (TSH, FT4, FT3 were used – especially in Germany and Japan).

In the mid-eighties, pressures on the clinical chemistry lab were beginning to be overwhelming. Such was the demand for tests that the disposal of radioactive waste was too great for licencing of disposal. Consequently non-radioactive detection methods had to be substituted. Two things happened around 1985.

First, second and third generation TSH tests were developed – now one could directly detect both hypo and hyperthyroidism. Secondly, the manufacturers produced several solutions to the nonradioactive detection methods, and integrated them into dedicated automatic analytical platforms. Now one had machines that took the place of the skilled hands-on technician – it was a case now of loading the machine, programming it and pressing the “start” button.

This led to lab monopoly – having chosen the machine, one was confined to the tests dedicated to that machine. However, the individual solutions of the manufacturers to the method of detection in tests led to problems with FT4 and FT3 test development (uniquely).

Unlike all other tests, FT4 and FT3 tests demand special and essential requirements. They must be run at blood temperature (37 degrees), they must sample only a tiny quantity of the available T4 and T3 so as not to sample the T4 and T3 bound to the transport proteins, they must use the same chemical surroundings (for example, salt content, phosphate content) as is present in blood, and they must work in the right acidity as present in blood.

The failure of the development scientists to understand these special requirements, and the compromises needed to make the detection methods work, led to great variation in the performance of the FT4 and especially the FT3 tests between manufacturers offerings. For FT4 this is at present up to 40% difference and for FT3 60%. I would expect no more than a 5% difference as a reasonable variation.

As a result, sensitive TSH tests began to have a paramount position in thyroid function testing. There exists a paradigm of thinking today which closely links FT4 and TSH as a constant relationship over the whole thyroid function spectrum. Therefore, if you do a TSH test, then why do an FT4 test because the TSH value implies an FT4 value – the FT4 test is controversial and inconsistent so why do it? The seeds of TSH only screening had started to sprout.

In 1988 I and my colleagues invented a new test for FT4 and FT3, based on the invention of 1980 but getting rid of the problems at the margins mentioned earlier. Shortly after, I left the field entirely for 10 years, only returning by accident in 1999.

On returning to the field I found it in chaos. In 1992, a group of American scientists had begun to analyse and dissect the commercial FT4 tests to understand why they were so inconsistent. They began a series of papers in the peer reviewed important leading journals which lasted until 2009.

Their findings were on the surface devastating – that is, they alleged that however it came about, all FT4 tests were influenced by the levels of transport proteins in blood – devastating because this meant that they were subject to the T4 and T3 bound by those transport proteins – and the whole point of doing FT4 and FT3 tests is to be independent of these effects.

As it turned out, the whole of this work was completely invalid and wrongly conceived from beginning to end – a completely meaningless study programme. I and a colleague pointed this out but, especially in America, their findings are accepted and further confuse today’s understanding of the FT4 and FT3 tests. Meanwhile, the cheap, easy to understand, rapid, and eminently automatable TSH test was gaining strength as a catch-all screen.

In 2005 a new group of US workers came on the scene with a specialised technique for measuring FT4 and FT3 which they alleged was superior to the commercial tests in that it more closely correlated FT4 and TSH.

In 2009 I looked into their work and found it had been done at the wrong temperature – this is important because T4/T3 binding to TBG is very temperature sensitive. On advising them of this, they merely obfuscated and blustered, and though henceforward using the right temperature, did not retract their earlier wrong work butactually included it in papers when they used the right temperature as if the wrong work somehow backed them up – scientific honesty?

Now we come to the present day. We have simultaneously in existence licensed, manufactured and used in diagnosis, tests based on the discredited thyroid hormone uptake test, tests based on sound methodology but including the earlier imperfect tests up to the modern improved ones, and tests offered that are to be run invalidly at room temperature.

This implies a complete failure to regulate by the international regulators whose job it is to ensure equivalence of results. The composite failure of the manufacturers to produce consistent FT4 and FT3 tests has already been mentioned. The failure of the medical thyroidology fraternity to ensure consistency of the tests they use is an additional factor in the diagnostic chaos that is now present. No wonder TSH only screening has gained credence in such an atmosphere.

There is a triple failure that has led to a diagnostic hiatus that urgently needs correcting. The paradigm of the TSH-FT4 relationship is wrong, especially in treatment. The whole conceptual thinking behind diagnosis thyroidology and the importance of personal diagnosis based on the patient rather than whether the numbers fall in or out of the normal range is fatally flawed. For the moment mechanical thinking has traduced medical diagnosis.

It’s not new – 2001 – Doctor Investigated for Using Basal Temperature Test and Natural Dessicated Thyroid

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BBC News  – Health – May 17, 2001

Investigation into thyroid doctor
testing

Tests for thyroid deficiency are controversial

A doctor offering controversial treatments for thyroid problems has been suspended from practice by the General Medical Council.

GP Dr Barry Durrant-Peatfield, 64, who has a practice in Purley, Surrey, has been stopped from working for 18 months so that the GMC can complete its investigation.

This may or may not lead to disciplinary action, although Dr Durrant-Peatfield says he cannot afford to fight to clear his name, and plans to retire.

He now cannot treat or prescribe medicines for patients unless the suspension is lifted, and told BBC News Online he was “outraged” by the decision.

“All the GMC wants to see is my head on a spike,” he said.

Dr Durrant-Peatfield, who works outside the NHS, is a controversial figure in thyroid medicine, offering treatments which are actively opposed by many other endocrinologists.

The complaints to the GMC allege that the private GP had failed to examine patients properly, and gone on to prescribe inappropriate drugs.

He has received vociferous support prior to the GMC hearing on Friday from a large number of past and present patients who wrote to the organisation praising him.

Many say their lives have been transformed for the better by his treatment regimes.

One, Linda Thipthorp, from Truro in Cornwall, said that treatments from other doctors, involving radical surgery, had done nothing to improve her condition.

‘My health is still improving’

She said: “After being successively treated by the NHS I could not walk, only crawl about on my hands and knees.

“To be asleep was the only way I could cope with the pain.”

“Dr Peatfield diagnosed immediately what some 20 other doctors had failed to do. After three days I began to feel alive again and my health is still improving nearly three years later.”

The controversy centres around the diagnosis, and treatment of patients with hypothyroidism – a condition in which the thyroid gland in the neck is not functioning properly.

Patients diagnosed with the condition have a slow metabolic rate and are normally given supplements of the hormones produced by the gland to make up for the deficiency.

Dr Durrant-Peatfield prescribed a “natural” form of thyroid hormone – which is derived from the glands of animals, and given in dessicated form.

This was the form in which thyroid hormones were originally produced at the turn of the century, but were phased out in this country, with many doctors now saying that synthetically-produced hormone is best.

This, they say, is because it is difficult to know exactly the concentration of hormone that is being delivered by the natural form.

In addition, Dr Durrant-Peatfield believes that standard thyroid function tests used by the majority of doctors are unreliable.

Basal temperature

He recommends heavier reliance on something called the “basal temperature test”, which involves measuring the internal temperature on waking.

Conversely, many other doctors treating thyroid patients maintain that blood tests for thyroid function are reliable and accurate, and that it is the basal temperature test that is misleading.

However, Dr Durrant-Peatfield said it was “impossible” to misdiagnose a patient if a proper clinical history was taken.

“Blood tests are appropriate in some cases, but I don’t necessarily believe them,” he said.

If patients who do not actually have hypothyroidism are given, over a long period, extra hormones when they do not need them over a long period, there is thought to be an increased risk of bone density loss – which could make patients’ bones more brittle.

There is also thought to be an increased risk of heart problems in these circumstances.

However, the GP insists that there is no evidence of any of his patients suffering physical harm as a result of his treatments.

He said: “I am totally and utterly devastated about this, both for my own sake, and for my patients, who now cannot receive their treatment.”

A spokesman for the GMC confirmed the 18-month suspension by its Interim Orders Committee.