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LETTERS: E H McLaren, C J G Kelly, and M A Pollock Trial of thyroxine treatment for biochemically euthyroid patients has been approved BMJ 1997; 315: 1463 [Full text]

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Hypothyroid Patients, Euthyroid Bloods.

Nikki Tovell   (21 June 2000)

Hypothyroid Patients, Euthyroid Bloods. 21 June 2000
Nikki Tovell, Informed patient, currently co-authoring a paper with Dr B. Durrant-Peatfield of Foxley Lane Clinic Foxley Lane Clinic/Home Send response to journal: Re: Hypothyroid Patients, Euthyroid Bloods.	Drs McLaren, Kelly and Pollack quite rightly state that it is arrogant of the medical profession to assume that everything is known about the thyroid. Currently, hypothyroid testing commonly only addresses T4 and TSH levels. A great number of patients have been helped back to full health by supplementation of thyroxine even where they show normal blood results of these two factors, which should demonstrate to the profession that other factors should be considered in the efficient diagnosis of hypothyroidism. However, many cases of apparent hypothyroidism are not due to an insufficiency of thyroxine, but to an insufficiency of T3 conversion or to low T3 uptake levels, and are therefore not helped by supplementation of this hormone. T3 conversion is greatly impaired where there exists a lack of adrenal steroids, since these are necessary to make the enzymes responsible for the conversion of T4 to T3in the liver. If such patients are given thyroxine, toxicity may ensue as a result of further stress being placed on the already insufficient adrenals. Give these same patients T3, and not only will toxicity certainly result, but there is obviously a real risk of precipitating an addisonian crisis. If adrenal insufficiency and the inevitable lack of T3 production have existed chronically, the T3 receptors "switch off" (it might be hypothesised that they in fact atrophy), and the cells are physically unable to take up any T3. The liver is then called upon to degrade the unuseable hormone, further stressing the adrenal system also. Many patients who persistently present with signs and symptoms of hypothyroidism are constantly told by their health practitioners that there is "nothing wrong", based solely on the normal TSH and T4 blood results. That T3, T3 conversion and T3 uptake levels are rarely checked is bordering on negligence, and certainly involves both ignorance and arrogance on the practitioners' part. Likewise, adrenal hormone levels should be checked as a matter of course in such patients. DHEA currently provides a far more sensitive measurement of the overall status of adrenal hormones than does cortisol, although that can be equally useful in the hands of an informed interpretator of the results. I myself was treated for hypothyroidism with first Armour Thyroid, then T3, and finally thyroxine. Thyroxine proved the least toxic of the three available treatment options, but after several episodes of recoverable collapse in the first year, total collapse came a mere 16 months after the start of treatment. I was unable to even stand unaided, couldn't do anything for myself, and even breathing and being alive seemed to take immense effort. Thankfully, I found a forward-thinking doctor and within a week of being correctly diagnosed and treated with low-dose steroids, I was able to start having an active life again. Two months on and the improvement is immense. When T3 is not reaching the cells, the effects are ultimately catastrophic; with no energy to fuel them, the cells are unable to perform their many and varied functions. This produces a huge range of "non- specific" symptoms, as all systems gradually deteriorate; low BP, headaches, repeated infections, exhaustion, skin problems, fibromyalgia, food and chemical intolerances, allergies, digestive disturbances, chronic constipation, depression, mood swings - all are common, and are most often put down to some fault in the psychological make-up of the patient, rather than to a flaw in the practitioners' methodology. The lack of metabolism adversely affects every single function in the body, and a downward spiral inexorably follows. The only way back to health for these patients is to get to the root of the problem via more relevant testing; if a patient has signs and symptoms of illness and test results are negative, you aren't performing the right tests. Nikki Tovell.