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To anyone who has studied the patients of Doctors Derry, Peatfield,
Lowe and Skinner, it is obvious that - when properly administered -
treatment with thyroid hormones does restore the majority of CFS patients
to full or near-full health.
The study carried out by M Anne Pollock, Alison Sturrock, Karen Marshall,
Kate M Davidson, Christopher J G Kelly, Alex D McMahon, and E Hamish
McLaren
(BMJ 2001 323: 891-895) failed to show such an effect for the simple
reason that their methodology was fundamentally flawed.
Doctors such as GRB Skinner et al have achieved highly impressive
improvements in the hypothyroid symptoms (of approximately 80% of their
patients), because their treatment regime, unlike in this study, takes
into account clinical evidence and decades of knowledge about the
effective treatment of hypothyroid patients when devising treatment plans
for their patients.
The methodology of this study does neither of these - indeed, their
methodology appears to have been designed so as to ensure that it achieved
a negative result. The designers appear to have ignored the clinical
experience and findings of doctors who treat CFS patients with thyroid
hormones.
Firstly; One finding of such doctors is that, with chemically euthyroid
patients having hypothyroid symptoms - usually labled as chronic fatigue
patients - the longer the patient has been ill , the longer it may take
for them to respond to thyroid treatment. So, to design a study which
tests for improvements after a mere 12 weeks seems utterly pointless.
In my own case, it was six MONTHS before I noticed ANY slight beneficial
effects from taking a mix of thyroxine and trithyronine (in the form of
Armour Thyroid) and about two years before the improvements became obvious
even to me. It was over five years before I was restored to near full-
physical health.
Secondly, in hypothyroid patients, psychological symptoms may often be
amongst the very last symptoms to disappear (mine did not go until after
almost six years of treatment), so to use this group of hypothyroid
symptoms as a measure in such a short term study is illogical and
pointless.
These two factors alone invalidate the methodology of this study; to look
for improvements which were highly unlikely to appear within the timescale
of the study seems perverse.
This study is further flawed, in that it ignored one important aspect of
good practise regarding the treatment of hypothyroid patients. Has it not
been demonstrated many times that, whilst a patient may need to eventually
achieve a dosage of, say, 100mcg, of thyroxine in order to be free of
hypothyroid symptoms, their body will not react positively if that dosage
is given as a starting dosage. It is usually far more effective (and
safer) to slowly build up the patient's dosage in 25mcg steps. Why then,
did this study's methodology ignore such basic good practice? To give a
starting dose of 100mcg to patients, contrary to standard good practice is
unethical.
There is little contraversy amongst those CFS patients being treated with
thyroid hormones, as to whether this treatment helps euthyroid patients
who have hypothyroid symptoms - we have experienced and are living proof
that this treatment does work. Our experinces may be anecdotal, but they
are still evidence. Anecdotal evidence may have less weight than clinical
evidence, but the success rates of Doctors like Skinner cannot be so
easily discounted. Specialists who seek to dismiss such a high success
rate as a placebo effect seem detirmined to ignore clinical facts. No
clinical trial has ever achieved positive results from a placebo at
anything like these sort of success rates. Also, to attribute such success
to a placebo effect one has to ignore the cynical attitude many CFS
patients held toward the medical profession. Having experienced numerous
false diagnosis and treatments which did not help them, many CFS patients
lost faith in the medical profession and, in sheer desperation, tried
various alternative therapies, which also did not work! It seems highly
improbable that such patients would be succeptable to any placebo effect,
let alone that such a high proportion would respond well to one particular
placebo treatment - thyroid hormones. On the contrary, one of the
problems Skinner experiences is getting his patients to recognise when
improvements have actually started to take place. In the early stages of
recovery, are afraid to believe that our thyroid hormone treatment is
working, in case the improvements we are experiencing are just temporary
remissions. We are therefore hardly the sort of patients succeptable to
show a positive response to a placebo effect.
To settle the contraversy which exists in the medical profession, all that
is required is a 12-24 months double-blind clinical trial, with dosages
being slowly increased in 25mcg stages, depending upon the patients'
responses to their previous dosages. Such a trial should also take into
account the findings of Doctors like Skinner who have found that many CFS
patients seem, at least in the early stages of recovery, to respond better
to natural (eg Armour) than to synthetic thyroid hormones.
Thyroxine DOES benefit euthyroid people with symptoms of hypothyroidism
To anyone who has studied the patients of Doctors Derry, Peatfield,
Lowe and Skinner, it is obvious that - when properly administered -
treatment with thyroid hormones does restore the majority of CFS patients
to full or near-full health.
The study carried out by M Anne Pollock, Alison Sturrock, Karen Marshall,
Kate M Davidson, Christopher J G Kelly, Alex D McMahon, and E Hamish
McLaren
(BMJ 2001 323: 891-895) failed to show such an effect for the simple
reason that their methodology was fundamentally flawed.
Doctors such as GRB Skinner et al have achieved highly impressive
improvements in the hypothyroid symptoms (of approximately 80% of their
patients), because their treatment regime, unlike in this study, takes
into account clinical evidence and decades of knowledge about the
effective treatment of hypothyroid patients when devising treatment plans
for their patients.
The methodology of this study does neither of these - indeed, their
methodology appears to have been designed so as to ensure that it achieved
a negative result. The designers appear to have ignored the clinical
experience and findings of doctors who treat CFS patients with thyroid
hormones.
Firstly; One finding of such doctors is that, with chemically euthyroid
patients having hypothyroid symptoms - usually labled as chronic fatigue
patients - the longer the patient has been ill , the longer it may take
for them to respond to thyroid treatment. So, to design a study which
tests for improvements after a mere 12 weeks seems utterly pointless.
In my own case, it was six MONTHS before I noticed ANY slight beneficial
effects from taking a mix of thyroxine and trithyronine (in the form of
Armour Thyroid) and about two years before the improvements became obvious
even to me. It was over five years before I was restored to near full-
physical health.
Secondly, in hypothyroid patients, psychological symptoms may often be
amongst the very last symptoms to disappear (mine did not go until after
almost six years of treatment), so to use this group of hypothyroid
symptoms as a measure in such a short term study is illogical and
pointless.
These two factors alone invalidate the methodology of this study; to look
for improvements which were highly unlikely to appear within the timescale
of the study seems perverse.
This study is further flawed, in that it ignored one important aspect of
good practise regarding the treatment of hypothyroid patients. Has it not
been demonstrated many times that, whilst a patient may need to eventually
achieve a dosage of, say, 100mcg, of thyroxine in order to be free of
hypothyroid symptoms, their body will not react positively if that dosage
is given as a starting dosage. It is usually far more effective (and
safer) to slowly build up the patient's dosage in 25mcg steps. Why then,
did this study's methodology ignore such basic good practice? To give a
starting dose of 100mcg to patients, contrary to standard good practice is
unethical.
There is little contraversy amongst those CFS patients being treated with
thyroid hormones, as to whether this treatment helps euthyroid patients
who have hypothyroid symptoms - we have experienced and are living proof
that this treatment does work. Our experinces may be anecdotal, but they
are still evidence. Anecdotal evidence may have less weight than clinical
evidence, but the success rates of Doctors like Skinner cannot be so
easily discounted. Specialists who seek to dismiss such a high success
rate as a placebo effect seem detirmined to ignore clinical facts. No
clinical trial has ever achieved positive results from a placebo at
anything like these sort of success rates. Also, to attribute such success
to a placebo effect one has to ignore the cynical attitude many CFS
patients held toward the medical profession. Having experienced numerous
false diagnosis and treatments which did not help them, many CFS patients
lost faith in the medical profession and, in sheer desperation, tried
various alternative therapies, which also did not work! It seems highly
improbable that such patients would be succeptable to any placebo effect,
let alone that such a high proportion would respond well to one particular
placebo treatment - thyroid hormones. On the contrary, one of the
problems Skinner experiences is getting his patients to recognise when
improvements have actually started to take place. In the early stages of
recovery, are afraid to believe that our thyroid hormone treatment is
working, in case the improvements we are experiencing are just temporary
remissions. We are therefore hardly the sort of patients succeptable to
show a positive response to a placebo effect.
To settle the contraversy which exists in the medical profession, all that
is required is a 12-24 months double-blind clinical trial, with dosages
being slowly increased in 25mcg stages, depending upon the patients'
responses to their previous dosages. Such a trial should also take into
account the findings of Doctors like Skinner who have found that many CFS
patients seem, at least in the early stages of recovery, to respond better
to natural (eg Armour) than to synthetic thyroid hormones.
Competing interests:
None declared
Competing interests: No competing interests