Awesome new research paper which shoots down previous T4/T3 research that concluded T3 did not help!

There is a new research paper from Hoermann, Midgley, Larisch and Deitrich.

It blows away ALL the research that has ever concluded in trials that T3 has little or no benefit.

It also shows the flaws in trials that support the simplistic  reference range use of TSH or FT4 in a generalised way to manage treatment.

It points the way to a better way to manage thyroid treatment which is  more focused on the patient and on the patient response to treatment.

It finally puts a bullet into the crazy conclusions that T3 does not help that so many doctors and endocrinologists have clung onto for so long.

My  new book, 'The Thyroid Patient's Manual' happens to be highly consistent with the new paradigm that the authors believe is absolutely necessary, if thyroid patients are going to get the treatment that relieves their symptoms. 

The FOLLOWING TEXT comes directly from Dr. Midgley, who is a co-author of the new research paper:

“The essential problem is that the implications of our physiological studies is lethal to the acceptability of randomized clinical trials. This is as true of comparing T4 only v T4/T3 combination responses, or TSH, FT4 and osteoporosis, or TSH, FT4 and atrial fibrillation.

The paper by Fisher et al is a complete rejection of the validity of most medical clinical trials based on RCTs (Randomised Crossover Trials), in whatever discipline. I cannot emphasise enough how great a paper this is. Our paper in the Journal of Thyroid Research follows exactly the same path in thyroidology and draws exactly the same conclusions.

It follows that no longer can one link parameters such as TSH and FT4 to OP and AF in a generalised fashion. The whole corpus of so called knowledge on which these conclusions rest is essentially swept away - there is no other conclusion, however strongly objectors may complain.

All thinking based on these trials has to be completely revisited.

The new paradigm is a return to individualised diagnosis and treatment, and not assessing patients by their placement within or without a particular range.

Thyroid diagnosis can no longer be a parameter-based acceptance of normal ranges but the examination of the particular and unique position that a patient occupies, perhaps in some cases outside the range, and their individual presentation. No longer simple biochemistry, but real medicine is needed. This conclusion has only gradually emerged as the disjoint between physiological and clinical trial implications has become clear.”

This is a short excerpt from the paper by Fisher et al.  I have put some parts in ‘bold’ for emphasis.

“That is, even in the best-case scenario, we should not think of a correlation in group data as an estimate that generalizes to any given individual in the population. Stated bluntly, this implies that the temptation to use aggregate estimates to draw inferences at the basic unit of social and psychological organization—the person—is far less accurate or valid than it may appear in the literature. Indeed, even the best-case scenario is quite alarming: Only 68% of all individual correlational values fall within a range that would be predicted by group data to cover 99.7% of all possible correlations—a discrepancy of nearly 32%.The worst-case scenario is clearly dire: It is plausible that inattention to nonergodicity and a lack of group-to-individual generalizability threaten the veracity of countless studies, conclusions, and best-practice recommendations.

A strong statement indeed!

NB Ergodicity is a term that states that variability within an individual is equivalent to that within a group. Noergodicity is when this doesn't happen, as in thyroid clinical trials.

Here are the relevant research papers (the second one needs to be paid for, but on accessing the link you can read the abstract and get a good sense of the nature of the paper):

Hoermann et al  https://www.hindawi.com/journals/jtr/2018/3239197/ 

Fisher et al http://www.pnas.org/content/115/27/E6106
"

The comments in quotes are from Dr. Midgely, with the quote near the end that starts "That is, even in the best case scenario.... " is from Fisher et al.

I hope you enjoy the new research and see the signficance. Very well done to the authors of both the new papers!

Best wishes,
Paul

P.s. Thank you to my friend Paul R Lundy for drawing my attention to this new resarch paper!