We Need a Better Wagon!

Current Thyroid Treatment is Flawed. 

Synthetic T4 (Synthroid, Levothyroxine) was first introduced in the 1950s. Current thyroid lab tests were invented in the 1970s.

Before these events, all doctors had available was good clinical judgement, based on the symptoms and signs of the patient, and the option to use natural desiccated thyroid (NDT). 

It worked pretty well a lot of the time. It ought to have moved forward from there, taking advantage of modern lab testing (but not being a slave to it), and having all the other thyroid medications available. 

Clinical judgement, and the patient's symptoms and signs should still have been paramount.

But we have gone backward, and patients are worse off today than they were then. Nowadays, T4 monotherapy (Synthroid, Levothyroixine) is almost always the only treatment on offer. All that is focused on, usually, are the patient's lab test results. Often it is just TSH. If the patient is lucky enough to have FT4 and FT3 tested, their doctor usually tells them that they are adequately treated if the results appear almost anywhere within the wide population reference range.

This situation is world-wide. It is not just a UK issue.

Here is an Analogy.

Imagine we are the very proud owner of a wagon. It has an engine, a simple wooden plank seat and two axles. Unfortunately, all the wheels are different sizes, they are made from wood and there is no suspension!

When the wagon moves, it is a very unstable and uncomfortable ride. If any bends in the road or slopes are encountered, it can tilt over in a very scary way.  Invariably, most passengers usually suffer with some degree of travel sickness, ranging from mild to horrendous!

It is can be a perilous ride when on it, but it is the only wagon we have! It is uncomfortable, slow, dangerous, makes us ill, and rarely gets us to where we want to go on time.

Our wagon isn't fit for purpose. This reminds me of the movie 'Jaws', in which one of the besieged guys says, "We need a bigger boat!", but in this case, we need a better wagon!

Now, we can choose to redesign it a little. But basically, our wagon design is truly useless. We need a better wagon!

Current Thyroid Treatment

In our thyroid world, we can fiddle around all we want with what level TSH needs to be managed to, or with lab ranges, or whether FT3 needs to be in the centre of the range or higher. It doesn't make a lot of difference, because the entire TSH-centric, lab-test-centric, T4-monotherapy-centric paradigm is still flawed.

Thyroid Treatment Requires a New Paradigm.

It needs to be symptoms and signs led, using the clinical judgement of physicians who are well-informed about thyroid treatment.

FT3 needs to be observed during treatment, as it ought to rise (it is the only thyroid lab result that actually tracks symptoms, as symptoms and FT3 alter after treatment changes).

TSH and FT4 can be observed to see how they alter, and if they behave how we expect them to.

However, there should not be specific targets for any of these lab results, as we do not know what the individual person-ranges are for an individual (simply having numbers sat in the current wide population ranges is not sufficient to guarantee good health). We know from research that, for those on T4 monotherapy, FT3 ought not to be above the very top of the reference range, but TSH can be zero - but that's about all that is really known. We also know from research now that patients's symptom improvement has to be the most important focus - far more than the labs that only provide some insight into what the medication is doing. 

We need a new paradigm for thyroid treatment - we need a better wagon, and there is plenty of research now to back this statement up.

My latest book, 'The Thyroid Patient's Manual', discusses many aspects of thyroid diagnosis and treatment. The book refers to some of this new research and how to really go about treatment in order to recover quickly from hypothyroidism.

Best wishes,