Diagnosis & Treatment of Thyroid Disease In The UK Limited By Restrictive Guidelines.
Thyroid Disease although perhaps more widely known is the US also affects many patients in the United Kingdom and unfortunately it seems the British medical establishment is making things even harder for UK sufferers to access the treatment they deserve, they may well be making it even harder for those same people to get a correct diagnosis in the first place.
Diagnosis is often not as quick as perhaps it should be due to the nature of many of the symptoms and the fact that they replicate many other conditions if considered individually.
My own experience with the diagnosis of my Thyroid condition led to me being misdiagnosed and treated incorrectly for several weeks prior to even being tested for the possibility of my having a thyroid disorder.
The fact that British Thyroid bodies are now making the diagnosis and treatment of Thyroid Disease harder seems to be unfathomable.
Within the profession this is the very same medical body, which already has a reputation for operating a seemingly intolerant and very outdated approach to thyroid disease.
Only ONE course of medication
This latest setback comes about following the release of guidelines from the Royal College of Physicians (RCP), in which they state that "thyroxine is the only treatment that should be given" for hypothyroidism.
These latest guidelines are considered a backward step in the level and effectiveness of Thyroid diagnosis and treatment for patients in the UK.
Unfortunately it appears that they've gained the support of many of the big players currently operating in the field of thyroid care in the UK.
These include the Society for Endocrinology, the British Thyroid Association, the British Thyroid Foundation Patient Support Group, and the British Society of Paediatric Endocrinology and Diabetes.
These new guidelines quite simply state and in-doing so restrict patients to just one kind of treatment when they say...
Hypothyroid Patients Will Be Limited to Synthetic T4 Only
It appears that Doctors on the NHS will be prevented from or at the very least limited in their ability to prescribe Armour Thyroid, Cytomel (T3), or any drug except for thyroxine (synthetic T4). Synthetic T4, Levothyroxine or Synthyroid becoming the only prescribed hormone replacement permitted for use in treating Thyroid disease. According to research and hence these guidelines, the following has been stated: There appears to be mounting evidence to support the use of Thyroxine (T4) alone in the treatment of hypothyroidism. Thyroxine is usually prescribed as levothyroxine.
The prescribing of additional Triiodothyronine (T3) in any presently available formulation, including Armour thyroid is not recommended, as it is inconsistent with normal physiology, has not been scientifically proven to be of any benefit to patients, and may be harmful.
There are potential risks from T3 therapy, using current preparations, on bone (eg osteoporosis) and the heart (eg arrhythmia).
It is noted that the extract marketed as Armour thyroid contains an excessive amount of T3 in relation to T4. Over-treatment with T4, when given alone, has similar risks... The College does not support the use of thyroid extracts or thyroxine and T3 combinations without further validated research published in peer-reviewed journals. Therefore, the inclusion of T3 in the treatment of hypothyroidism should be reserved for use by accredited endocrinologists in individual patients.
Just one test - Diagnosis of Hypothyroidism Relies Only on TSH and Free Thyroxine (Free T4)
"The only validated method of testing thyroid function is on blood, which must include serum TSH and a measure of free thyroxine (T4)... There is no indication for the prescription of T4 or any preparation containing thyroid hormones to patients with thyroid blood tests within the reference ranges. In patients with suspected primary hypothyroidism there is no indication for the prescription of T4 or any preparation containing thyroid hormones to patients with thyroid blood tests initially within the normal range.
Thus patients with normal T4 and TSH do not have primary hypothyroidism and even if they have symptoms which might suggest this should not be given thyroid hormone replacement therapy." In the UK, the reference range for the TSH test is .4 to 4.5, and TSH levels between 4.5 and 10.0 -- with Free T4 levels within the reference range -- are considered subclinical hypothyroidism. In the UK, only at levels above a 10.0 is a patient considered overtly hypothyroid. The decision to treat patients with a TSH under 10.0, therefore, is left to the practitioner.
Why is are these Guidelines wrong - No Proof
It is very difficult to begin here.
But here goes, there isn't any peer-reviewed research proving synthetic T4 therapy is safer or even any more effective than the combination T4/T3 synthetic treatment, or natural desiccated thyroid drugs like Armour often prescribed in the US. Nor is there peer-reviewed research that proves that proper management of hypothyroidism with thyroid medications that include T3 is dangerous to bone or heart health.
Restricted from relying on knowledge and experience
However without the benefit of conclusive research, the RCP and its fellow thyroid organizations have opted to restrict the methods of treatment practitioners are able to offer despite the fact many want to use these medications primarily based on their own previous experiences of treating this condition.
It is not however only a restriction on practitioners they are also drastically reducing the choices options open to patients, may of whom have been safely using these medications for years, or who given the opportunity to try might benefit from their use as their treatment progresses.
These new guidelines have also stated the diagnosis of thyroid disorders should be based purely on TSH and Free T4 tests only. The exclusion of thyroid antibody tests, does nothing but prevent practitioners from diagnosing symptomatic Hashimoto's disease. In some cases, symptoms develop when antibodies are elevated, without TSH reflecting the damage being done to the thyroid gland. Hypothyroidism treatment can relieve symptoms in such patients, and can in some cases stop the development of their condition to that of overt hypothyroidism. The guidelines offered here, as a result exclude treatment for the entire spectrum of Hashimoto's sufferers who have a TSH level under 10.
What is the reference range for testing, diagnosis and treatment
This brings us then to the subject of the "reference range" that the guidelines are based on. As noted, TSH levels under 4.5 are considered normal and within the reference range. Only TSH levels above 10.0 are considered overtly hypothyroid. Levels within 4.5 and 10.0 are, if Free T4 is normal -- considered "subclinical" and for patients that fall into that category, the decision to treat is left to the practitioner's discretion. Research experts in the U.S. are still discussing and exploring the following, however it seems to be widely accepted now that a TSH test indicating levels over 3.0 are in fact proof of hypothyroidism.
Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now. (Source: AACE Thyroid Awareness 2003)
It is also accepted that untreated subclinical hypothyroidism is a contributing factor in the increased risk of heart disease, obesity, infertility, miscarriage, and a host of other health problems.
A Backward Step
It seems then the United Kingdom is taking a backwards step, and seems to be determined to reduce the capabilities of its own physicians to practice medicine in the way they were initially trained.
These guidelines make diagnosing and treating thyroid disease a very precise if incorrect process not allowing for anything other than the results dictated in the guidelines be viewed as warranting treatment even if the practitioner feels differently.
Doctors who have until now used years of experience and practice to make there are now being expected to disregard all that knowledge and blindly follow these insanely restrictive guidelines.
It now seems more and more thyroid patients in the U.K. will be forced to go outside the National Health Service to seek private medical care in order to have their Thyroid conditions treated in a way, which provides a more balanced approach.
Even for Private Practitioners there is mounting pressure to comply with the guidelines specified, those who are not endocrinologists especially will face increased scrutiny and limitations in their ability to prescribe T3 medications to their patients.
It seems that once again medical science is refusing to look beyond what they first identify as the best and only treatment for a particular condition, refusing to accept other alternative and often-complimentary medicines are available.
This seems to be something, which is going to affect the Thyroid sufferers of the UK much more than those it would seem now luckily living elsewhere in the world.
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