Re: blood test and stopping thyroid

[Guest guest]

48 hrs is the recommened amount of time to stay off thyroid meds before a blood test. Could be placebo effect re taking meds at night? You want it to make you feel better, but I thought you were feeling fantastic since starting the HC? Why change what time you your thyroids?

From: marsaday1971 <jphenderson@...>Subject: blood test and stopping thyroidthyroid treatment Date: Tuesday, 26 August, 2008, 10:31 AM

i now take my thyroid at night and can say it is loads more effective.i will be having a blood test tomorrow at 9am. do i need to NOT takemy thyroid tonight or will 11 hours difference be ok for the thyroidto be processed?Send instant messages to your online friends http://uk.messenger.

[Guest guest]



Hi - a small study has been carried out to show that most people prefer to take their L-thyroxine at night - this is something you might wish to try when you go back onto your thyroxine on Saturday. Many of our members changed over to taking their Lthyroxine at night and reported back they feel so much better. http://thyroid.about.com/od/thyroiddrugstreatments/a/bedtime.htm

Luv - Sheila

48 hrs is the recommened amount of time to stay off thyroid meds before a blood test. Could be placebo effect re taking meds at night? You want it to make you feel better, but I thought you were feeling fantastic since starting the HC? Why change what time you your thyroids?

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[Guest guest]

well i have had the test today and took meds 10h's earlier (11pm).

i had an off day recently and i know why. my armour ran out and i

moved over to nature-throid. this cant be taken under the tongue and

so i was just taking it with breakfast. the effect of the medication

was decreased and so i started to feel tired.

i read that taking it at night could be useful. anyway i tried it and

within 30 mins of it going in i picked up. it is loads easier taking

it at night because i know i wont be eating at that time and so no

complications to worry about - it seems to work for me.

and yes i am feeling brill. still on 7.5mg of HC and dont need to go

up it seems. the next step is to go up 1/2 grain eventually.

i am just running with health being good and seeing how i go. being

able to play sport so much easier is great and just having basic

energy is great.

i will write and update people on here in a few months. hopefully

what i have done and learnt will help others in the future.

J

> Â 48 hrs is the recommened amount of time to stay off thyroid meds

before a blood test. Could be placebo effect re taking meds at night?

You want it to make you feel better, but I thought you were feeling

fantastic since starting the HC? Why change what time you your

thyroids?

>

[Guest guest]

I wonder why and how this can be, I have read about people feeling it works better by taking it at night, I have been so used to taking mine in the morning though. I might give it a try though just to see.

From: sheilaturner <sheilaturner@...>Subject: Re: blood test and stopping thyroidthyroid treatment Date: Wednesday, 27 August, 2008, 12:35 PM

 Hi - a small study has been carried out to show that most people prefer to take their L-thyroxine at night - . http://thyroid. about.com/ od/thyroiddrugst reatments/ a/bedtime. htm

Luv - Sheila

48 hrs is the recommened amount of time to stay off thyroid meds before a blood test. Could be placebo effect re taking meds at night? You want it to make you feel better, but I thought you were feeling fantastic since starting the HC? Why change what time you your thyroids?

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Send instant messages to your online friends http://uk.messenger.

[Guest guest]



http://www3.interscience.wiley.com/journal/117998170/abstract?CRETRY=1 & SRETRY=0

Conclusion: l-thyroxine taken at bedtime by patients with primary hypothyroidism is associated with higher thyroid hormone concentrations and lower TSH concentrations compared to the same l-thyroxine dose taken in the morning. At the same time, the circadian TSH rhythm stays intact. Our findings are best explained by a better gastrointestinal uptake of l-thyroxine during the night.

I wonder why and how this can be, I have read about people feeling it works better by taking it at night, I have been so used to taking mine in the morning though. I might give it a try though just to see.---

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[Guest guest]

,

You wrote:

>

>

> 48 hrs is the recommened amount of time to stay off thyroid meds before

> a blood test....

Recommended by whom? T4 has a half life of seven days, so how would 48

hours make an intelligible difference? All four of my family members,

plus our dog, have been directed to take levothyroxine as scheduled on

days of blood draws. That's four different doctors and two veterinarians.

The 48 hour withdrawal would only have a significant effect with a T3

medication.

Chuck

[Guest guest]

I have been advised that by my good knowledgable friends on here and my doctor!> > > 48 hrs is the recommened amount of time to stay off thyroid meds before > a blood test....ChuckSend instant messages to your online friends http://uk.messenger.

[Guest guest]



Hi Chuck

It was actually recommended by Professor Weetman - ex President of the British Thyroid Association. Professor Weetman acted as expert witness in Dr Skinner's Hearing at the Generl Medical Council last July (which I attended every day). In his evidence he stated that L-thyroxine should never be taken on the day of a thyroid function test because of the possibility of the results being skewed. The effect of thyroxine works different in different people. I couldn't find it this morning, there is too much to go through, but it is definitely there if you want to go through the evidence. The days Weetman gave evidence are Day 4 and Day 5. This is why I tell people not to take any thyroxine for 24 hours before the test and definitely not to take any form of T3 whatsoever.

You might be interested (and others - especially) to have a look through his 'evidence' and I have pasted just a part below. Perhaps it will help everybody to know the reason many of ous are finding it so difficult in getting a diagnosis for hypothyroidiosm (or anything else for that matter). Questions need to be asked - and - yes, he does give a definition of the 'ism' in hypothyroidism.

If you are reading this in 'Rich Text' you will be able to click on each day of the Hearing - I have pasted these below, but otherwise, go to our website www.tpa-uk.org.uk and scroll down to Dr Skinner's photograph, and you can click on the full Transcript there.

Luv - Sheila

__________________________________________

Day 4 - page 65

Q.Would you be able to give us a working definition of health or healthy?

A The absence of disease.

Q Does the patient’s view or any symptoms they complain of, is that relevant to thequestion of their health?

A A patient complains of a number of symptoms to a doctor and seeks anexplanation as to what those symptoms are due to. Doctors are aware of a large numberof diseases that may cause symptoms. As I said this morning, there are a large number ofpatients who come and have no discernible cause for their symptoms. As I mentioned,between 25 to 35 per cent of outpatient consultations are from patients who have noobvious known at present explanation for their symptoms. As I said this morning, that isnot to say that those symptoms are not real and indeed as research continues I amabsolutely sure we will find causes for those symptoms. So those patients are unhealthy,but we do not have a satisfactory explanation as yet for those symptoms and the definitionthat we give to that group of symptoms complexes are the function of somatoformdisorders.

Q You would say then that there is a lot more research that needs to be done?

A I would.

Q Are you familiar with the concept that when a patient meets the doctor it is ameeting of two experts?

A I am indeed.

Q Perhaps we can just explain that for those who may not be familiar with it?

A I think that when you meet a patient, particularly one with unexplained symptoms,in whom after extensive investigation there is no obvious cause for the symptoms, thereare three sorts of consultation that may occur. One is dismissive where the doctor maysimply say. “All of your tests are normal. Go away. There is nothing wrong.†That isclearly unsatisfactory.

There is a collusive type of consultation where the doctor may go along with the patient'sfixed beliefs and collude with them in an erroneous diagnosis or give them treatment theyfeel is necessary even when it is not necessary. The third (and to my mind the best type ofconsultation) is the empowering consultation where a doctor empowers a patient to understand that at present we have no explanation for symptoms and tries to help thepatient to adjust their lifestyle to those symptoms in order to feel better

[Guest guest]

It is quite curious that Weetman could demonstrate the need for a

fT4 test for pre-thyroid, secondary (pituitary) hypothyroidism, but

could not suggest the potential of post-thyroid deficiencies. Or

could not suggest that there were any other hormones that might have

some or all of the symptoms of hypothyroidism. Thus, his advocacy

of the " functional somatoform disorder " when there are realistic

possibilities of phsical causes for patients' symptoms is condoning,

if not instigating, mass malpractice.

If these symptoms which remain are nominally the symptoms of

untreated hypothyroidism (Baisier, Hertoghe, and Eeckhaut) and they

prompted lab test investigations, why would they not prompt lab test

investigations with a " normal " TSH?

Further, assuming normal is the center 95% of a statistical study

assumes that only 2.5% of the population has developed

hypothyroidism. That unfounded assumption is smashed by the fact in

the US over 4% of the population is being treated for hypothyroidism

and the estimate is that the total numbers should be about 9%.

This 95% assumption is really just quackery.

Saravanan, et al., found that 13% of all those treated for

hypothyroidism are not happy with their therapy. This could be that

they are under treated with levothyroxine sodium or are missing a

different hormone replacement like T3, testosterone, etc.

I believe now that any patient who is given the " nonspecific

symptom " or " functional somatoform disorder " diagnosis upon results

of the standard thyroid tests (TSH, fT4, and antibodies) should

report that physician to the authorities for malpractice. The

complaint may not go anywhere, but the process of answering the

complaint may require more labor than investigating other physical

possibilities.

Have a better day,

>

> Hi Chuck

>

> It was actually recommended by Professor Weetman - ex

President of the British Thyroid Association. Professor Weetman

acted as expert witness in Dr Skinner's Hearing at the Generl

Medical Council last July (which I attended every day). In his

evidence he stated that L-thyroxine should never be taken on the day

of a thyroid function test because of the possibility of the results

being skewed. The effect of thyroxine works different in different

people. I couldn't find it this morning, there is too much to go

through, but it is definitely there if you want to go through the

evidence. The days Weetman gave evidence are Day 4 and Day 5. This

is why I tell people not to take any thyroxine for 24 hours before

the test and definitely not to take any form of T3 whatsoever.

>

> You might be interested (and others - especially) to have a

look through his 'evidence' and I have pasted just a part below.

Perhaps it will help everybody to know the reason many of ous are

finding it so difficult in getting a diagnosis for hypothyroidiosm

(or anything else for that matter). Questions need to be asked - and

- yes, he does give a definition of the 'ism' in hypothyroidism.

>

> If you are reading this in 'Rich Text' you will be able to click

on each day of the Hearing - I have pasted these below, but

otherwise, go to our website www.tpa-uk.org.uk and scroll down to Dr

Skinner's photograph, and you can click on the full Transcript there.

>

>

> Luv - Sheila

> __________________________________________

>

>

> Day 4 - page 65

>

> Q.Would you be able to give us a working definition of health or

healthy?

>

> A The absence of disease.

>

> Q Does the patient’s view or any symptoms they complain of, is

that relevant to the

> question of their health?

>

> A A patient complains of a number of symptoms to a doctor and

seeks an

> explanation as to what those symptoms are due to. Doctors are

aware of a large number

> of diseases that may cause symptoms. As I said this morning, there

are a large number of

> patients who come and have no discernible cause for their

symptoms. As I mentioned,

> between 25 to 35 per cent of outpatient consultations are from

patients who have no

> obvious known at present explanation for their symptoms. As I said

this morning, that is

> not to say that those symptoms are not real and indeed as research

continues I am

> absolutely sure we will find causes for those symptoms. So those

patients are unhealthy,

> but we do not have a satisfactory explanation as yet for those

symptoms and the definition

> that we give to that group of symptoms complexes are the function

of somatoform

> disorders.

>

> Q You would say then that there is a lot more research that needs

to be done?

>

> A I would.

>

> Q Are you familiar with the concept that when a patient meets the

doctor it is a

> meeting of two experts?

>

> A I am indeed.

>

> Q Perhaps we can just explain that for those who may not be

familiar with it?

>

> A I think that when you meet a patient, particularly one with

unexplained symptoms,

> in whom after extensive investigation there is no obvious cause

for the symptoms, there

> are three sorts of consultation that may occur. One is dismissive

where the doctor may

> simply say. “All of your tests are normal. Go away. There is

nothing wrong.†That is

> clearly unsatisfactory.

>

> There is a collusive type of consultation where the doctor may go

along with the patient's

> fixed beliefs and collude with them in an erroneous diagnosis or

give them treatment they

> feel is necessary even when it is not necessary. The third (and to

my mind the best type of

> consultation) is the empowering consultation where a doctor

empowers a patient to

> understand that at present we have no explanation for symptoms and

tries to help the

> patient to adjust their lifestyle to those symptoms in order to

feel better.

>

> Q The patient is the expert about how they are feeling and what

their symptoms are?

>

> A As I have mentioned, an empowering consultation is exactly

designed to help the

> patient, who is the expert about their symptoms, understand them

better.

>

> Q Can we come to what hypothyroidism is because it is important

that we have

> a working definition so that we can discuss it. It is an

underactive thyroid?

>

> A Yes.

>

> Q Can you tell us how we define hypothyroidism so far as tests,

signs and symptoms

> are concerned? Is it just the blood chemistry?

>

> A No, it is not the blood chemistry because we do not believe we

should routinely

> test every single member of the population. So when a patient

describes symptoms then

> one tries to get to the bottom of them and one uses a number of

blood tests depending on

> the symptoms that the patient presents with. If a patient presents

with symptoms that are

> suggestive of hypothyroidism, one would do, as I have mentioned,

thyroid function tests.

> Laboratories differ in the thyroid function test combination that

might be used, but

> provided that you check the TSH and that is normal and provided

that you have

> established that there is no evidence of secondary hypothyroidism,

then you can be sure

> the patient is not hypothyroid.

>

> Q Can we come to the reference range and I know you have drawn a

second line as

> part of the triangle towards the right-hand side superimposed on

it. The reference range,

> what is it, a modified Poisson distribution?

>

> A No, I think it is a modified normal distribution and, as I said,

it was a log

> transformed to make it into a normal distribution.

>

> Q You have shown us how it is that 95 per cent of the patients

within that reference

> range, 95 per cent of the patients that are looked at fall within

the reference range?

> A No, these are not patients; they are healthy subjects

>

> Q Of the people who are tested?

>

> A Yes, but a patient is someone who complains of disease. The

point I made this

> morning very clearly is that one takes either a group of people

who are otherwise healthy,

> have no complaints, laboratory staff, samples that are the sent in

for screening, a variety

> of ways that one might collect such a sample of normal or one can

go the whole hog, as it

> were, and screen individuals to make sure there is not the

slightest evidence whatever of

> any thyroid abnormality and use those in your reference range and

you will still get two

> reference ranges which overlap in iodine sufficient populations.

They are not patients.

>

> Q You are getting result for specific individuals?

>

> A Yes.

>

> Q You are putting them on a chart?

>

> A Yes, and they range from one part of the reference range to

another exactly as

> height varies in a general population.

>

> Q I understand. Let us take height. Is there any problem, is there

any difficulty with

> those who are right at the bottom two and a half per cent?

>

> A Well of course height charts are produced and when somebody lies

outside of

> three standard deviations that is when one gets worried about

their height.

>

> Q Here we are dealing with two.

>

> A Here we have two. As a conservative measure and, I mentioned

this morning, that

> means that if you are lying just outside the reference range you

are very likely to be

> normal and you are very likely to be normal because we have got

that conservative

> element built in. We are not taking three standard deviations

which would include 99 per

> cent of healthy individuals, we are taking 95 per cent.

>

> Q Of any given patient, let us take a patient this time, do they

have a normal TSH

> reading? Do they have one which is specific to them?

>

> A Individuals do have set points for their TSH and these are

healthy individuals we

> are talking about, not patients again, but healthy individuals’

TSH is determined by their

> age, by their sex, by their body mass and one can show variations

at that level. There are

> genetic differences between individuals and there are differences

due to nutrition. As

> I mentioned, iodine deficient populations will give a different

TSH range, but all of these

> factors are accommodated within the reference range which is why

there is more than a

> single value which is normal.

>

> Q I understand, but if you take one individual and you measure

their TSH, is that

> going to tell you, that reading whatever it is, is that going to

be their normal TSH reading?

> A I am afraid I do not understand the question.

>

> Q How can you tell if that individual, given one reading for them,

whether that is a

> healthy TSH reading for them?

>

> A Well we know that if you repeatedly test individuals over a

period of months the

> TSH level will vary very little. Indeed, you have seen in some of

the cases that we have

> looked at that the GP has repeated the TSH level and it has varied

little.

>

> Q Could there be people outside the reference range who are

perfectly healthy? I

> think you have said they could.

>

> A Of course.

>

> Q There will be people within the reference range who are not

healthy?

> A As I mentioned to you this morning (and this is where my line

rises up) we know

> that from the Wickham Survey, which looked at a group of people

over 20 years, that if

> you followed those who had TSHs above two, there was a slight

increased risk of future

> hypothyroidism. That is the vast majority ---

>

> Q Can I interrupt you? You have turned the X axis into an axis

over time, have you

> not, by plotting that in that way?

>

> A No, it was meant to give you the idea that if you took a snap

shot of somebody’s

> TSH 20 years ago that would be a distribution of population who

later became

>

> Q Let me come back to my question. Could you have an individual

with a reading

> within the reference range for their TSH, but who was not healthy?

>

> A In general terms, of course, you can, as you have heard from Dr

Prentice, there are

> many non-specific illnesses that can affect TSH.

>

> Q I would suggest there may well be individuals who have an

underactive thyroid

> who would appear within the normal chemistry range.

>

> A I have not seen any such evidence.

>

> Q Well that is because you defined hypothyroidism as reflecting

the chemistry or

> abnormal chemistry. Is that not right? Your definition of

hypothyroid requires that the

> chemistry is abnormal that is why you cannot contemplate a patient

who is hypothyroid

> and who falls within the normal reference range?

>

> A Well that is right. I am sorry, I may have misunderstood

something here, but if a

> patient has a normal TSH and a normal 3T4 then we do not regard

that as hypothyroidism.

>

> Q The suggestion I make is that there may be patients who have an

underactive

> thyroid but whose TSH falls within the reference range.

>

> A I made the point to you this morning (and I think the Panel

probably understood it)

> that the TSH is incredibly sensitive to changes within the thyroid

hormone range and it is

> as T4 falls slightly there is a logarithmic, an amplified TSH

response and we use that

> because that helps us to determine that the TSH is very sensitive

to minor perturbations of

> T4. I also described to you this morning the reservoir effect of

thyroid hormones and the

> regulation that occurs at the tissue level for the distribution of

T3 at the tissue level and

> that is why that even when you take individuals whose TSHs lie

above the reference

> range, unequivocally above on repeat, so these are patients with

subclinical

> hypothyroidism, most of the recommendations recently have been

that treatment is not

> necessary until the TSH rises above ten. There are very few

patients who have symptoms

> it is thought within that group that will respond to treatment. So

if you like that is a

> further line of reasoning that even if one takes people whose TSHs

are just above the

> reference range, many recommendations, not all, but many

recommendations are that you

> will not need to treat even those until their TSH became ten.

>

> Q I will come back to the point I made and I suggest that there

will be patients who

> have signs and symptoms of underactive thyroid and who nonetheless

fall within the

> normal reference range, the 95%?

>

> A Except in the situation of secondary hypothyroidism where the T4

will be

> abnormal, I disagree.

>

> Q I suggest the reason why you disagree is because you define

hypothyroidism as

> meaning someone who falls outside the reference range for TSH?

>

> A That would be the same as saying someone who has short stature

if their height is

> five foot six. That lies within the reference range. You would not

say someone who is

> five foot six was short stature. You have to lie outside of a good

reference range in order

> to be considered abnormal and warrant investigation.

>

> Q Let me agree that the blood tests for TSH and T4 and T3 are very

accurate in that

> they do indeed measure what they purport to measure, components of

blood and various

> chemicals within the blood. The question is what the correct

interpretation to be placed

> on those levels is. Would you agree? To say that they are accurate

and reliable means

> that they may accurately reflect what is in them but I suggest the

important thing is the

> interpretation that can be placed upon them. The question that

arises is whether someone

> where the TSH is within the reference range, whether that actually

means that the patient

> is not hypothyroid?

>

> A All the evidence that we have so far is that that does not

exist. I have mentioned

> the need for further research. If a trial were to be done which

were to show that those

> individuals who had a free T4 of 3.5 truly benefited from

treatment and a test was devised

> which could show that, then endocrinologists would of course shift

their practice as they

> continually do, but so far no such information or evidence exists.

>

> Q Would you agree that there is a need for large scale trials and

many more? There

> have been many, many trials done but there is a certainly a need

for many more to be

> done?

>

> A I do not think †" there is no need at the moment, I believe,

for treatment of patients

> who have unexplained symptoms with normal TSH. I think that if we

had the resources

> we would put that into answering questions more with regard to sub-

clinical

> hypothyroidism where there is still some uncertainty because if

one were able to show

> definitively the treatment of TSH at levels between, let us say, 4

and 10 was useless †" and

> I think the evidence is on balance that it is not necessary but if

one was able to show that

> definitively †" then further investigation in those whose TSH

levels were lower would be

> clearly futile.

>

> Continued...........................

>

> Day 1 Day 2

> Day 3 Day 4

> Day 5 Day 6

> Day 7 Day 8

> Day 9 Day 10

> Day 11 Day 12

> Day 13 Day 14

> Day 15 Day 16

> Day 17 Day 18

> Day 19

>

>

>

> > 48 hrs is the recommened amount of time to stay off thyroid

meds before

> > a blood test....

>

> Recommended by whom? T4 has a half life of seven days, so how

would 48

> hours make an intelligible difference? All four of my family

members,

> plus our dog, have been directed to take levothyroxine as

scheduled on

> days of blood draws. That's four different doctors and two

veterinarians.

>

> The 48 hour withdrawal would only have a significant effect with

a T3

> medication.

>

> Chuck

>

>

>

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.138 / Virus Database: 270.6.9/1637 - Release Date:

27/08/2008 07:01

>

[Guest guest]

Grrrrrrrrrr!!!! How can somebody be a professor and yet be so dumb!

I hate the idea of conspiracy type theories as I feel they often just

sound paranoid BUT I can only think of two explanations why this man

is sticking to this TSH story. 1. He is thick as pigsh*t, or 2. He

has an agenda which I do not understand.

It's extremely obvious to me that if you diagnose a disease with a

test and treat accordingly to that test then you should expect that

very few people would still feel unwell(except those who have

hypochondria type disorders - presumably a small proportion of the

population).

However if many people are complaining still feel poorly once

treated, and people who's tests come back normal complain of the same

symptoms, it is obvious that there is something going wrong. Either

with the test, the treatment, or both!

To deny this in the face of the evidence of patients reminds me of

Monty Pyhton Holy Grail, when the guy cuts his limbs of one by one

and he refuses to believe it, despite blood spurting out everywhere!

Leah x

[Guest guest]

HI

It is quite curious that Weetman could demonstrate the need for a fT4 test for pre-thyroid, secondary (pituitary) hypothyroidism, but could not suggest the potential of post-thyroid deficiencies. Or could not suggest that there were any other hormones that might have some or all of the symptoms of hypothyroidism. Thus, his advocacy of the "functional somatoform disorder" when there are realistic possibilities of phsical causes for patients' symptoms is condoning, if not instigating, mass malpractice.

Could it be that Dr Skinner's Barrister failed to ask the right questions here. You are absolutely right in their dismissal of the 'non specific symptoms' not being looked at further to find the true cause. It is too easy to send us all on our way with the only diagnosis of a 'funcitonal somatorm disorder' and leave us to get on with our misreable lives. As you say, this is condoning - and how I wish we could prove malpractice. We need a lawyer - but how can we afford one. If all the thyroid organisations pooled their resources and helped each other, this might be a possibility, but this will never happen sadly.I believe now that any patient who is given the "nonspecific symptom" or "functional somatoform disorder" diagnosis upon results of the standard thyroid tests (TSH, fT4, and antibodies) should report that physician to the authorities for malpractice. The complaint may not go anywhere, but the process of answering the complaint may require more labor than investigating other physical possibilities.

Problem with this is that these patients have been left in a situation where they are too ill to go through a complaints procedure and report their medical practitioner to the right authorioty. However, anybody who finds themselves in this position, let us know and we will do what we can to help you. We are here to help each other, and we cannot allow this situation to carry on unchallenged.

Luv - SheilaHave a better day, >> Hi Chuck> > It was actually recommended by Professor Weetman - ex President of the British Thyroid Association. Professor Weetman acted as expert witness in Dr Skinner's Hearing at the Generl Medical Council last July (which I attended every day). In his evidence he stated that L-thyroxine should never be taken on the day of a thyroid function test because of the possibility of the results being skewed. The effect of thyroxine works different in different people. I couldn't find it this morning, there is too much to go through, but it is definitely there if you want to go through the evidence. The days Weetman gave evidence are Day 4 and Day 5. This is why I tell people not to take any thyroxine for 24 hours before the test and definitely not to take any form of T3 whatsoever.> > You might be interested (and others - especially) to have a look through his 'evidence' and I have pasted just a part below. Perhaps it will help everybody to know the reason many of ous are finding it so difficult in getting a diagnosis for hypothyroidiosm (or anything else for that matter). Questions need to be asked - and - yes, he does give a definition of the 'ism' in hypothyroidism.> > If you are reading this in 'Rich Text' you will be able to click on each day of the Hearing - I have pasted these below, but otherwise, go to our website www.tpa-uk.org.uk and scroll down to Dr Skinner's photograph, and you can click on the full Transcript there.> > > Luv - Sheila> __________________________________________> > > Day 4 - page 65> > Q.Would you be able to give us a working definition of health or healthy?> > A The absence of disease.> > Q Does the patient’s view or any symptoms they complain of, is that relevant to the> question of their health?> > A A patient complains of a number of symptoms to a doctor and seeks an> explanation as to what those symptoms are due to. Doctors are aware of a large number> of diseases that may cause symptoms. As I said this morning, there are a large number of> patients who come and have no discernible cause for their symptoms. As I mentioned,> between 25 to 35 per cent of outpatient consultations are from patients who have no> obvious known at present explanation for their symptoms. As I said this morning, that is> not to say that those symptoms are not real and indeed as research continues I am> absolutely sure we will find causes for those symptoms. So those patients are unhealthy,> but we do not have a satisfactory explanation as yet for those symptoms and the definition> that we give to that group of symptoms complexes are the function of somatoform> disorders.> > Q You would say then that there is a lot more research that needs to be done?> > A I would.> > Q Are you familiar with the concept that when a patient meets the doctor it is a> meeting of two experts?> > A I am indeed.> > Q Perhaps we can just explain that for those who may not be familiar with it?> > A I think that when you meet a patient, particularly one with unexplained symptoms,> in whom after extensive investigation there is no obvious cause for the symptoms, there> are three sorts of consultation that may occur. One is dismissive where the doctor may> simply say. “All of your tests are normal. Go away. There is nothing wrong.†That is> clearly unsatisfactory.> > There is a collusive type of consultation where the doctor may go along with the patient's> fixed beliefs and collude with them in an erroneous diagnosis or give them treatment they> feel is necessary even when it is not necessary. The third (and to my mind the best type of> consultation) is the empowering consultation where a doctor empowers a patient to > understand that at present we have no explanation for symptoms and tries to help the> patient to adjust their lifestyle to those symptoms in order to feel better.> > Q The patient is the expert about how they are feeling and what their symptoms are?> > A As I have mentioned, an empowering consultation is exactly designed to help the> patient, who is the expert about their symptoms, understand them better.> > Q Can we come to what hypothyroidism is because it is important that we have> a working definition so that we can discuss it. It is an underactive thyroid?> > A Yes.> > Q Can you tell us how we define hypothyroidism so far as tests, signs and symptoms> are concerned? Is it just the blood chemistry?> > A No, it is not the blood chemistry because we do not believe we should routinely> test every single member of the population. So when a patient describes symptoms then> one tries to get to the bottom of them and one uses a number of blood tests depending on> the symptoms that the patient presents with. If a patient presents with symptoms that are> suggestive of hypothyroidism, one would do, as I have mentioned, thyroid function tests.> Laboratories differ in the thyroid function test combination that might be used, but> provided that you check the TSH and that is normal and provided that you have> established that there is no evidence of secondary hypothyroidism, then you can be sure> the patient is not hypothyroid.> > Q Can we come to the reference range and I know you have drawn a second line as> part of the triangle towards the right-hand side superimposed on it. The reference range,> what is it, a modified Poisson distribution?> > A No, I think it is a modified normal distribution and, as I said, it was a log> transformed to make it into a normal distribution.> > Q You have shown us how it is that 95 per cent of the patients within that reference> range, 95 per cent of the patients that are looked at fall within the reference range?> A No, these are not patients; they are healthy subjects> > Q Of the people who are tested?> > A Yes, but a patient is someone who complains of disease. The point I made this> morning very clearly is that one takes either a group of people who are otherwise healthy,> have no complaints, laboratory staff, samples that are the sent in for screening, a variety> of ways that one might collect such a sample of normal or one can go the whole hog, as it> were, and screen individuals to make sure there is not the slightest evidence whatever of> any thyroid abnormality and use those in your reference range and you will still get two> reference ranges which overlap in iodine sufficient populations. They are not patients.> > Q You are getting result for specific individuals?> > A Yes.> > Q You are putting them on a chart?> > A Yes, and they range from one part of the reference range to another exactly as> height varies in a general population.> > Q I understand. Let us take height. Is there any problem, is there any difficulty with> those who are right at the bottom two and a half per cent?> > A Well of course height charts are produced and when somebody lies outside of> three standard deviations that is when one gets worried about their height.> > Q Here we are dealing with two.> > A Here we have two. As a conservative measure and, I mentioned this morning, that> means that if you are lying just outside the reference range you are very likely to be> normal and you are very likely to be normal because we have got that conservative> element built in. We are not taking three standard deviations which would include 99 per> cent of healthy individuals, we are taking 95 per cent.> > Q Of any given patient, let us take a patient this time, do they have a normal TSH> reading? Do they have one which is specific to them?> > A Individuals do have set points for their TSH and these are healthy individuals we> are talking about, not patients again, but healthy individuals’ TSH is determined by their> age, by their sex, by their body mass and one can show variations at that level. There are> genetic differences between individuals and there are differences due to nutrition. As> I mentioned, iodine deficient populations will give a different TSH range, but all of these> factors are accommodated within the reference range which is why there is more than a> single value which is normal.> > Q I understand, but if you take one individual and you measure their TSH, is that> going to tell you, that reading whatever it is, is that going to be their normal TSH reading?> A I am afraid I do not understand the question.> > Q How can you tell if that individual, given one reading for them, whether that is a> healthy TSH reading for them?> > A Well we know that if you repeatedly test individuals over a period of months the> TSH level will vary very little. Indeed, you have seen in some of the cases that we have> looked at that the GP has repeated the TSH level and it has varied little.> > Q Could there be people outside the reference range who are perfectly healthy? I> think you have said they could.> > A Of course.> > Q There will be people within the reference range who are not healthy?> A As I mentioned to you this morning (and this is where my line rises up) we know> that from the Wickham Survey, which looked at a group of people over 20 years, that if> you followed those who had TSHs above two, there was a slight increased risk of future> hypothyroidism. That is the vast majority ---> > Q Can I interrupt you? You have turned the X axis into an axis over time, have you> not, by plotting that in that way?> > A No, it was meant to give you the idea that if you took a snap shot of somebody’s> TSH 20 years ago that would be a distribution of population who later became> > Q Let me come back to my question. Could you have an individual with a reading> within the reference range for their TSH, but who was not healthy?> > A In general terms, of course, you can, as you have heard from Dr Prentice, there are> many non-specific illnesses that can affect TSH.> > Q I would suggest there may well be individuals who have an underactive thyroid> who would appear within the normal chemistry range.> > A I have not seen any such evidence.> > Q Well that is because you defined hypothyroidism as reflecting the chemistry or> abnormal chemistry. Is that not right? Your definition of hypothyroid requires that the> chemistry is abnormal that is why you cannot contemplate a patient who is hypothyroid> and who falls within the normal reference range?> > A Well that is right. I am sorry, I may have misunderstood something here, but if a> patient has a normal TSH and a normal 3T4 then we do not regard that as hypothyroidism.> > Q The suggestion I make is that there may be patients who have an underactive> thyroid but whose TSH falls within the reference range.> > A I made the point to you this morning (and I think the Panel probably understood it)> that the TSH is incredibly sensitive to changes within the thyroid hormone range and it is> as T4 falls slightly there is a logarithmic, an amplified TSH response and we use that> because that helps us to determine that the TSH is very sensitive to minor perturbations of> T4. I also described to you this morning the reservoir effect of thyroid hormones and the> regulation that occurs at the tissue level for the distribution of T3 at the tissue level and> that is why that even when you take individuals whose TSHs lie above the reference> range, unequivocally above on repeat, so these are patients with subclinical> hypothyroidism, most of the recommendations recently have been that treatment is not> necessary until the TSH rises above ten. There are very few patients who have symptoms> it is thought within that group that will respond to treatment. So if you like that is a> further line of reasoning that even if one takes people whose TSHs are just above the> reference range, many recommendations, not all, but many recommendations are that you> will not need to treat even those until their TSH became ten.> > Q I will come back to the point I made and I suggest that there will be patients who> have signs and symptoms of underactive thyroid and who nonetheless fall within the> normal reference range, the 95%?> > A Except in the situation of secondary hypothyroidism where the T4 will be> abnormal, I disagree.> > Q I suggest the reason why you disagree is because you define hypothyroidism as> meaning someone who falls outside the reference range for TSH?> > A That would be the same as saying someone who has short stature if their height is> five foot six. That lies within the reference range. You would not say someone who is> five foot six was short stature. You have to lie outside of a good reference range in order> to be considered abnormal and warrant investigation.> > Q Let me agree that the blood tests for TSH and T4 and T3 are very accurate in that> they do indeed measure what they purport to measure, components of blood and various> chemicals within the blood. The question is what the correct interpretation to be placed> on those levels is. Would you agree? To say that they are accurate and reliable means> that they may accurately reflect what is in them but I suggest the important thing is the> interpretation that can be placed upon them. The question that arises is whether someone> where the TSH is within the reference range, whether that actually means that the patient> is not hypothyroid?> > A All the evidence that we have so far is that that does not exist. I have mentioned> the need for further research. If a trial were to be done which were to show that those> individuals who had a free T4 of 3.5 truly benefited from treatment and a test was devised> which could show that, then endocrinologists would of course shift their practice as they> continually do, but so far no such information or evidence exists.> > Q Would you agree that there is a need for large scale trials and many more? There> have been many, many trials done but there is a certainly a need for many more to be> done?> > A I do not think â€" there is no need at the moment, I believe, for treatment of patients> who have unexplained symptoms with normal TSH. I think that if we had the resources> we would put that into answering questions more with regard to sub-clinical> hypothyroidism where there is still some uncertainty because if one were able to show> definitively the treatment of TSH at levels between, let us say, 4 and 10 was useless â€" and> I think the evidence is on balance that it is not necessary but if one was able to show that> definitively â€" then further investigation in those whose TSH levels were lower would be> clearly futile.> > Continued...........................> > Day 1 Day 2 > Day 3 Day 4 > Day 5 Day 6 > Day 7 Day 8 > Day 9 Day 10 > Day 11 Day 12 > Day 13 Day 14 > Day 15 Day 16 > Day 17 Day 18 > Day 19 > > > > > 48 hrs is the recommened amount of time to stay off thyroid meds before > > a blood test....> > Recommended by whom? T4 has a half life of seven days, so how would 48 > hours make an intelligible difference? All four of my family members, > plus our dog, have been directed to take levothyroxine as scheduled on > days of blood draws. That's four different doctors and two veterinarians. > > The 48 hour withdrawal would only have a significant effect with a T3 > medication.> > Chuck> > > > > No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.138 / Virus Database: 270.6.9/1637 - Release Date: 27/08/2008 07:01>No virus found in this incoming message.

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[Guest guest]

Hi Sheila and

[[......Could it be that Dr Skinner's Barrister failed to ask the right questions here. You are absolutely right in their dismissal of the 'non specific symptoms' not being looked at further to find the true cause. It is too easy to send us all on our way with the only diagnosis of a 'funcitonal somatorm disorder' and leave us to get on with our misreable lives. As you say, this is condoning - and how I wish we could prove malpractice. We need a lawyer - but how can we afford one. If all the thyroid organisations pooled their resources and helped each other, this might be a possibility, but this will never happen sadly.....]]

I thought so too.

I think there was a 'giveway' somewhere in amonsgt all that........'I'd expect the doctor to order more tests', or words to that effect ~ an exhausting and highly inappropriate outpatient procedure whilst the patient waits for the potential disaster to strike......one of the baddies is Long QT gap induced by low magnesium or exposure to any of the other useless 'tentative' drugs prescribable along the route ... that also cause Long QT gap ..... ~ and catastrophic cardiac arrhythmia.

It's rather unforgiving ~ oh, the doctor couldn't have known that was going to happen ( doesn't care?).....

gets the electrolytes advice wrong, or worse, don't test them and the same can happen....oh, a medical oversight !

It's funny ( well, not funny actually) that magnesium goes a long way to resolving many of the myalgia/CFS type symptoms

activating the 'pumps' that keep all the kit ticking along.

see Dr Myhill's site

Bob

> HI > It is quite curious that Weetman could demonstrate the need for a fT4 test for pre-thyroid, secondary (pituitary) hypothyroidism,

[Guest guest]

sarah s wrote:

>

>

> I have been advised that by my good knowledgable friends on here and my

> doctor!

That still doesn't explain why anyone would think that. There are some

doctors that will tell you to stay off thyroid medications for more than

a week, an Inquisitional scale torture, if ever there was one.

Chuck

[Guest guest]

Sheila,

Again it would depend on the blood test.

TSH is very slow to respond to changes in T4 input. I always wait to

take levothyroxine until after the blood draw, even for just a TSH, but

that is not because the doctor told me to do so. OTOH, a T4 assay would

definitely be affected. T3 takes an hour or two to kick in, but it would

also jump. With a T3 medication, T4 would not be affected, but T3 would

definitely spike.

Chuck

[Guest guest]



Hi Chuck

Staying off T4 for a week will not make much difference to how a person felt because there is still a good amount of T4 in the system. As it converts (or should) to T3 and the T3 has a very short half life, it is best to stop it for 24 hours before a test. You must might be one of the people where the peak in T3 would show, and you would run the risk of the doctor cutting back on your thyroid medication. Play safe, whatever the science might try to tell us. Now - being off T3 for a week - that would be something else, even being off T3 for a day for some people can be pretty awful.

Sheila

That still doesn't explain why anyone would think that. There are some doctors that will tell you to stay off thyroid medications for more than a week, an Inquisitional scale torture, if ever there was one.ChuckNo virus found in this incoming message.

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[Guest guest]

>

Hi Sheila and Chuck

I am afraid this is simply not true for everyone. I take mine at

night and by the next night I am gagging to take it knowing full

well if I forget I will feel the effect of 1 missed dose of T4 the

next morning. I cannot imagine the terrible state I would be in

leaving it off 1 week.

Chris

> Hi Chuck

>

> Staying off T4 for a week will not make much difference to how a

person felt because there is still a good amount of T4 in the

system.

>

> Sheila

>

>

>

> That still doesn't explain why anyone would think that. There

are some

> doctors that will tell you to stay off thyroid medications for

more than

> a week, an Inquisitional scale torture, if ever there was one.

>

> Chuck

>

>

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.138 / Virus Database: 270.6.10/1638 - Release Date:

27/08/2008 19:06

>

[Guest guest]

Hi Chris

This is so true for some people, and I know you have been taking thyroid hormone replacement since you were a little tot. You are one of the people who does, however, need to stop your T4 for 24 hours because the way your body reacts to T4 because your results could well be skewed. We have had so many of our members who have taken their medication the day of the blood test and their doctors have told them they need to reduce their meds.

You should get a blood test done early in the morning and take your L-thyroxine with you and take it immediately after you have had your blood drawn. However, you are one of the rarer birds, many of us can stay off our T4 for a few days without feeling any effect whatsoever - as has had to do of necessity recently, though I would suspect she may start to feel a lack of her T4 soon.

Luv - Sheila

>Hi Sheila and ChuckI am afraid this is simply not true for everyone. I take mine at night and by the next night I am gagging to take it knowing full well if I forget I will feel the effect of 1 missed dose of T4 the next morning. I cannot imagine the terrible state I would be in leaving it off 1 week. Chris> Hi Chuck> > Staying off T4 for a week will not make much difference to how a person felt because there is still a good amount of T4 in the system. > > Sheila> >

..

No virus found in this incoming message.Checked by AVG - http://www.avg.com Version: 8.0.169 / Virus Database: 270.6.13/1641 - Release Date: 29/08/2008 07:07

[Guest guest]

Hi Sheila

On reading what you have just written, something really frightening

has just dawned on me and that is that I could be actually ADDICTED

to thyroxine and maybe it is withdrawal symptoms I get if I dont

take it such as waking up with anxiety, headache, unable to co-

ordinate properly etc etc. I've never thought it as a drug just a

hormone and I know I've said it before but I never realised just how

dependant I am on it. Is there any way an addiction can be possible,

do we know if thyroxine is addictive. I take nothing else at all.

Chris

>

> Hi Chris

>

> This is so true for some people, and I know you have been taking

thyroid hormone replacement since you were a little tot. You are one

of the people who does, however, need to stop your T4 for 24 hours

because the way your body reacts to T4 because your results could

well be skewed. We have had so many of our members who have taken

their medication the day of the blood test and their doctors have

told them they need to reduce their meds.

>

> You should get a blood test done early in the morning and take

your L-thyroxine with you and take it immediately after you have had

your blood drawn. However, you are one of the rarer birds, many of

us can stay off our T4 for a few days without feeling any effect

whatsoever - as has had to do of necessity recently, though I

would suspect she may start to feel a lack of her T4 soon.

>

> Luv - Sheila

>

>

[Guest guest]

Hi

I've just been reading up on Naltrexone.....

It'll take a few days to get this sorted in my mind; one or other kappa-

opioid antagonists may help.

I don't know if there is an 'addictive' component to thyroxine use.

best wishes

Bob

> Hi Sheila

> On reading what you have just written, something really frightening

> has just dawned on me and that is that I could be actually ADDICTED

[Guest guest]

Hi Bob

It would be very interesting to know if this is what should be

expected to happen when you are on it all your life.

Chris

>

> Hi

>

> > I don't know if there is an 'addictive' component to thyroxine

use.

>

>

>

[Guest guest]

Thats true but I have been off all my T4 for nearly 3 weeks now and dont miss it, I feel no worse or no better!

From: chrischids <no_reply >Subject: Re: blood test and stopping thyroidthyroid treatment Date: Friday, 29 August, 2008, 9:53 AM

>Hi Sheila and ChuckChris> Hi Chuck> > Staying off T4 for a week will not make much difference to how a person felt because there is still a good amount of T4 in the system. > > Sheila> > > > That still doesn't explain why anyone would think that. There are some > doctors that will tell you to stay off thyroid medications for more than > a week, an Inquisitional scale torture, if ever there was one.> > Chuck> > > > No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.138 / Virus Database:

270.6.10/1638 - Release Date: 27/08/2008 19:06>Send instant messages to your online friends http://uk.messenger.

[Guest guest]

Hi

I'll keep it on the radar screen for reading...next few days

Bob

> Hi Bob

> It would be very interesting to know if this is what should be

[Guest guest]

As it happens Chuck I am on day 18 of no thyroxine and feel no different from not taking!

I stopped for just over week then started cortisone for my adrenals and have been on that for a week on its own, one more week and I am re starting the thyroxine so it does show some people can stop the T4 and still have enough in their system to not miss it, I will have been off it for over 3 weeks when I restart it, I wouldnt consider it torture and if it was I would be taking it again pretty quick and moaning!!!> > > I have been advised that by my good knowledgable friends on here and ChuckSend instant messages to your online friends http://uk.messenger.

[Guest guest]

Hi

I agree, I dont in any way feel phychologically addicted to it at

all, if my body didnt need it I would have no problem with

forgetting it all together and not taking it.

Chris

>

> I'm not Sheila, but I think you can be psychologically addicted to

darn

> near anything. I don't think you can be physiologically addicted

to

> T4, but as I posted before I'm no expert...

>

> Luck,

>

>

> >

> >

[Guest guest]

Hi - it takes up to 6 weeks for thyroxine to get completely out of your system, so you can still chug along for a fair old time with just a little T4.

Sheila

That does seem strange, given that the half life of T4 is 6.7 days. I'll bet most people could not tell any difference whatsoever if they forgot a dose, even if they were terribly under treated. But then we're all different...Luck,..>> Fri Aug 29, 2008 2:04 am (PDT)>> > >> Hi Sheila and Chuck>> I am afraid this is simply not true for everyone. I take mine at> night and by the next night I am gagging to take it knowing full> well if I forget I will feel the effect of 1 missed dose of T4 the> next morning. I cannot imagine the terrible state I would be in> leaving it off 1 week.>> Chris

No virus found in this incoming message.Checked by AVG - http://www.avg.com Version: 8.0.169 / Virus Database: 270.6.13/1641 - Release Date: 29/08/2008 07:07