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Ann Milton's Researcher asked me for a further question that she could ask in The House. I sent him the following with the question I thought most appropriate at the end.

Luv - Sheila

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Hi ,

First, the link to the ‘Clinical Knowledge Summaries’ web site doesn’t work, as recommended by Ann Keen. So we cannot check the contents. Second, there is overwhelming medical evidence to show that the treatment of hypothyroidism and its mimics does not work for all sufferers and that the proscribed hormone (T3) is needed as it is the predominant hormone for post thyroid

Ann Keen has not answered the question as to the correct definition of ‘hypothyroidism’ satisfactorily. She touched on the narrow (first) and the broad (second) definitions. These are not physiologically equivalent.

The first definition focuses upon the deficiency in the secretion of hormones by the thyroid gland. The second definition focuses upon the deficiency of thyroid related hormones in the blood or body. The second definition encompasses any somatic function that impacts the thyroid related hormones in the blood or body, not just the thyroid gland.

The definition of hypothyroidism is made even more critical when considering the prescribed therapy (Levothyroxine Sodium (T4)) which replaces the primary thyroid gland hormone, thyroxine (T4), and the proscribed therapies (containing triiodothyronine (T3) which is the predominant post thyroid hormone, essential for normal bodily function. This proscription is then only compatible with the narrow (first) thyroid gland definition and is not compatible with the broad (second) definition.

Therefore the double definition given by Ann Keen has a significant problem. The narrow (first) component is acceptable - the second half is not acceptable as it is not compatible with the new guideline on ‘the diagnosis and management of primary hypothyroidism’ produced by the British Thyroid Association and the Royal College of Physicians, which proscribe any prescription of T3 hormone replacement. This does, and will continue to cause real and serious harm to those patients who have post thyroid deficiencies.

The lack of a single definition for “hypothyroidism” and the general, but routinely ignored, demand for clarity, requires the stipulation of its definition. Such stipulations were recognised by 17th Century linguists, are part of the standard of care in legal documents, are a part of required clarity for medical practice guidelines, and specifically required by a protocol for the authorship of guidelines.

“Careful use of definitions can clear up many disputes arising from the ambiguity of expressions which one disputant takes in one sense, and other in another sense. . . When the idea we want to express by some word is not indicated precisely and clearly enough, it is almost impossible to avoid equivocating in the course of an argument. – Antioine Arnold – 17th Century

If this linguistic standard of care was met and logical consistency was maintained, patients would not suffer needlessly and doctors would not be prosecuted wrongly. If the definition of “hypothyroidism” was stipulated narrowly to the thyroid gland, then the scope or jurisdiction of the guidelines would be limited to the thyroid gland, and the doctor could then treat his patient ethically for non-thyroid and post-thyroid aetiologies. Alternatively, if the definition of “hypothyroidism” were broad and logical consistency maintained, the medical practice guidelines must embrace the post-thyroid aetiologies with appropriate diagnostics and maintenance measures. Unfortunately, for both patient and doctor, neither is done.

It is a real depravity that the victims of post thyroid deficiencies are relegated to misery for the rest of their lives by medical practitioners who ignore medical science that has been available for 40 years. It is even a greater depravity that these victims are ignored by a medical system that claims to hold patient concerns paramount. When can we expect positive government action on this without, once again, referral to the British Thyroid Association as the ONLY source of opinion on this matter, which will merely evince its well worn ‘blinkered’ response?

As there have now been over 60 'clicks' to show Ann Keen's response to the question was not satisfactory, and because of the many comments as to the reason why, please could Ann follow this up by asking the question:

Q: Will the Department now agree the scientifically correct definition of ‘hypothyroidism' that encompasses both the post thyroid hormone deficiencies and the deficient production of hormones produced by the thyroid gland?

Kind regards

Sheila