Re: how is T4 converted to T3

[Guest guest]

Hi Nadia,

You need to focus on whether you feel well or not. If you feel well then nothing

else matters.

For any thyroid patient who does not feel well on T4 then the journey begins.

You start by trying to use either natural thyroid or T4/T3 or even NT/T3.

Some people do well on these medications and do find that by experimenting with

various T4/T3 ratios and levels that they get well.

Your current dosage is not extravagantly out of the ordinary in any way.

If you ever get to the point where you feel that this medication is failing you

then you have the option, with your endos support, to try combinations with

higher T3 and lower T4 and eventually, if nothing else works, to try T3 on its

own. Most people find good solutions with T4/T3 or natural dessicated thyroid

without having to resort to T3.

Don't worry about your own thyroid status. The problems you are now having with

getting thyroid hormone to work correctly is almost certainly nothing to do with

how much your thyroid has been destroyed. The problems may be connected with any

autoimmune reaction that did occur within your body but the level of thyroid

destruction is not important at this point.

You will only be able to tell if your thyroid had eventually been destroyed by

having an FT4 test when you are not taking any T4 medication. This test is

really rather pointless though as it won't inform what your problems are or what

your should do about them. Forget it. Just get on and try and find a good

solution - trial and error is the order of the day.

You appear to be on the right track of starting this trial and error process.

Don't forget that iron, folate, B12 and vitamin D can also have a profound

effect on thyroid hormones and that these need to be at very good levels in

order to allow thyroid hormones to work well.

Don't just accept the GP's assessment of iron, B12, folate and vitamin D either

- check the actual results against what thyroid patients have experienced as

being acceptable levels of these.

Take care,

>

> Hi, I have Hashis and was just wondering how T4 is converted to T3? Reason for

the question is that I read soemthing in a recent post about going onto T3 only

if you don't have a working thyroid. If that's the case, how do I know when

Hashi's has finished destroying my thyroid?

>

> I'm on T4/T3 combo from GP (100mcg and 20mcg) respectively which I take in the

morning about 6.30am, and up til now I was taking another 125mg (2 gr I think)

erfa at 12pm. I just had to increase this today by 1/2 a 125mg efra tablet (so 1

more gr) in the morning too as things have stopped working and I wonder what's

going on in there! Any comments on my level of meds welcome too.

>

> Thanks

> Nadia

>

[Guest guest]

there are other things to consider, too, eg estrogen:

http://www.space-age.com/hypothyroidism.html

Estrogen Dominance & Thyroid Function

Estrogen causes food calories to be stored as fat. Thyroid Hormone causes fat

calories to be turned into usable energy. Thyroid Hormone and Estrogen therefore

have opposing actions.

Estrogen dominance inhibits Thyroid action and lowers the rate of metabolism of

the Body. Natural Progesterone inhibits Estrogen action.

The symptoms of Hypothyroidism may also occur because of Estrogen Dominance

(deficiency of Progesterone). Hypothyroidism, which results in weight gain and a

host of other symptoms, can be corrected by the presence of Natural Progesterone

in the body. Natural Progesterone levels can be enhanced in the body by

supplementation of the diet with Herbal Dietary Supplement Wild Yam during the

perimenopausal years and once corrected can be easily maintained by increasing

the intake of Protein rich Food in the Diet - 2 bowls of Mung Sprouts per day is

adequate in most cases to continue maintaining your Body in a Hormonally

Balanced state. To increase Progesterone levels during the Menopausal years,

topical application of Progest Gel containing Bioidentical Progesterone Hormone

is recommended..

> Don't forget that iron, folate, B12 and vitamin D can also have a profound

effect on thyroid hormones and that these need to be at very good levels in

order to allow thyroid hormones to work well.

>

[Guest guest]

I didn't respond to the question that is stated in your title because the body

of your message doesn't come back to the question of how T4 is converted to T3.

Here is some more information on T4 to T3 conversion:

A significant amount of the circulating T4 is converted into T3 by the cells in

the liver and kidneys. The remaining T4 is converted in the gut and in other

peripheral tissues throughout the body. The T3 converted from T4, as well as the

relatively small amount of T3 produced by the thyroid gland itself, increases

the level of circulating T3 in the bloodstream. Although the thyroid gland does

produce some T3, it is thought that around 80% of the circulating T3 is derived

from conversion from T4, primarily by the liver and kidneys.

It is essential to understand that it is only the T3 thyroid hormone that is the

biologically active thyroid hormone within our cells. T3 can only achieve this

biological action, once it is inside the cells. T3 does nothing of any use when

it remains in the bloodstream.

I could write a lot more on this but this is probably enough at the moment. I

doubt that T4 conversion is something that you ought to be worried about.

There is a lot of scaremongering about T4-T3 conversion and high rT3 levels.

This is based on lack of information. Sometimes, rarely, people can have a

conversion issue. More often there are nutrient issues or other cellular

barriers to thyroid hormone rather than just conversion of T4 to T3.

T4 to T3 conversion issues have been latched onto by many people as a simplistic

explanation of why thyroid hormone doesn't work. For a few folks this is the

real issue for many others there are other classes of cellular issues that

prevent normal levels of thyroid hormones from working as nature intended them

to.

Good luck and take care,

Please fire back any more specific questions that you have.

[Guest guest]

is right - there are a multitude of other considerations.

Only you can tell what was at the heart of your original posting. We often try

to answer the question that has been posted but in actual fact there was another

question or questions sitting behind the original question.

Take care,

>

> there are other things to consider, too, eg estrogen:

>

[Guest guest]

Hi

Please can you explain why you think this (see below) as they are pretty much

the opposite of what i've read and what's advised by various authorities? Why

would people need to take any t3 if they could convert ok? I have read that

it's not that many people can't convert, but cannot convert fast enough for the

bodies demands.

Just interested why you think this... have you read this:

http://nahypothyroidism.org/deiodinases/ - that explains a lot about the

various mechanisms, rt3, conversion etc.

i think what you've written is too simplistic...and i don't really agree with

it. :-)

i do not think that it is rare for people not to be able to convert t3 fast

enough (that is the key point, can they convert fast enough)

chris

>There is a lot of scaremongering about T4-T3 conversion and high rT3 levels.

This is based on lack of information. Sometimes, rarely, people can have a

conversion issue. More often there are nutrient issues or other cellular

barriers to thyroid hormone rather than just conversion of T4 to T3.

>T4 to T3 conversion issues have been latched onto by many people as a

simplistic

explanation of why thyroid hormone doesn't work. For a few folks this is the

real issue for many others there are other classes of cellular issues that

prevent normal levels of thyroid hormones from working as nature intended them

to.

[Guest guest]

HI,

It's thought that about 16% of people don't convert from T4 to t3.... often

given as a T4 failure rate....

here is one theory (genetic) as to why this happens:

http://www.goodhormonehealth.com/geneticvariation%20.pdf

.

>

> There is a lot of scaremongering about T4-T3 conversion and high rT3 levels.

This is based on lack of information. Sometimes, rarely, people can have a

conversion issue. More often there are nutrient issues or other cellular

barriers to thyroid hormone rather than just conversion of T4 to T3.

>

[Guest guest]

MODERATED TO REMOVE MOST OF PREVIOUS MESSAGE: PLEASE DELETE MOST OF PREVIOUS

MESSAGE YOU'RE RESPONDING TO AND LEAVE JUST A SENTENCE OR TWO.

Hi

To be honest I can't make head or tails of your question.

Can you be very precise about the question.

Also - if you are going to state 'authorities' then be specific about who they

are.

As for my previous statements. Let me try and be more clear.

A lot of people immediately state that T4 to T3 conversion is 'The Issue'

whenever thyroid hormones don't actually work right. A lot of people suggest

that reverse T3 syndrome is the cause when thyroid hormones don't work right.

Actual researchers tend to find that life is a lot more complex than this. One

tiny example of this is the findings of Lowe in the USA. When faced with a

large number of patients for whom T4 did not work he assessed rT3 levels in

order to determine if there was any fundamental evidence for T4 to T3

conversion. The conclusion was simple - there was no obvious evidence for it.

Speed of conversion is an even more narrow interpretation and one that I've been

lucky not to hear of before today.

Many people are making money out of the 'idea' of T4 to T3 conversion issues. In

actual fact there are many causes of the failure of T4. Not one. Not two. Not

three etc.

There is little point pinning our hopes on a single theme or cause because the

medical research suggests multiple causes.

The result is the same. Hypothyroid symptoms in the presence of normal thyroid

blood test results. OF COURSE some people do have problems with one or more

deiodinase enzymes. Yes, I know the biochemistry of these intimately and how

they are produced and used. However, the failure of deiodinase enzymes are only

ONE of many causes of T4 failure.

Converting T4 OK is not enough if the hormones can't get through to the nuclear

thyroid receptors or mitochondria. Imagine if there are blockages between the

thyroid hormones and their targets. Several of the causes of T4 failure involve

blockages to thyroid hormone of one form or another. Perfect cellular levels of

thyroid hormone will still result in poor cellular activity if there are

blockages. In this case, even with perfect T4 conversion the only way to

overcome these 'blockages' is to introduce a higher density of T3 into the

cells, thus enabling a higher hit rate of T3 to the cell nuclei and

mitochondria.

I could list all the reasons for blockages to thyroid hormone - but you'll have

to wait for my book.

Also I don't believe anything is 'rare', I just think that there are many

different causes of problems. I get tired of hearing the same old simplistic

explanations that are hawked around - often my people with an 'angle' or a

reason to make money out of people.

I'm not going to argue about this anymore - if you post a counter argument I

won't reply. I'm tired of trying to be a voice of reason in a world where people

appear to want only simple explanations - even though the simple explanations

don't actually explain all the various cases.

Take care,

>

> Hi

>

> Please can you explain why you think this (see below) as they are pretty much

the opposite of what i've read and what's advised by various authorities? Why

would people need to take any t3 if they could convert ok?

[Guest guest]

Sorry but I don't think the medical research supports a certain percentage of

poor conversion.

If you are referring to the WATTS study then this is only one large study. Run

in part by my own endo and in my own neck of the woods. It drew conclusions

about well being and associated this with a genetic defect which impairs one of

the deiodinase enzymes. I know the study well and have referred to it many

times.

Here is what I've already written about the Watts study (elsewhere):

A recent study in the UK highlights a potential genetic defect that affects

critical enzymes involved in the processing of thyroid hormone within the

tissues. This problem cannot be detected by TSH, FT4 or FT3 thyroid blood tests,

yet may prevent patients from feeling well on T4 replacement therapy.[6]

The study analysed over six hundred, hypothyroid patients treated with T4 and

combined T4 and T3 replacement therapies and looked at whether genetic defects

might lead to problems with the deiodinase enzymes responsible for processing

thyroid hormones, including the conversion of T4 into T3. This was the largest

and most comprehensive study to date, involving hypothyroid patients treated

with T4 and combinations of T4 and T3.

Defective gene linked to poor health on T4, patients on T4/T3 healthier

This study concluded that some patients only achieve an improved sense of well

being when taking a combination of T4 and T3. The results identified that a

commonly impaired gene (DIO2), is associated with a poor sense of patient health

when on T4 replacement. The impaired gene is associated with problems with one

of the deiodinase enzymes involved in the conversion of T4 to T3. However, this

impairment is undetectable in blood tests, as the problems occur entirely within

the cells of the body. Patients on a combined T4/T3 replacement fared

considerably better, despite possessing the same genetic defect.

The results of the study have encouraged some inspired doctors to make public

statements emphasising that the medical profession should take patients far more

seriously, if they claim that they do not feel well on T4 replacement therapy.

This is particularly worrying because these patients may possess normal thyroid

blood test results, despite the fact that hypothyroid symptoms may persist. One

doctor even stated that patients in these circumstances should be asking for a

combined T4/T3 treatment option, because it is likely that T4, on its own, is

unable to replenish the reduced intra-cellular levels of T3.

There is no reason to believe that this is the only cause of defects in, or

diminished levels of, critical enzymes involved in thyroid hormone metabolism

within our cells.

You can't take the study results and conclude 16% of a population have

conversion problems. Sorry - not possible. Yes, conversion issues do exist and

form a part of the great tapestry which is our crappy thyroid hormone

metabolism.

But is is only one issue. Because it is only one issue there is no point for the

majority of us to assume that this is our own issue. Only when the researchers

have definitive tests for all the failure modes and measures of effective

thyroid hormone metabolism will we be able to do anything useful with this

information.

If all our doctors were less inclined to latch on to specific causes of T4

failure then we'd be a lot better off. The level of misinformation is

astonishing, given that the published medical research is very clear that MANY

CAUSES OF T4 and THYROID HORMONE FAILURE EXIST. Not just one. Not conversion.

Not rT3. MANY.

Enough said.

> >

>

> > There is a lot of scaremongering about T4-T3 conversion and high rT3 levels.

This is based on lack of information. Sometimes, rarely, people can have a

conversion issue. More often there are nutrient issues or other cellular

barriers to thyroid hormone rather than just conversion of T4 to T3.

> >

>

[Guest guest]

Hi

Ok you have me interested now.

So can you tell me when your book is out? Who is the intended audience?

I am not looking to argue, sorry, I did sound argumentative. My bad, as they

say. :-) I just want to find what works!

Chris

[Guest guest]

>>>The impaired gene is associated with problems with one of the deiodinase enzymes involved in the conversion of T4 to T3<<<<

Could this impaired gene suddenly come about or would you be born with it?

Lilian

[Guest guest]

Hi

No probs. All of us have slightly off days - god knows I know I do.

If you have any specific questions regarding 'what works' then post them - maybe

there is someone who can help.

As for the book - I'm hoping sometime in the next 3-6 months.

It is going to be called 'Recovering with T3 - my journey from hypothyroidism to

good health using the T3 thyroid hormone' and will be aimed at both patients and

doctors.

It will cover my personal journey from ill health on T4 due to Hashi's through

to eventually getting well on T3 only. I cover everything I have learned and

observed and discovered about T3 and thyroid problems along the way - including

anything I have mentioned here. It is highly technical because trying to use T3

correctly requires more understanding than needed when using any other thyroid

hormone. Because of this it is possible that the book may be of use to people

using other thyroid hormones also - because of the level of background

information.

Anyway, it is written and is in the final stages of being reviewed by some key

people - including your very own forum owner - Sheila.

Take care,

> I am not looking to argue, sorry, I did sound argumentative. My bad, as they

say. :-) I just want to find what works!

[Guest guest]

,

Would your book cover people who do not have Hashi? Are you discussing T3 for people who have normal blood results?

My blood results after many successful years on thyroxine alone, then showed low TSH, T4 on lowest number of reference range and T3 below reference range. I was told it was a conversion problem but now think it is probably a lazy pituitary (to put it simply) as there is nothing they can find wrong with it.

I am fine on Armour and a little added T3 - or I think I am fine, until I know what fine really is like I don't know. I know I am much better than I was.

Will your book cover problem like mine?

Also there are some people, like me, who only understand simple answers. I have never studied chemistry or anything else medical so it has to be very simply explained

Lilian

[Guest guest]

Hi Lilian,

Well tricky. A better question might be: Could someone with this type of problem

develop issues later in life rather than immediately at birth? To this second

question I'd say a definite 'Yes', because many other impairments may come into

place as we age and have less efficient metabolisms that could then allow any

genetic impairment to have a greater effect.

In terms of your original question - I don't think the research is in place to

answer it. My guess is that people are born with it. However, with age, free

radicals etc genetic material in our cell nuclei do get damaged - so I guess it

might be possible. The only answer I can really give to that is that I don't

know - sorry.

> Could this impaired gene suddenly come about or would you be born with it?

>

> Lilian

>

[Guest guest]

Hi Lilian,

The book is not restricted to Hashi's patients. In fact I frequently mention

that thyroid blood tests can appear quite niormal (as Sheila has also stated in

many places on this forum) and yet at the cell level bad things can be going on

to make normal levels of thyroid hormone simply not work correctly.

I even believe that many people are wondering around with diagnoses like ME,

fibromyalgia, chronic fatigue syndrome, depression or are simply unnaturally

dog-tired all the time and have been tested for thyroid hormones and have been

pronounced 'normal' in terms of thyroid. Hence, some of these (not all

obviously) may be walking around with labels that they will probably have for

life and yet there at a cellular level is a thyroid issue - that might respond

to NT, T4/T3 or T3. These people are in the most unfortunate group. Without a

radical breakthrough in thyroid research these people will never get a thyroid

diagnosis and never be given a trial of a thyroid drug like T3.

The book does focus heavily on my experience with T3. There is no book currently

that covers in detail the use of T3 and it is this need that I'm trying to

address. It is also not that simple because the problems themselves aren't

fundamentally simple. I have reviewed it with about 10 thyroid patients so far

and none of them have found it too difficult though. When you have a need for

information you tend to work at it until you have it in your grasp.

Take care,

> Would your book cover people who do not have Hashi? Are you discussing T3

for people who have normal blood results?

[Guest guest]

Thanks for you two answers to my questions and I look forward to having a good read.

There is a clinic in London who get the gene tested for T3. They say it is a new thing and have to send abroad to do it.

One of the doctors there was the one I went to when my GP said there was nothing wrong and he prescribed the T3 so I think it is quite reputable.

I was debating whether or not to try this. What is your opinion please.

Lilian

[Guest guest]

I don't think I'm allowed to give specific advice to people.

If you mean - what is my opinion about using T3 then I'd have to say that this

is something you should discuss with your own medical advisor.

If you mean - should you have the test. I'd say probably not because it won't

change a thing in terms of what medication you need to get 100% well.

I'm not sure what decision you are trying to make. One thing is very clear to me

and that our lives disappear in tiny pieces, so small that we don't notice them.

One day we look up and many years have gone by and we realise we have been ill

during it all.

Time is very precious Lillian - use it wisely. Investigate trials of different

treatments, investing only enough time in each to work out if they are going to

work or not.

Remember also that all your nutrients need to be at good levels (iron, B12,

folate, D etc) and that issues like gut health and blood sugar balance can all

play a part.

Find a doctor who you can work with quickly and effectively to try different

forms of treatment - which may include natural thyroid or T4/T3 or even T3.

Time is precious - it is one of the most important things to be managed when you

have thyroid disease and are searching for solutions.

Good luck.

>

> I was debating whether or not to try this. What is your opinion please.

>

> Lilian

>

[Guest guest]

Yep I got it slightly wrong.... on the first page of the TPA web site, we refer

to the 13% who are acknowledged as T4 'failures'.

" WHY are medical associations ignoring the 13% failure rate of T4-only therapy

for the past 50 years? Why are patient's complaints dismissed? "

I just read some more on the link I sent about the Watts study, and it's

thought that 16% of those 13% failures have a defective gene.....

That means that for every 100people taking T4 only, 13 of them are thought to

fail and 2 of these may have the defective gene.

Thank you for pointing out my rubbish maths...

>

> Sorry but I don't think the medical research supports a certain percentage of

poor conversion.

>

> You can't take the study results and conclude 16% of a population have

conversion problems. Sorry - not possible. Yes, conversion issues do exist and

form a part of the great tapestry which is our crappy thyroid hormone

metabolism.

>

>

>

[Guest guest]

>

> I even believe that many people are wondering around with diagnoses like ME,

fibromyalgia, chronic fatigue syndrome, depression or are simply unnaturally

dog-tired all the time and have been tested for thyroid hormones and have been

pronounced 'normal' in terms of thyroid. Hence, some of these (not all

obviously) may be walking around with labels that they will probably have for

life and yet there at a cellular level is a thyroid issue - that might respond

to NT, T4/T3 or T3.

>

This is exactly what happened to me .

I was diagnosed with " post viral immune deficient chronic fatigue " after

suffering with Epstein Barr Virus nine years ago and was offered Prozac and told

to " go home & rest. "

I was determined that I should be tested for anything that might be treatable

and I pushed & begged my doctors to do various tests including thyroid but they

only tested my TSH and I was told it was " normal " .

It's only because my DENTIST mentioned DR P and told me to get my adrenals &

thyroid checked properly that I got soem tests done privately and found out I

have thyroid auto antibodies, low cortisol & DHEA and high arsenic & uranium!

I havent started any thyroid meds yet as I am still working on my adrenals but

at least I feel I am heading in the right direction now instead of being left to

rot at home!

I know a few other people who have been diagnosed with ME & Fibromyalgia and I

have been mentioning to them that they should get their adrenals & thyroid

checked out properly, but some people seem to cling to their diagnosis of ME or

CFS. Personally, I will be glad to be rid of it and hope to be well again after

nine long years. I want to prove the doctors wrong!

Anyway, rant over lol! I look forward to reading your book as Dr P recommended I

try T3 when I am ready.

Best wishes,

. x

[Guest guest]

Because it is only one issue there is no point for the majority of us to assume that this is our own issue. Only when the researchers have definitive tests for all the failure modes and measures of effective thyroid hormone metabolism will we be able to do anything useful with this information.Would you say then , that it would be reasonable for patients who are not feeling better to be allowed a trial of T3 with or without their T4, in the absence of adequate testing?

Dr Broda and Dr Peatfield in his book and other's too suggest a trial is a reasonable way forward, when blood test results and sympotms/clinical findings etc don't tally. Very often these docs used/use NDT or T4 but why shouldn't the same apply to T3, until such time that we can adequately test. Interested in your thoughts. xx

[Guest guest]

Some disorders and diseases appear to lay dormant but when the right situation occurs then the switch turns ON and the disease becomes a reality. Also many things happen to our body in life, environmental stuff is all around us, ageing, poor nutrition which can have a big impact on how our body is able to function. I agree about free radicals, DNA damage cell mutations etc. Who knows what occurs. Certainly in my own situation there are certain things I can now look back, and identify some which go toward the ill health I suffer today.

I would argue we should eat less meat/animal protein and more fruit and vegetables. The human body is most unusual in that it doesnt have the capacity to make vitamin C; most other animals do make vitamin C. Those animals that dont have the capacity to produce vitamin C are vegetarians such as the fruit eating bat and the Guinea pig (and humans). All animals who depend on a diet dependant upon meat CAN make vitmin C. All those animals who are predators make theri own vitamin C.

Vitamin C is an anti-oxidant, essential for fighting free radicals, we need large amounts of vitamin C each day and each 4hours through the day as we loose this water soluable substance easily. Those animals who do not make Vit C (should) eat and graze on fruit and veg, thus ensuring a constant supply of this it since we do not have the capacity to store vitamin C in our body; (we lost this capacity as we have evolved). It is only since we have organised our lives in the way we do eating 2-3 (predominatntly carbohydrate, fat and protein) cooked meals, that this has changed. So our western lifestyle, diet and farming methods/food production if you like has altered how we eat.

Further we get B12 from fish and meat. We can store vit B12 and we store it for a very long time 5-7 years, further we only need a very small amount of B12, but we do need it as we all know. This is the one viitamin denied to vegans and some vegetarians. Too much animal protein, especially meat causes digestive/bowel problems (i.e. we know there is a raised incidence of bowel cancer in meat eaters compared to vegetarians - probably due to low roughage/fibre in meat eaters diet), but this also raises our homocysteine levels and these raised levels are known to cause heart disease in humans. So in saying all of this I am supporting the fact that a good diet is essential and although a simplistic consideration it is no less important for that in my opinion. xx

I'd say a definite 'Yes', because many other impairments may come into place as we age and have less efficient metabolisms that could then allow any genetic impairment to have a greater effect.In terms of your original question - I don't think the research is in place to answer it. My guess is that people are born with it. However, with age, free radicals etc genetic material in our cell nuclei do get damaged - so I guess it might be possible. The only answer I can really give to that is that I don't know - sorry.> Could this impaired gene suddenly come about or would you be born with it? > > Lilian>

[Guest guest]

Stick with it , it can be a long road to good health but you'll get there.

I had EBV also (but 10 years prior to the Hashi's diagnosis).

Please make sure you have vitamin D tested - 25 hydroxy vitamin D test. Also,

depending on the result take vitamin D supplementation. If it is low then

consider a vitamin D intake in the range of 5000-10,000 IUs per day. It in the

lab range then take 2000-5000 IUs or none if you are out in the sunshine a lot

in the summer months.

Keeping vitamin D levels at the high end of normal is linked to a calming of the

immune system and will potentially halt the autoimmune response

If you have any other issues that are a stress on the immune system - like a

sensitivity to dairy or wheat/gluten then consider avoiding the sources of

stimulus. The more you can calm your immune system down then likelier you can

halt the autoimmune response and prolong the life of your thyroid gland.

Good luck,

> This is exactly what happened to me .

> I was diagnosed with " post viral immune deficient chronic fatigue " after

suffering with Epstein Barr Virus nine years ago and was offered Prozac and told

to " go home & rest. "

>

[Guest guest]

Sally,

Dr Antony Toft said that people should be given a trial of T3 and that it's ok

to have supressed tsh so long as free t3 is not out of range.....

Toft is the endo who wrote the little handbook which is sold in chemists......

under the wing of the BMA.

You can find what he said if you go to the files on the left hand side, and

scroll down to the Pulse article....

thyroid treatment/files/

x

>

> Would you say then , that it would be reasonable for patients who are not

feeling better to be allowed a trial of T3 with or without their T4, in the

absence of adequate testing? 

>