Nobody seems to have really addressed Pete's original question of "has anybody had enquiries from GPs about this" and what do we suggest to GPs who have an irate patient in front of them demanding measurement of FT3.
I can't think that we have recently had any specific enquiries about FT3 that relate to this article, however, we do occassionally get specific requests from very demanding patients who have read something similar on the internet and are convinced that they need their FT3 measured. Whilst we always try and reason that their normal TSH (we do not offer FT4 as first line) means that they are more than likely completely euthyroid we always offer them the option to pay for FT4 and/or FT3 privately. You would be surprised how many of them are completely thrilled by this suggestion so you get the double bonus of gettting them to stop shouting at you whilst also proving your original assertion to be entirely correct.
I think the other important point made by others here is that the numbers don't always tell the whole picture. It's important that our GPs know that we are there on the end of the phone and we are always happy to make exceptions for individual cases where the clinical picture just doesn't fit with what the TSH (and/or FT4) is telling you. Perhaps there are very rare cases of pure low T3 syndrome and while this possibility doesn't justify measuring FT3 in everyone who wants it we have to remember that (in most cases) we don't see (or have to deal with) the patient and there may be times when measurement is fully justified even if it is only to act as a rule out. Aren't we always being told to treat the patient and not the numbers?
Fiona Davidson
Senior Clinical Biochemist
Kingston Hospital NHS Trust
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