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Hi Stuart, I had to read the paper fairly carefully to work out the relationships between the SNPs they are investigating, the resultant base changes in the gene and the resultant amino acid change in the protein (which is what is quoted in the report) - quite a dense paper for a nonspecialist! They do however mention both in the statistical analysis section and early on in the discussion that it is underpowered. I thought it was worth noting though that they didn't obviously over-replace these patients - in fact if anything the final TSH results on the T4/T3 treated group were higher than those in the T4-only group (although not compared statistically, as far as I could tell). I'd definitely keep an open mind about this, but as Robert said wouldn't want to base any decisions on this study alone. Sophy Dr Sophy Smith Clinical Biochemist Blood Sciences Queen Alexandra Hospital, Portsmouth 023 9228 6397 ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hill Robert (SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST) Sent: 01 November 2013 14:56 To: [log in to unmask] Subject: Re: Private thyroid genetics --- This message was sent from an email address external to NHSmail but gives the appearance of being from an NHSmail (@nhs.net) address. The recipient should verify the sender and content before acting upon information contained within. The identified sender is [log in to unmask] --- Hi Stuart, It's worth looking at the "about us" section of Thyroid UK. It's the Armour thyroid lobby in a new disguise. The paper quoted draws attention to the fact that its findings need to be confirmed. "Replication of this result, including prospective studies with genotype-selected populations, are required before changes in treatment approach can be recommended in routine practice." Why would one do gene testing on the basis of a single small study whose measured variable is how the subjects feel? Most people feel energised on a bit too much thyroid hormone but we know there are risks. T3 therapy may at some time in the future be shown to have benefits so we should keep an open mind. For now genetic testing is not justified. Robert Dr Robert Hill Consultant Clinical Biochemist ________________________________ From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of JONES Stuart (Pathology) (RF4) BHR Hospitals [[log in to unmask]] Sent: 01 November 2013 13:52 To: [log in to unmask] Subject: Private thyroid genetics Dear all, our endocrinologists have a patient who has arranged private genetic testing for polymorphisms in the DIO2 (diodinase) gene. She is apparently now quite insistent that she should be started on T3 despite being biochemically euthyroid with TSH/FT4/FT3 all well within the normal range. I attach an extract of the report and what little explanation came with it. It appears testing is oganised via http://www.thyroiduk.org.uk/tuk/testing/DIO2_test.html who are promoting the test. The analysis is seems to be carried out in a lab in Luxembourg. ThyroidUK state: "If your report shows that you have inherited either one or both faulty genes, it may be worth taking your report, along with the research article, to your GP or endocrinologist and asking for a trial of T3 to be added to your levothyroxine." The website references one paper in JCEM (http://jcem.endojournals.org/content/94/5/1623.full.pdf+html) which suggests "poorer psychologic well being" and "enhanced response to combined T4/T3 therapy" in patients with polymorphisms in the DIO2 gene. Has anybody else come across this? Any help/advice/views much appreciated. Stuart Stuart Jones | Principal clinical scientist Clinical biochemistry / Pre-natal screening King George Hospital Barking, Havering and Redbridge University Hospitals NHS Trust Barley Lane Ilford Essex Technical lead | Lab Tests Online UK http://www.labtestsonline.org.uk/ Barking, Havering & Redbridge University Hospitals NHS Trust: Working to make our hospitals better. This communication, together with any files or attachments transmitted with it contains information which is confidential and may be subject to legal privilege and is intended solely for the use by the person(s) or entity to whom it is addressed. If you are not the intended recipient you must not copy, distribute, publish or take any action in reliance on it. If you have received this communication in error, please notify [log in to unmask] and delete it from your computer systems. 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