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Whilst there are some patients who are mad there are some that really do seem to need T3. I have one patient (age 22) whose TSH remains > 100. On doses of up to 500mg of T4 there was no change but when given T3, she lost weight and began to resume normal activities [she can even make it to clinic on time now instead of turning up 3 hours late]. Even now on T3 her TSH has not dropped much but the obviously symptomatic hypothyroidism has resolved and she is much better. Biochemistry does not always give the right answers... ************************************************************************ ************** Prof. Tim Reynolds Consultant Chemical Pathologist / Clinical Director - Diagnostics / R&D Lead, Burton Hospitals NHS Foundation Trust work tel: 01283 511511 ext 4035 work fax: 01283 593064 work email: [log in to unmask] work URL: www.burtonhospitals.nhs.uk This e-mail, and any files transmitted with it, are confidential and intended solely for the use of the individual to whom it is addressed. If you are not the intended recipient please destroy this message, delete any copies held on your systems, and notify the sender immediately. You should not retain copy or use this e-mail for any purpose, nor disclose all or any part of its content to any other person. If you have received this e-mail in error, please notify me on 01283 511511 Ext 4035 [Picture of tree not available] Please consider the environment before printing this e-mail ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Salter Simon (ROYAL FREE LONDON NHS FOUNDATION TRUST) Sent: 09 September 2014 4:39 PM To: [log in to unmask] Subject: Re: Low T3 syndrome --- 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] --- During my short time in clinical biochemistry, I have seen a number of cases of patients desperate for their FT3 to be measured and not being given it. Some of the comments on the article interesting...one particularly, which blames us lab staff for being part of the problem... "The arrogance of those running the laboratory service astounded me" "Whilst the article points out "So, if your blood test doesn't show you to be low in T4, you won't be prescribed thyroid hormones that could alleviate your symptoms", there's a good chance that your local lab (which supposedly works for your Doctor) won't provide a T4 result. The testing laboratory have their own protocol which frequently means that if the TSH result is in the Normal Range (~ usually 0.3 to 5.0), then they routinely don't provide a T4 result let alone any of the other thyroid function tests. My result was just above the Reference Range and my own doctor asked three times for more than the TSH but was ignored and when I wrote to the Area Health Authority, I received a reply which said that my own doctor ought to know better than to ask. They said they had provided GP's with guidelines as to what they would test for and she should not have asked! The arrogance of the those running the laboratory service astounded me. " When lab reports go directly to patients I imagine we will receive a significant number of calls from educated patients wanting FT4/FT3 measurements if they haven't been given one. Simon From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Peter Beresford Sent: 09 September 2014 16:19 To: [log in to unmask] Subject: Low T3 syndrome Dear Mailbase, We have received calls from GPs who have been approached by a number of patients regarding the article below, which was published in the Daily Mail last week. http://www.dailymail.co.uk/health/article-2734215/Cold-hands-Always-tire d-It-hidden-thyroid-problem-doctors-refuse-treat.html The subject of the article is 'Low T3 syndrome", and it suggests to patients that they require FT3 measured routinely in addition to FT4, as well as opening up a debate with regards to treatment with T3. The article quotes respectable Endocrinologists quoted both for and against (although I suspect some of their comments may have been taken out of context). I would be interested to know if others have also been approached in response to this article and what guidance has been given to GPs responding to these queries. The guidance documents available on the British Thyroid Association website (http://www.british-thyroid-association.org/Guidelines/ ) are very helpful, but recognising that this is a complex area I wonder if anyone is aware of any more recent evidence or guidelines about the role of T3 in the aetiology and treatment of hypothyroidism? Best wishes Peter Peter Beresford Consultant Clinical Scientist Southmead Hospital DISCLAIMER: The information in this message is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorised. 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