A brief history:
PH - total thyroidectomy for hashimoto's. Histology not done here so I cannot look to see what was found.
Symptomatically very hypothyroid - cold, sluggish significant weight gainetc.
April 2013 TSH 299 fT4 0.7 fT3 1.4: Referral from GP - taking 200 ug T4 at same time as Ca supplements - advised dose timing change
May 2013 TSH 314 fT4 0.8: Increased dose to 300 ug T4
July 2013 TSH 308 fT4 0.7 fT3 0.4 Missed treatment due to UTI - left dose at 300 ug
Sept 2013 TSH 331 fT4 0.3 fT3 0.7 Had definitely been taking tablets - no improvement: changed to T3 40am/40pm
Nov 2013 TSH 100 fT4 0.3 fT3 0.4 Symptomatically improved but not 'normal - increased to T3 60/40 am/pm
Jan 2014 TSH 100 fT4 0.3 fT3 0.4 Feeling improved - dose left unchanged
Mar 2014 TSH 100 fT4 0.3 fT3 1.0 Still tired but improved - increased to T3 80/40 am/pm
May 2014 TSH 164 fT4 0.3 fT3 0.4 Now lost 2 stone in wt [back to mormal], able to wake up in the morning, not feeling cold. Symptomatically feels much better [like she was before thyroidectomy]
As she is on a high dose of T3, I have not increased the dose and she is symptomatically well. So, I am monitoring but not increasing doses to get the numbers correct.
**************************************************************************************
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]
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-----Original Message-----
From: Mohammad Al-Jubouri [mailto:[log in to unmask]]
Sent: 09 September 2014 4:55 PM
To: [log in to unmask]; Reynolds Tim (RJF) BHFT
Subject: Re: Low T3 syndrome
Really Tim, 500 mcg thyroxine and no effect on TSH >100? what was the FT4 level? I would seriously consider false elevation of TSH due to HAMA, HARA ore even Macro-TSH especially that even T3 didn't suppress it.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath Consultant Chemical Pathologist
--------------------------------------------
On Tue, 9/9/14, Reynolds Tim (RJF) BHFT <[log in to unmask]> wrote:
Subject: Re: Low T3 syndrome
To: [log in to unmask]
Date: Tuesday, 9 September, 2014, 16:44
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
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and any files transmitted
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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
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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-tired-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
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