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Most Recent News I have been corresponding with Sir Ian Gilmore since August 2008. At that point I sent my report on The Polemics Surrounding the Diagnosis and Management of Hypothyroidism My last communication to him was the 2nd October 2008 when I sent him yet more evidence that the medical profession are misinterpreting thyroid blood test results. Seven weeks later the RCP statement was prepared (19th Novemeber 2008). I am amazed that the medical profession have chosen to disregard important eveidence and I have stated this in my letter to Sir Ian Gilmore. Many people have written to Sir Ian Gilmore and there will be a review. I urge people to write in protest against the recent statement made on behalf of the RCP titled, "The Diagnosis and Management of Primary Hypothyroidism" For the statement go to Royal College of Physicians website. Articles covered on this page in order: - 1. The Polemics Surrounding The Diagnosis and Management of Hypothyroidism. 2. Letter to Patients under the care of Dr Gordon Skinner. 3. Dr Gordon Skinner has obtained information from endocrinologists - it is a 'must' read. 4. Dr Gordon Skinner's rebuttal of the new guidelines for Thyroid Stimulating Hormone (TSH). 5. Sian Birkinshaw - Diploma in Nutritional Therapy/Anatomy & Physiology. **********************************************************
1. The Polemics Surrounding The Diagnosis and Management of Hypothyroidism.
I attended a meeting at the House of Commons on June 11trh 2007 and 5th December 2007 and presented the paper set out below.
Copyright © 2007 by Diana Holmes. All rights reserved. No part of the “paper” set out below may be used
or reproduced in any manner whatsoever
Plus the Influences of our Toxic Environment Contributing to the Lack of Well-Being of the Nation. This in Turn Leads to a Financial Drain
on the State. INTRODUCTION Diagnosis and Management of Hypothyroidism (under active thyroid gland). HYPOTHYROIDISM (under active thyroid Gland) Exhaustion - tiredness all the time (known as “tatt” within
the medical profession) Patients who manifest all or some of these signs and symptoms are told that they have ME, depression or some other condition if their blood test result for thyroid function lies within the reference interval. Using the upper and lower end of the reference range as ‘cut off’ points is bad practice and yet that practice is used universally. The condition of the patient is then perpetuated through lack of a correct diagnosis. Not only has their condition been perpetuated but the humiliation and loss of dignity that they have been subjected to, which has been and is meted out by the medical profession, knows no bounds. This includes accusatory comments made by certain members of the medical profession declaring them to be suffering from some form of mental disease. Sufferers have been exploited by those who take advantage of the sick. In addition they have been discredited and have lived, and are living lives of abject misery. Over decades millions of people have suffered and are suffering today. The Department of Health (UK) has never commissioned guidelines for DMH with the result that confusion abounds for practitioners, so easy options have evolved. Thyroid Function Test (TFT) The word normal, as in ‘normal’ blood test result’, has been and is used today by the medical profession en masse, including biochemists and pharmaceutical companies in their clinical trials protocol. This is but one example of unacceptable terminology that has been subsumed into medical literature and vocabulary, which has resulted in the controversy that surrounds DMH and failure to detect every case of hypothyroidism. Today hundreds of thousands of people in the UK and millions worldwide are suffering with a chronic illness, namely hypothyroidism - undetected. The medical profession is ignorant of the true number of sufferers of hypothyroidism this is due to the use of incorrect terminology and total reliance on TFT results. Misdiagnoses Evidence-based Medicine The Environment The Criminal Perspective Financial Implications This brief overview will outline what has happened, what is happening and what will happen in the future if these issues are not addressed regarding DMH. In addition what will happen if toxic chemicals that interfere with thyroid function do not come under stricter control? THYROID FUNCTION TESTS In 1969, Professor Ralph Gräsbeck helped to develop the reference value concept with Professor Saris. In 1990 he warned the medical profession not to use incorrect terminology such as, ‘normal values’ and ‘normal reference ranges.’ He also stated that, “Reference values are not always derived from ‘healthy’ persons and that the field of reference values is only one part of laboratory medicine”. [2] In my recent communications with Professor Gräsbeck he stated that, “To make the diagnosis on the basis of only one test such as TSH is decision making based on thin evidence.” [2a] This reference indicates that the initial developers of reference values never intended the medical profession to use the terminology ‘normal’ when discussing ‘reference values’ or reference intervals’. How many practitioners know how the ‘reference interval’ was derived in the first instance? If they do know they would have a full understanding of how to interpret the results of the values that lie within the ‘reference interval’. In 1994 The World Health Organisation stated, “Laboratory experts are recommending abandoning the term, ‘normal range’ and replacing it by ‘reference interval’ while keeping in mind that the limit values for the ‘reference interval’ will depend on the selected population that was investigated for their establishment. Experts in the laboratory diagnosis of thyroid disease do not stop to point out that in individual cases the levels of thyroid hormones may well be within the so-called ‘normal range’ in patients with thyroid disease, and the existing disease can only be diagnosed properly by investigating the spectrum of factors contributing to the regulation of thyroid metabolism. No doubt that the clinician must be aware of all the limitations when taking care for a patient on the basis of laboratory investigations only. Unfortunately we often observe an unsatisfactory communication between the laboratory and the practitioners, which may in some cases, be the reason for misinterpretation of laboratory results. [3] What is ‘normal’ for one person can differ significantly from that of another person. If the word ‘normal’ is generalised within a set of parameters, then there must be flexibility upon interpretation of the results. These considerations were commented upon by Peterson in the review “The latest on reference values. Klee compared reference limits and decision limits and made it clear that, “In General, the reference limits should not be used as ‘cut-off’ points”. He also points to the costs related to wrong diagnosis and he stresses the need for improving the analytical and clinical quality. Fraser points to, “The flaws of population based reference intervals are due to the biological individuality presented by all. Hence the use of 95% reference intervals is questioned; both due to changed probabilities according to repeated testing and due to misuse of reference limit as decision limit i.e. ‘cut-off point’. Further, the use of population-based reference intervals is criticised as individual reference intervals for each single individual are preferable if available.” [4] Anderson stated, “Population-based reference ranges are necessary but that it is important to recognise their limitations for use in individuals.” [5] In a letter to the BMJ Haslam (2006) stated, “Patients’ are commonly told, “Your blood test results were absolutely normal”. And later in the letter, “In an ideal world, this phrase would never be used. In reality it is used all the time.” [6] This is important. It is time to put a stop to incorrect terminology! Typically, a patient visits the GP’s surgery and relates his/her symptoms to the doctor. The doctor who, with a high index of suspicion of a diagnosis of hypothyroidism, requests a TFT. When the blood test result is returned and the biochemist states ‘normal’ on the laboratory report, the doctor then disregards all his previous diagnostic intention that the patient may have a thyroid disorder. Rather than send the patient away he chooses to either diagnose the patient with another condition e.g. ME/CFS Fibromyalgia or depression etc, or he will treat the signs and symptoms independently – very very costly. Bearing in mind that the biochemist has never seen the patient nor knows the patient’s signs and symptoms, how can he state whether the result is normal for that said patient? What the biochemist actually means is that the result lies within the ‘reference interval,’ but because the biochemist has used the word ‘normal’ the practitioner believes that the patient is euthyroid – has normal thyroid function. Here we have a double meaning, which is either deliberate or caused by inexactness of expression, and because of ambiguity with the ‘reference interval’ and improvidence by the medical profession, patients are suffering unnecessarily. It would be preferable if biochemists omitted putting comments on the laboratory report. INTENDED GUIDELINES FOR THYROID FUNCTION TEST. They suggest remarkably that, “TSH levels >10mU/L combined with an FT4 below the reference range indicates the presence of overt primary hypothyroidism in ambulant subjects.” [7] However, according to the National Audit Office (UK) they stated, “Whilst these guidelines offer advice on the use of thyroid function tests, they do not introduce an NHS-wide standard of medical care”, and in their understanding that “so far NICE has not issued any guidance on the diagnosis and treatment of hypothyroidism.” [8] The American Association of Clinical Endocrinologists (AACE) and The National Academy of Clinical Biochemistry (NACB) issued revised guidelines for the testing of TSH in 2002 and encouraged doctors to refrain from using a TSH level of 0.5-5 but instead use a narrower margin based on a TSH level of 0.3 to 3.04. [9] Later these guidelines were revised yet again in 2004 with a TSH level of 0.4 -2.5. Spencer reported “The TSH upper reference limit that appears in laboratory reports is inaccurate and that those who are the most healthy euthyroid persons have a serum TSH concentration below 2.5 mIU/L. Also, “Another NACB guideline recommends a target of TSH range of 0.5 to 2.0 mIU/L for levothyroxine replacement therapy. Even if the TSH is confirmed below the reference range, the degree of abnormality has to be interpreted in the context of the individual patient”. Later in the article it was stated that, “Clinicians should understand that the reference range is not the ‘normal range’, but merely a marker to be used with other patient-specific factors”. [10] In Australia the TSH level is 0.3-3.5 [11] One has to ask, why then has the upper figure of the ‘reference interval’ for the TSH (UK) been raised (it is assumed that the latest assay packs are being used), when other countries have lowered the upper figure? Thus UK hypothyroid sufferers are at a distinct disadvantage. Additionally Zöphel, Wunderlich and Kotzerke stated, “Should We Really Determine a Reference Population for the Definition of Thyroid-Stimulating Hormone Reference Interval? The NACB recommended the use of˜ 2.5 mIU/L˜ 4mIU/L, because reference populations, on which the definition of the reference interval is based, contain individuals experiencing an initial phase of autoimmune thyroid disease, thus skewing the upper reference limit of TSH”. [12] The TSH blood test is the all-time favourite and is classed by biochemists and endocrinologists alike as the ‘gold standard’ test. The actual determination of thyroid hormone levels in the blood is not in question it is the interpretation of the results that is the main problem. No one accuses biochemists of wrongly valuing the hormone content of the blood but do biochemists and clinicians know how much T4 is usable for conversion to T3 and how much T3 is usable at cell level? In other words, are the thyroid hormones in the blood all pure, active hormones or are some in active? There has been too little attention paid to the standardisation of blood collections. As far back as 1983 Symons & Murphy stated, “The levels of T4 FT1 and FT4 in patients receiving thyroxine should be interpreted in relation to the time of thyroxine administration. Standardisation of blood collection in patients receiving thyroxine replacement would be desirable”. [13] Twenty three years later and this recommendation for blood collections are still not in place. Professor Ralph Gräsbeck communicated to me recently that rules regarding specimen collections that he managed to get approved nationally and internationally are not followed at all. [13a] See 2a If a blood sample is taken between the time of ingestion of thyroxine and within six hours the reading for serum hormone levels will show higher. If the biochemist or the practitioner is not aware of this information then their interpretation of the blood test results will be incorrect. A Trial was conducted by the Departments and Biochemistry, Stobhill Hospital, Glasgow. Pollock et al “Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial.” Method COMMENTS –The duration of treatment was far too short. Many hypothyroid suffers can take twelve months to two years to regain their health. The initial and only dosage was a 100mcgs of thyroxine and this was never taken up to the optimal for each patient. Thyroxine was the only preparation of thyroid replacement therapy used
in the trial. Some patients may have had a conversion problem whereby
T4 (thyroxine) conversion to T3 (triiodothyronine) was lacking and replacement
therapy for these particular patients should perhaps have been Tertroxin
(triiodothyronine) T3. **Haynes, Devereaux and Guyatt “Initially, evidence-based medicine
focused mainly on determining the best research evidence relevant to
a clinical problem or decision and applying The *subsequent version seems to be well-rounded in its design but there are limitations of available evidence which can limit effectiveness of any approach. Indications are that this model of evidence-based medicine is not being followed correctly regarding thyroid conditions because in many instances there is a bias towards sole reliance on TFT results while ignoring any biological evidence in the **diagnose of a patient with hypothyroidism. Montori states, Evidence-based endocrinology how far have we come? Evidence-based endocrinology is hindered by limited high level evidence assessing patient-important outcomes, limited systematic summaries of this evidence, lack of time and lack of systematic training of endocrinologists in evidence-based medicine. [16] Whatever information doctors’ do manage to retrieve, putting evidence-based medicine into practice requires not only their clinical knowledge and experience but expertise in retrieving, interpreting, and applying the results of the scientific studies and then to communicate this to the patients informing them of the risks and the benefits.
Time in the surgery is of the essence not only to the patient but to
the attending physician and he most certainly does not have the time
to go through the six steps MISDIAGNOSES When blood test results for thyroid function are solely relied upon and signs and symptoms are not taken into consideration, together with the upper and lower figures of the reference interval used as “cut-off points”, then it is feasible that frequently patients will have been misdiagnosed with other diseases or conditions. The information below was retrieved on15/05/2007 from the website of the British Thyroid Association stating that, “Currently the BTA does not hold the view that treatment for thyroid disease, either under-or-over-active, should be commenced if patients have thyroid function test results within the normal laboratory reference range. [18] No mention here of observing signs and symptoms, carrying out a clinical appraisal or the history of patient. It must be stressed that whilst the BTA is putting out literature of the above nature then GP’s do not stand a chance of ever diagnosing a patient with hypothyroidism, if their TFT result lies within the ‘reference interval’. These patients may have many clinical features of hypothyroidism which are being totally ignored because of sole reliance on TFT results. It has resulted in many thousands of undetected hypothyroid sufferers in the United Kingdom and this equates to millions world wide. A great number of patients are misdiagnosed with ME/CFS because their TFT results lie within the reference interval. The medical profession has used and is using today the diagnosis of ME/CFS as a ‘dumping ground for these patients. It also has far reaching effects on patients’ families and society in general. e.g. financial hardship, relationship problems, time off work due to sickness, inefficiency in the work place, out of control behaviour, drug and alcohol abuse, anger which can lead to violence, and much more. Some practitioners think that there is no such condition as ME/CFS and others think that the patients are suffering from a somatoform disorder. Psychiatric clinicians talk of the bio-psychosocial management approach because they fully believe it is a mental problem. There are those who would like to classify it as a psychiatric ‘behavioural’ illness. The World Health Organisation classified ME as a “neurological disorder” in 1969. Where is the consensus of opinion within the medical profession regarding ME/CFS? The Countess of Mar at the House of Lords Debate on April 16th, 2002 stated that, “As Nero fiddled while Rome burned, so the Wessely School fiddles the facts while people suffer and die. And later on she stated, “Simon Wessely, Michael Sharpe, Anthony David and Peter White, all psychiatrists, proceeded systematically to flood the UK literature with their own beliefs about non-existence of ME. They commandeered medical journals and the media. They became self-designated experts in medically unexplained symptoms such as ME, Gulf War syndrome and multiple chemical sensitivity. They have received disproportionate funding, amounting to over 5 million pounds for research into their own beliefs to the exclusion of virtually all research into organic causes. [19] In 2004 they received a further 11.1 million pounds for ‘more research.’ This Group of psychiatrists have been determined in their exploits to pressurize the medical profession and sufferers into believing that ME/CFS is a mental disorder. Egotism has prevented them from understanding why sufferers do not agree with them. They have done a great disservice to those who suffer with ME/CFS and maybe it is time for their arrogant assumptions to be laid to rest. An independent enquiry into this fiasco is much needed. ME/CFS/FIBROMYALGIA Importantly, Dr Gordon Skinner (virologist) has treated hundreds of
patients diagnosed with ME/CFS but who presented with hypothyroid signs
and symptoms, DEPRESSION Depression Alliance states, “More than 2 million people in the UK are diagnosed as having depression at any one time with as many as three in four cases of depression neither recognised nor treated. 70% of recorded suicides are by people who have experienced some form of depression”. [21] The symptoms listed for depression are very similar to some of the features of hypothyroidism. Many with depression may well have a thyroid disorder. Sokolov, Kutcher and Joffe “Basal thyroid indices in adolescent depression and bipolar disorder.” [22] Lasser and Baldessarini, “Thyroid hormones in depressive disorders: a reappraisal of clinical utility.” [23] Jackson, “The thyroid axis and depression. “ [24] POSTPARTUM DEPRESSION Harris et al, “Association between postpartum thyroid dysfunction and thyroid antibodies and depression.” In his conclusion stated, “Depressive symptoms are associated with positive thyroid antibody status in the postpartum period.”[25] Harris - “Postpartum depression and thyroid antibody status” stated, “It has long been known that primary thyroid disorder is associated with mood disorder and vice versa so that the features of major depression can occur in individuals with hypothyroidism.” [25a] Australia’s Central Health and Medical Information. CRIMINAL PERSPECTIVE ATTENTION DEFICIT DISORDER (ADD) & ATTENTION DEFICIT HYPERACTIVE DISORDER Our prisons and young offenders’ institutes are full of inmates suffering from ADD, ADHD and/or Dyslexia. These conditions are linked to thyroid disease. Barnes and Galton stated that, “a few children suffering from hypothyroidism will be very nervous, hyperactive and unusually aggressive. Emotional problems are frequent. A Low thyroid child may cry for no apparent reason, and object vigorously to any restrictions. Temper tantrums are common, probably related to undue fatigue. The child may sleep longer than youngsters of his/her own age, be a slow starter in the mornings and have a short attention span and flit from one activity to another. Infections are common”. [27] These manifestations can be related to ADD and ADHD. In children, this disorder manifests frustration in many forms. In the classroom when a teacher tries to explain a subject, the lack of comprehension by the child sometimes leads to impatience by the teacher, which in turn prompts the child to react because of his/her frustration to understand the subject. Initially the child is on the defensive and soon becomes frustrated, which later turns to resentment and then defiance and so to anti-social behaviour In 2003 The BBC reported, ‘Young offenders ‘are ill’. Up to 60% of teenagers in young offenders institutions could be suffering from a behavioural disorder. Dr Geoffrey Kewley, a consultant paediatrician with the National Learning Assessment and Neurocare Centre states, “Many young offenders have ADHD and this is based on his experience rather than research”. [28] Hauser states, “Thyroid hormone plays an essential role in prenatal brain growth and development, as well as in normal behavioural and intellectual development. Even moderate impairment of thyroid hormone function has been associated with various problems in behavioural and intellectual development and certain thyroid diseases resistant to thyroid hormone (RTH) are associated with attention deficit disorder (ADD) or attention deficit hyperactive disorder (ADHD) and language disorders.” And later in the article, “Human and animal studies have demonstrated that exposure to dioxin-like compounds can alter thyroid hormone function and produce neurobehavioural changes, but it remains to be definitely established that changes in thyroid function are responsible for the neurobehavioural effects”. [29] The signs and symptoms of hypothyroidism are diverse and some apply to ADD/ADHD namely, anger, irritability, panic attacks, anxiety, hallucinations, voices in the head, suspicious of people’s motives, persecution complex, easily upset, mood swings, and depression. Journals have published case reports of those people who have committed criminal acts whilst suffering from a thyroid disorder. See below: - Easson stated, “In the course of a hypothyroid psychosis a young
man committed murder. There are approximately 300,000 ADHD sufferers in the UK. A high number of these persons could have an under active thyroid. FINANCIAL ASPECT STATE - COST IMPLICATION - Invalidity benefit, incapacity benefit, disability living allowance, which includes care component and mobility, wheelchairs, independent living fund. NATIONAL HEALTH SERVICE (NHS) – COST IMPLICATION There are substantial demands on social, primary and secondary care; Over months or even years each patient can be subjected to diagnostic testing, x-rays, referrals (patients are often referred to more than one specialist), signs and symptoms treated individually with expensive prescriptive drugs (that may not be needed), physiotherapy, unnecessary operations, periods of hospitalisation for investigative procedures and much more. Needlessly, thousands of pounds are expended on each patient and this has become a significant financial burden. SCIENTIFIC STUDIES AND TRIALS – COST IMPLICATION A Group of psychiatrists namely Simon Wessely, Peter White, Michael Sharpe and others received 11.1 million pounds for ‘more’ research into the claimed benefits of Cognitive Behavioural Therapy in ME/CFS. They ignored physical signs and the results of their research showed ME/CFS to be a mental disorder. If all of the features of a disease are not taken into the equation with regard to researching that said disease then the findings must surely be suspect. TAX REVENUE - COST IMPLICATION INSURANCE COMPANIES – COST IMPLICATIONS PATIENT - COST IMPLICATION You may ask, why are there more people suffering from hypothyroidism today? Our environment leaves a lot to be desired. ENVIRONMENT How Environmental Chemicals Destroy your Endocrine System: World-wide, millions of people are sick and they tend to work around their sickness with a misplaced notion that all is well. Toxic chemicals bring about sickness. WHAT IS AN ENDOCRINE DISRUPTER? ED’s also come in the form of synthetic chemicals, hazardous air pollutants from industrial processes; chemicals such as pesticides and herbicides that are sprayed onto crops, fluoride in our domestic water supplies etc, which are not so easy to bypass. There are three routes whereby toxins can enter our bodies. By inhalation (breathing), oral (eating or drinking), or dermal (through the skin). ** Toxins are added to the food chain, the air we breathe, the water we drink, the clothes we wear, the cosmetics applied, the toys our children and grandchildren play with, water pipes, flooring, medical supplies, dental preparations, flame-retardants and the use of household plastics, chemicals and DIY materials - and the list goes on. Research has shown that children exposed to common environmental toxins like dioxin and polychlorinated biphenyls (PCBs) prenatally and during infancy can suffer behavioural, learning and memory problems. ED’s mimic, interfere or block endocrine hormones. Hisao Seo et al discuss “Endocrine disrupters and thyroid function.” They state, “Indeed suppression of thyroid function by post natal exposure to chlorinated dioxins and related chemicals was reported in Japanese breast- fed infants. A higher intake in dioxin results in decreased serum levels of thyroxine and increased TSH concentrations.” [32] We are all exposed to thousands of chemicals. However, it is not the individual exposure of one chemical that needs to be taken into account but the total exposure of chemicals that have a bio-accumulative effect. On November 2nd 2001, Jonathan Leake reported in The Sunday Times that the HEINZ Company admittedlining its cans with an endocrine disrupting chemical, namely Bisphenol A. This chemical can cause early puberty in females and may reduce the growth of reproductive tissues in males. There are four areas of contamination by toxic chemicals to concentrate on: FOOD CHAIN - AIR - LAND - WATER FOOD CHAIN - there are many Neurotoxic chemicals present in our food today including certain preservatives, pesticides, herbicides, together with fungicides that are sprayed onto the growing plants. GREAT SMOKIES MEDICAL CENTER –Ashville –USA. “Are Pesticides and Herbicides Bugging You.” And later in the article, “In addition to congenital defects and infertility, human pesticide exposure has been linked with Parkinson’s disease; myasthenia gravis; prostate; testicular and breast cancers; leukaemia; asthma; thyroid disorders; and chronic fatigue. [33] Thompson et al. stated in their article, (“The Health Effects of Waste Incinerators.”) “The precise content of the emission varies with the materials incinerated: emitted chemicals include persistent organic pollutants, hormone disrupters, and carcinogens but not all the organic components have been identified.” [34] AIR ? Sulphur dioxides, ? Particulate matter Contrails - long contrails left behind by commercial jets, according to NASA linger for hours and eventually become clouds. Commercial jet pollution is therefore added to all other air pollution and is rained upon the land and surface water. According to a former CAA expert, the EU is to bring into force some stricter regulations with regard to emissions from commercial jets. This unfortunately will not apply to airline companies from non-EU countries. Airline companies have a moral obligation to use engines that burn cleaner fuel. Unfortunately some burn very dirty fuel and “black exhaust” gets into the atmosphere. Acid Rain - power generation and general industry are the main sources of sulphur dioxide emissions (the precursor for sulphuric acid as in acid rain). Acid rain is rain, snow or fog that is polluted by acid in the atmosphere and damages the environment. LAND - Land can become contaminated in many ways: INDUSTRY AGRICULTURAL LAND WATER AGRICULTURAL RUN-OFFS Industrial Accidents - Besides the addition of toxic chemicals into the environment there is also the risk of industrial accidents. This cannot be ignored! The Bhopal disaster in India in 1984 polluted large volumes of water. The explosion at the Chernobyl Nuclear Power Station in the Ukraine in 1986 manifested dust, which travelled and spread over many countries and the effects are still being felt today. Many children in the area of Chernobyl have had or have thyroid cancer. Many children in the North Wales area of the UK contracted leukaemia. In the UK there was an accident at a water works in 1988 with aluminium sulphate. Polyvinyl chloride (PVC) should be added to the list of toxic chemicals. Professor Frederick vom Saal, University of Missouri was interviewed by Doug Hamilton in 1998, (Producer of Frontline’s “Fooling with Nature”). It was stated that every four years one trillion pounds of plastics are made in the world, which subsequently are thrown into landfills and leach back into ground water and surface water. How much more is dumped into landfills today 8 years later? It is to be remembered that the majority of chemical breakdown is in the liver and therefore the liver is under a great deal of stress from unwanted contamination. Most of the conversion of thyroid hormones e.g. from T4 hormone to T3 hormone takes **place in the liver and therefore this action can be compromised. ADVERSE HEALTH EFFECTS ON THE ENDOCRINE SYSTEM BY CHEMICALS THAT ARE
KNOWN ENDOCRINE DISRUPTERS
The conditions listed above can be manifested in the condition of hypothyroidism, (under active thyroid gland) although a person need not be suffering from all of these at one time to be classified as hypothyroid. Table 2 HEART
All who took part were offered counselling and those who had alarmingly high individual readings were given medical advice Porterfield stated that, “Certain polyhalogenated aromatic hydrocarbons such as polychlorinated biphenyls (PCB’s) and dibenzo-p-dioxins (dioxins, 2, 3, 7, 8,-terachloridienzo-p-dioxin) have been shown to have neurotoxic effects and to alter thyroid function during critical periods of thyroid hormone-dependent brain development. [36] Environmental Protection Agency –“Health Effects of PCB’s”. [37] There are three common denominators: ? Worldwide decline in health. ? Neurotoxic chemicals (that are known endocrine disrupters) that brings about sickness. ? Total reliance and misinterpretation of thyroid function test results bring about undetected hypothyroidism. Prevention is better than cure and it would make sense if dangerous toxic chemicals were limited in the environment. Instead we now have a worldwide pandemic of hypothyroidism with the majority of sufferers undiagnosed so the true figure of hypothyroid suffers is not known. These health issues need to be addressed urgently because our immune systems are being radically compromised! Earlier it was stated that ED’s mimic, interfere or block endocrine hormones. This is a fact! Then what value is there in testing for thyroid hormone levels in the blood? **Much more research is needed in this area. EDM PETITION THE PETITION We the undersigned [thyroid patients, families/friends] wish to lodge this petition with the General Medical Council as a formal complaint against the clinical practice of the majority of the medical profession with regard to the diagnosis and management of hypothyroidism on four counts: - 1. Over reliance on thyroid blood test results and a total lack of reliance on signs, symptoms, history of the patient and a clinical appraisal. 2. The emotional abuse and blatant disregard by the majority of general practitioners and endocrinologists over the suffering experienced by untreated/incorrectly treated thyroid patients and their lack of compassion over the fate of these patients. 3. Stubbornness by the majority of general practitioners and endocrinologists to treat patients suffering with hypothyroidism with a level of medication that returns the patient to optimal health. In addition, the unwillingness to prescribe alternative thyroid treatment for patients on individual clinical grounds e.g. a combination of T4/T3, T3 alone or a natural thyroid treatment such as Armour Thyroid. The ongoing reluctance to encourage debates or further research on hypothyroidism.
The GMC’s reply completely missed the point and yet both the
GMC and Liam Byrne M.P received exactly the same petition. [39] SUMMARY The most chilling factor that has come out of the research is, ironically, that the medical profession has been, and is responsible for a high proportion of: - Heart disease Misdiagnosis
Areas of Concern Regarding Thyroid function Test results ? The ‘reference interval’ for thyroid function testing is made up very loosely but heavily relied upon. ? The upper figure and the lower figure of the reference interval are nearly always used as ‘cut-off’ point. ? In 1990 the medical profession was warned not to use the terminology ‘normal range’, it is used continually today. ? Using the TSH test result as the only indicator to diagnose hypothyroidism is thin evidence. Internationally the upper figure for the TSH has come down from 5mIU/L to 3.5mIU/L in Australia and to 2.5mIU/L in the United States, whereby the UK upper figure has been raised to over 10mU/L for a diagnosis of hypothyroidism. There appears to be no consensus of opinion between other countries and the UK regarding DMH. ? Biochemists writing on the laboratory report indicating whether or not the patient has a ‘normal’ result. The attending physician for the patient abides by this information. ? Flawed Laboratory methodology. Taking these points into account the thyroid function test appears to be a very weak indicator. When the parameters are loosely made up initially and there are ambiguities within the terminology for DMH this can bring about misinterpretation and the consequences can result in undetected hypothyroidism hidden in a misdiagnosis. One topic of NICE interventional procedure is, quote, ‘whether
there is inappropriate variation in practice across the country’
unquote. When terminology is misleading and there is ambiguity there
is bound to be variation in practice. There is variation in medical
practice regarding DMH [40] There is some concern that the intended new guideline for the upper figure of the TSH (thyroid stimulating hormone) set at more than 10mU/L by the BTA, ACB and the BTF, could be utilised by the medical profession simply because there are no other guidelines set, which subsequently could be responsible for even more cases of undetected hypothyroidism. Medicine is not an exact science and it never will be because of the individualistic make-up presented by each person. Reference values were developed by Professor Ralph Gräsbeck and Professor Saris in 1969. After a warning from the developers in 1990 there is still no respite from the use of unacceptable terminology that has been incorporated into medical literature and vocabulary. It is not surprising that undetected hypothyroidism is now on a global scale. The Health Service and others would benefit substantially if these discrepancies in medical procedure were corrected. Work load would be dramatically reduced and costs would be lowered if successfully treated patients no longer frequently attended the GP’s surgery with a multiplicity of signs and symptoms all seemingly unrelated. Incorrect terminology for TFT results is one of the culprits of erroneous procedure resulting in undetected hypothyroidism. The words “normal”, “cut off levels” “upper limits and lower limits” “borderline” “all affect decision making regarding a diagnosis. If the terminology “cut off levels” was abandoned there would be no “borderline” cases. A person either is hypothyroid or is not hypothyroid. The word limit in its context of ‘upper limits’ and ‘lower limits’ is far too restrictive and too confining for reference values which are loosely made up in the first instance and too tempting to use as a ‘cut off’ point. It should be removed from medical terminology in relation to ‘reference intervals’. In an article in the European Journal of Endocrinology, Vol: 154, Issue 5, 2006 [ ] A total of 8 endocrinologists discussed “cut off levels” of the TSH and definition of the upper “normal limit” of serum TSH. [41]. This is bad practice. Areas of concern regarding medical procedure for DMH ? Total reliance on thyroid blood test results. ? One indicator is used (i.e. the blood test result) for DMH when ? Outdated, misleading and incorrect terminology in medical literature and medical vocabulary. ? Doctors’ lack of training in the diagnosis of thyroid conditions ? Within the medical profession there is no consensus of opinion regarding DMH. ? Standardisation of blood collection not adhered to. Endocrinologists perpetuate the use of incorrect terminology with regard to DMH. Certain well known psychiatrists insist that the condition of CFS/ME is a mental behavioural problem. While these two groups are dictating to the medical world, the problem of undetected hypothyroidism will remain obscure as will the solution to determining the aetiology of CFS/ME The medical profession has been approached on these issues many times but their inflexibility knows no bounds. If this matter is not addressed then sufferers will have no respite from their torment. Inheritance - DNA If a child is born of parents who are both untreated hypothyroid sufferers the child surely then becomes susceptible to hypothyroidism. Thyroid hormones are compromised by neurotoxic chemicals in the environment and therefore people become hypothyroid and thus need treatment. Worldwide, people are exposed to chemicals that are known endocrine disrupters e.g. polychlorinated biphenyl’s (PCBs). The majority of chemicals that come onto the market each year are not tested for toxicity, or indeed tested for their ability to disrupt hormones. In some areas technological advances in the field of medicine are destroying the whole essence of the clinician’s care for the patient. When TFT results for DMH are solely relied upon the practitioner is in danger of losing sight of his/her patient in the biological sense and also their powers of observation are at risk of being lost completely. In other words, the GP’s discretion and initiative have been inappropriately dispossessed. Those suffering with any of the diseases or conditions listed below need a reappraisal of the illness or condition in the light of the evidence in this paper. URGENT INVESTIGATION IS NEEDED FOR THOSE SUFFERING WITH: - ? ME/CFS/PVS/FIBROMYALGIA ? DEPRESSION ? POST NATAL DEPRESSION ? INFERTILITY ? CERTAIN CONDITIONS LINKED TO HEART DISEASE – possibly
linked to hypothyroidism. E.g. high cholesterol levels, blood clotting
problems, and/or high blood pressure. ? ADD & ADHD – CHILDREN & YOUTH in schools ? ADD & ADHD – YOUNG OFFENDERS – Those serving sentences in the young offenders units. ? ADD & ADHD – ADULT OFFENDERS – Those serving prison sentences. ? ADD & ADHD - ADULTS ? ALZHEIMER’S ? SENILE DEMENTIA ? OBESITY Vanderpump, Ahlquist, Franklyn and Clayton BMJ 1996 state, “Many
aspects of the management of thyroid disease have not been subjected
to controlled clinical trials yet there The medical profession has for decades and is today entrenched into unacceptable medical procedure with regard to DMH. I have, for thirteen years, raised awareness to the DOH and to the medical profession regarding the unacceptable procedure and the polemics surrounding DMH all to no avail. Dr Skinner, Dr Ahmed and I met with the department of Health three times during that period and each time we were encouraged to go and find funding for clinical trials. Clinical trials are much needed in this area but they will not erase unacceptable medical terminology or unacceptable medical practice. We believe that the DOH should now take full responsibility and therefore we urge ministers to press for an independent enquiry especially in view of the evidence that has been put forward in this paper. T This is without doubt the most monumental ‘faux pas’ in medical history Diana Holmes © 2007
Set out below are the references for the Polemics 'paper'. THE POLEMICS SURROUNDING THE DIAGNOSIS AND MANAGEMENT OF HYPOTHYROIDISM
Gräsbeck R. Reference values, why and how. Scand J Clin Lab Invest Suppl. 1990 201: 45-53. Per Hyltoft Petersen, “The Latest on Reference Values and reference Interval”. Department of Clinical Biochemistry, Odense, University Hospital, 5000 Odense C Denmark. Stig Anderson, Niels Henrick Bruun, Klaus Michael Pedersen, Peter Lauberg, Haslam David, What about the patient. BMJ, Vol. 33 - 9th September 2006. American Association of Clinical Endocrinologists (AACE) Revised TSH Guidelines. Patricia A Stephens, Current issues in thyroid disease management The Endocrine Society. April 2004, Volume 29 No 2. Klaus Zöphel, Gerd Wunderlich and Jörg Kotzerke, Should we really Determine a Reference Population for the definition of thyroid-stimulating Hormone Reference Interval? Clinical Chemistry, Department Nuclear Medicine, Carl Gustav Carus Medical School, University of Technology Dresden Fetcherstrasse 74, D-01307 Dresden, Germany. Symons R.G. Murphy L.J. Acute changes in thyroid function tests following ingestion of thyroxine. Clinical Endocrinology (Oxford). 1983 Oct;19(4):539-46 Pollock Anne M, Sturrock Alison, Marshall Karen, Davidson Kate M, Kelly Christopher J.G. McMahon Alex D, McLaren Hamish E, Thyroxine treatment in patients with symptoms hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial. BMJ Volume 323 20th October 2001. Haynes Brian R, Devereaux P.J, Guyatt Gordon H. Clinical expertise in the era of evidence-based medicine and patient choice.BMJ 2002, 7:36-38.
Evidence based medicine, BMJ, 2003; 8:165. 2 www.britishthyroidassociation
Skinner GRB, Holmes DM, Ahmed A, Davies A , Benitez J, Clinical Response to Thyroxine Sodium in Clinically Hypothyroid but Biochemically Euthyroid Patients. Journal of Nutritional and Environmental Medicine 2000, 10, 115-124.
Lasser RA, Baldassarini RJ. Thyroid Hormones in depressive disorders: a reappraisal of clinical utility. Harv Rev Psychiatry 1997Mar-Apr; 4(6):291-305. Jackson IM, The thyroid axis and depression, Thyroid. 1998 Oct;8(10):951-6 Harris B, Othman S, Davies JA, et al, Association between postpartum thyroid dysfunction and thyroid antibodies and depression. BMJ 1992 July 18; 305(6846):152-6. Harris B, Postpartum depression and thyroid antibody status. Thyroid. 1999 Jul;9(7):699-703 Dr Geoffrey Kewley, Young Offenders are ill, BBC news 17th July 2003 Experts: Psychiatry and Psychology—General/ADHD and Hypothyroidism
Web Page. University of Maryland, Baltimore. Thyroid Hormone Disruption: Dioxins linked to attention deficit, Learning Problems. Easson WM Myxedema psychosis-insanity defence in homicide, Journal of Clinical Psychiatry, 1980 Sep;41(9):316-8 Nathan R, Rix K, Kent J, Myxoedema madness and grievous bodily harm, Journal of Forensic medicine1997 June;4(2):85-90 Hisao Seo, Endocrine disrupters and thyroid function, Nagoya University, Japan The Great Smokies Medical Centre of Ashville, Are Pesticides and Herbicides Bugging You?
Thyroid Hstory, History of Fluoride/Iodine Antagonist, Portfield SP, Thyroidal dysfunction and environmental chemicals- potential impact on brain development, Environmental Health Perspective, 2000 June108 Suppl 3:433-8 G Brabbant, Beck-peccoz B, Jarzab B, et al, Is there a need to redefine the upper normal limit of TSH, European Journal of Endocrinology<VOL 154, issue 5, 633-637 Vanderpump MVJ, Ahlquist J A O, et al, Consensus statement for good practice and audit measures in the management of hypothyroidism. BMJ 1996; 313: 539-544 For further research use http://www.thyroidresearch.com *************************************************************************************
************************************************************ 2. Letter to Patients under the care of Dr Gordon Skinner. Dr Gordon Skinner Below is a letter from Dr Gordon Skinner to all the patients under his care. Gordon RB Skinner MD (Hons) DSc, FRCPath FRCOG
I thought it proper to advise that on the 2nd July of this year I have been asked to attend a Fitness to Practise hearing of the General Medical Council where it is alleged that I have impaired fitness to practise and am prescribing inappropriately and putting my patients at risk. This is not the arena to debate these issues but suffice to say that I refute these allegations without qualification. I believe I have helped many patients return to health and am unaware of any significant adverse effect in any of my patients. I also believe that there is no case to answer and am presently arguing that this Fitness to Practise should not take place. The only silver lining is that it may highlight the manifest shortfall in the diagnosis and management of patients with hypothyroidism however the other side of the coin is that if I be found ‘guilty’ (Lord knows of what!) then other practitioners will become too terrified to diagnose and prescribe adequate thyroid replacement. It has been ‘relatively cheering’ that colleagues particularly in general practice have continued to refer patients and have not been influenced by this silliness where a difference in academic opinion with no harm to any patient has been transmuted into allegations of mispractice by the GMC. My patients fall into different ‘categories’. The majority return to the care of the Family Practitioner who prescribes thyroid replacement and monitors the progress of the patient. This is the general objective and the ideal outcome; there remains two other arrangements which could be problematical. 1. Some of you are monitored by regular visit to the Clinic but your Family Practitioner provides your prescription. We can resolve this situation by discussion between your Family Practitioner and myself and should not pose a difficulty particularly if you are now more or less stabilised and returned to optimal health at your present level of medication. 2. The difficulty may arise if you only attend the Clinic and I monitor your progress and/or provide your prescription for thyroid replacement. The saving grace here is that I have been scrupulous in writing to your Family Practitioner on each and every occasion you have attended the clinic and thus your Family Practitioner will be well versed and up to date with your thyroid status and level of thyroid replacement. However it is an inevitable that there could be a difference of opinion and your Family Practitioner may not agree with the diagnosis or the level of your replacement or the display of triiodothyronine (tertroxin, T3) or Armour Thyroid; I know that some of you get very tense about this but I emphasise that this does not represent a horrendous controversy between your Family Practitioner and the work of the Clinic! The first step here will be for me to discuss your case with your Family Practitioner and try to find a sensible accommodation. This might (for example) involve a short trial of thyroxine versus tertroxin or Armour Thyroid which, if not successful, most Family Practitioners will agree to reversion to a medication which had been hitherto successful. I am saying that in all but the most deep-rooted differences of opinion this should again be resolvable by good will on both sides. On this aspect I would encourage you to not charge off and obtain medications via the Internet. This is not because these are necessarily suspect or sham preparations but because it is important that a medical practitioner is able to monitor your clinical progress and, if indicated, your thyroid chemistry at appropriate stages in your management. This is an issue whose implications extend beyond the present discussion and is a matter which the GMC and the Department of Health need to give sensible consideration. In the absolute last analysis, if a patient feels that his/her health is being prejudiced by lack of thyroid medication and has run into indifference or obduracy by ‘us lot’ then the patient may feel – and it is difficult to argue against this - that they have a right to optimal health with or without the assistance of my profession. Nevertheless, I do plead that prior to this recourse, you allow your Family Practitioner and/or myself to try to resolve this problem for you. I do regret having to write to you in this way but I think it would be irresponsible to not advise you of the present situation without a back-up strategy. I hope there will be a favourable outcome. I had one bit of good news; I am going to be a Granddad in September! Kind regards, Gordon R B Skinner MD, DSc, FRCOG, FRCPath ************************************************************************************** Set out below a survey carried out by Dr Skinner Thyroid Replacement in Clinically Hypothyroid Patients who have Free Thyroxine or Thyroid Stimulating Hormone within 95% Reference Intervals; Report; 23.07.07. There is controversy in the medical profession on the advisability of thyroid replacement in patients whose thyroid chemistry in particular the free thyroxine (FT4) and or thyroid stimulating hormone (TSH) lie outside the laboratory 95% reference intervals. This is a central issue in an ongoing GMC v Skinner Fitness to Practice Hearing which has been deferred until September 2007 pending the outcome of judicial review. I thought it would be relevant to establish in part measure what proportion of colleagues practicing endocrinology had ever provided thyroid replacement in these situations (Tables 1, 2 and 3). A total of 173 respondents replied within 28 days of receiving the questionnaire wherein 56 of the respondents requested anonymity. There were 93% respondents who had at least once provided thyroid replacement to patients with TSH level above the 95% reference intervals with a lesser proportion of 69% for patients with FT4 level below the lower limit of the 95% reference interval and a lower but significant proportion (12%) where both were inside the 95% reference intervals. There was little difference in results between eponymous and anonymous respondents. These conclusions do not engross information on the precise levels of thyroid hormone within a given reference interval. This matter is often cheerfully ignored by certain colleagues who advance the strange concept that if (for example) a TSH value is within a reference interval then the patient is not hypothyroid irrespective of the level of the hormone within that interval. La Place and his contemporary Gauss – they of probability distribution fame – would be astonished to learn that Gaussian theory is now being applied to the distribution of thyroid hormone levels and then, erroneously, to the frequency of hypothyroidism; they would also be astonished to learn that there is no evidence correlating thyroid hormone values within the 95% reference intervals with the frequency and/or severity of hypothyroidism and that an unproven statistic has been transmuted into a gold standard of diagnosis wherein hypothyroidism cannot apparently exist if thyroid chemistry lies within 95% reference intervals. In the absence of secure correlative evidence, only one situation permits this approach, namely if a condition has been defined ab initio via laboratory findings which for example might apply to hypercholesterolaemia or even sub clinical hypothyroidism where the condition has been defined as having a raised TSH level above the 95% reference interval. The ‘coincidence’ of a 5% incidence of hypothyroidism – and indeed of other 5% disease frequencies similarly derived - requires critical re-examination. It must be emphasised that the frequency responses recorded in Tables 1, 2 and 3 do not represent usual or current practice of the respondents; there are of course many interpretations from information presented outwith a contextual framework. There is an urgent case to examine the efficacy of thyroid replacement in patients who have clinical evidence of hypothyroidism with clinical chemistry lying within 95% intervals. I thank colleagues for their courteous and timely responses to this questionnaire.
TABLE 1. Eponymous responses
TABLE 2. Anonymous responses
TABLE 3 Total responses
4. REBUTTAL Document of Record concerning UK guidelines for thyroid function
test In October 2005 the Association for Clinical Biochemistry, British Thyroid Association, and British Thyroid Foundation kindly prepared the document named as above and invited comment and input through the medium of e-mail with assurance that due consideration would be given to any such advice. Some eight weeks have elapsed and it is unclear how such input has been integrated or its authorship or indeed when will be the next consultation paper; these are not criticisms but we feel that there is a need to enshrine a Document of Record as a future point of reference for both the profession and patients; the latter in particular may find themselves in a difficult position if the Department of Health and the medical profession adopt or even advocate these Guidelines. This is important as there is little doubt that as time goes by Guidelines soon become Rules and the profession will believe – and not without justification in the present environment – that report of non adherence to Guidelines to the General Medical Council can result in adverse outcome or civil litigation. We require clear directives from the General Medical Council and Defence Societies that sensible decision-making outside Guidelines does not engender disciplinary action for the Practitioner. A second concern is that once Guidelines have transmuted into Rules, the precise authorship of these Guidelines and, importantly, any caveats or arguments against precepts contained within the Guidelines slip into obscurity; it is then assumed that Guidelines represented a majority view of the wise and any deviation from that view bespeaks a certain ‘charlatanry’ or marginality in the medical practice of that colleague. This document focuses specifically on hypothyroidism. This Working Group believes that too many patients’ have suffered at the hands of an ‘evidence-based’ mantra’which (ironically) has been paraded as ‘evidence based’ where there is no evidence (for example) to support the core precept of Guidelines namely that thyroid chemistry will tell you if you are well; this is purposefully stated in the simplest terms to avoid any possible confusion on this fundamental misconception which will result in continuing ill health for many patients’ and will continue so to do if these Guidelines are enshrined in stone for the future diagnosis and management of hypothyroidism. We respectfully submit that we do not accept the following precepts contained in the Guidelines. 1. EXCLUSION OF HYPOTHYROIDISM ON THE BASIS OF THYROID CHEMISTRY There is no evidence that free thyroxine or thyroid stimulating hormone levels within 95% reference intervals exclude a diagnosis of hypothyroidism. If there is contrary evidence to this view then it should be presented and further time allowed for analysis and discussion of such evidence; if there is no such evidence, then this must be unequivocally stated towards redirection of medical practice vis-a-vis management of hypothyroidism. 2.THERAPEUTIC BENEFIT IN RELATION TO DIAGNOSIS BY CLINICAL OR THYROID HORMONE LEVELS. There is no evidence on a crucial therapeutic issue mainly that the outcome of thyroid replacement is better or worse if the diagnostic criterion has been based on clinical features of thyroid chemistry. Pending formal clinical trial, we argue that patients will fare better if diagnosis is based on clinical features. 3.INTERPRETATION OF THYROID HORMONE LEVELS AND REFERENCE INTERVALS. There is little discussion in the Guidelines concerning possible technical and pharmacological shortfalls in a non critical interpretation of free thyroxine and thyroid stimulating hormone and 95% reference intervals as pivotal criteria in the diagnosis of hypothyroidism; various arguments on these issues have been presented in the following references (1, 2, 3, 4). 4. THYROID HORMONE REPLACEMENT AS MONITORED BY THYROID HORMONE LEVELS. Levels of thyroid replacement or choice of thyroid preparation should be monitored by clinical considerations rather than thyroid chemistry which is virtually an axiomatic proposition In the present environment, chronic hypothyroid ill health is too often accepted from an unfounded anxiety over perceived pathogenicity of raised FT4 and/or low TSH readings out with 95% reference intervals; we have provided evidence in publication that clinical outcome is not related to thyroid chemistry but more closely to thyroid dosage level which was based on clinical evaluation of the patient (!) 5. RELATIVE THERAPEUTIC EFFICACY OF AVAILABLE THYROID PREPARATIONS There is no evidence teaching advantage of thyroxine versus triiodothyronine versus Armour Thyroid excepting observation of practitioners who have used all three preparations over a number of years. It is thus unreasonable that there is repetitive suggestion from a number of colleagues in the field that Armour Thyroid must prove its mettle when it was actually first at the post by a long way. We ask for a measure of equability in the evaluation of medicinal products; there is urgent need for a comparative evaluation.
Long term adverse outcome from abnormal thyroid chemistry has been exaggerated from non cognisance of the clinical status of patients’ in long term studies of this issue. It is realised of course that patients with long term evidence of thyrotoxicity may well develop pathological sequelae but there is no secure evidence that suppressed TSH in clinically euthyroid patients’ carries such detriment. If there is such evidence, it should be stated but if not then we feel the document should make unequivocal statement to the contrary. It is considered highly improbable that continuance of hypothyroidism with its manifest pathological sequelae - including the oft ignored long term complications of increased cholesterol level and athoromic deposition - is a safe alternataive to clinical euthyroidism and optimal health. CONCLUSION We submit that the diagnosis of hypothroidism and evaluation of replacement dosage levels should not be pivotally dependent on thyroid chemistry but on clinical evaluation of the patient with sensible cognisance of thyroid hormone levels as an adjunct if required in patients where there might be dubiety or uncertainty on the evidentiallity of clinical features. There is no evidence from clinical trial to support the relative therapeutic benefit of either the three available thyroid preparations singly or in combinative use. There is urgent need to subject unresolved issues as highlighted above in 1 – 6 to the scrutiny of formal clinical trial. REFERENCES 1. Clinical Response to Thyroxine Sodium in Clinically Hypothyroid
but 2. Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients. G R B Skinner, R Thomas, M Taylor, M Sellarajah,S Bolt, S Krett, A Wright. Letter to the Editor. BMJ. 14th June 1997. 3. Diagnosis and Management of Hypothyroidism. G R B Skinner. Louise Lorne Publication. Birmingham, UK. 2004. Communication to Dr Beastell in response to proposed ‘UK Guidelines’ 22.12.2005 (Enclosed) ********************************************** The new guidelines have been set by The British Thyroid Association (BTA), The Association for Clinical Biochemistry (ACB) and the British Thyroid Foundation. These guidelines will be in place for one year. In September 2007 they will be up for review. Importantly the National Audit Office state, "Whilst these guidelines offer advice on the use of thyroid function tests, they do not introduce an NHS-wide standard of medical care". Also, "That so far NICE has not issued any guidance on the diagnosis and treatment of hypothyroidism *************************************************** This
page is for those who wish to be pro-active regarding undetected
hypothyroidism (whether sufferer, carer, family, or friend) because
of the clinical practice that has been carried out, by the medical
profession for the last 30 years. Why
won’t the doctors listen to you? These
feelings of anger, frustration and sadness are injurious to
our beings.
I would like to introduce you to Sian Birkinshaw a Nutritional Therapist who also has a diploma in anatomy and physiology. . HERE IS HER STORY
SIAN BIRKINSHAW S.A.C. Dip., MY STORY For the last ten years I have had a long hard battle with my health and have researched extensively in order to get myself well. As a result I now feel that I would like to use my experience and knowledge to help other people. Looking back over my life I realised that I never seemed to have much energy. After giving birth to my daughter in 1996, however, I appeared to get very much worse. Amongst many other symptoms, I suffered with chronic fatigue which made even simple tasks such as getting up from a chair a major effort. I had extremely bad constipation and was constantly very cold (I always needed the central heating turned to maximum even in hot weather ). The thing that was of most concern to me, however, was my inability to walk unaided because my balance was so bad. My movements were really slow and I was to weak to climb the stairs. In 1999I went to see a private doctor who specialised in thyroid disorders. He immediately put me on Armour Thyroid, but, although I did make some progress, I never really felt well. The next course of action was to consider adrenal insufficiency so I was prescribed cortical replacement. Over the course of the next three years, however, I went from bad to very much worse. I was forced to use a wheelchair as the physical effort of walking was just too much for me. I had severe toxicity to such an extent I was unable to eat or drink things I had always previously enjoyed and was reacting to chemicals, paint fumes, exhaust fumes, perfumes, magazine covers and all simple, everyday cleaning agents used in the home. Life was very miserable. The next few years were spent visiting countless
different therapists and kinesiologists including a Harley Street
doctor. They all came up with different diagnosis but were unanimous
in their opinion that candida was not present. I also undertook
two gut dysbiosis tests but they to proved negative. Because I had thoroughly researched the subject, however, I was convinced they were wrong, so, at this stage, feeling extremely ill, I decided to take matters into my own hands. I cut everything out of my diet until I was only eating protein and after three weeks I was eliminating candida and parasites ( proof at last ) which I identified via colonic irrigation. I was, unfortunately, forced to use this method of elimination because my under-active thyroid was making my metabolism sluggish and I was unable to boost it due to the fact I could not tolerate my thyroid medication. Candida albicans lives on sugar and yeast,
therefore, as my diet was so restricted I was starving the candida.
Living on protein alone, however, is detrimental to the liver
and also puts a strain on other organs so, after a short while,
I did have to introduce some carbohydrates. My body had so much candida I was unable to
tolerate anti-fungals. Whenever I started taking them I would
poison my system with toxins from dead candida and would take
weeks for my system to settle down again. I finally overcame
this by introducing caprylic acid. This came in three different
strengths. I would have to divide the lowest dose into quarters
and start with one quarter of a capsule. In my case I had a very Toxic Colon, Leaky gut, Candida, Parasites, Adrenal Insufficiency, Under-Active Thyroid, Multiple Chemical Sensitivities, Liver Toxicity and Food Intolerances. I am now a qualified Nutritional Therapist with a Diploma in Nutritional Therapy and have just also obtained a Diploma in Anatomy and Physiology. I specialise in Chronic Fatigue--Food Intolerances--I.B.S.--Thyroid/Adrenal problems--Multiple Chemical Sensitivities--Candida and any disorders of the gut. To book a consultation EMAIL THE ADDRESS BELOW.
First consultation £80.00 for two hours
_________
GENERAL PRACTITIONERS ARE GETTING A RAW DEAL FROM those
in the hierarchy of the medical profession.When
a"flaw" is pointed out re interpretation of thyroid
blood tests results they are not interested and insist that
the blood tests are sensitive, ergo millions of people suffer
world-wide.
******************************** IMPORTANT INFORMATION Dr Gordon Skinner (UK) holds clinics in:- BIRMINGHAM For further information contact Dr Skinner at:- VACCINE RESEARCH INSTITUTE 22
Alcester Road Tel: 0121 449 8895 *************************************************************** . If you want to carry out some of your own research go to: - formerley www.thyroidhistory.net
FROM WEDNESDAY 27TH MAY 2009 THERE WILL BE NO FURTHER POSTINGS TO THIS WEB SITE.
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