| Thyroid decision puts lives at risk |
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| Written by Dawn | |
| Monday, 29 June 2009 | |
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Date: as sent Press release Royal College Of Physicians decision on Thyroid Management to put “countless” lives at Risk A decision by the Royal College of Physicians, the British Thyroid Association, The Association for Clinical Biochemistry, The Society for Endocrinology, The British Thyroid Association and The British Society of Paediatric Endocrinology and Diabetes, to stop the use of a number of thyroid medications, and also to raise the diagnostic reference range for hypothyroidism, will place many patients with both undiagnosed and treated thyroid disease at risk, a leading thyroid patient support organisation announced today. Whilst many patients are identified and receive appropriate hormone therapy, many wait years for diagnosis and may or may not respond to thyroxine supplementation. Patients presenting with symptoms commonly associated with underactive thyroid disease, such as weight gain, hair loss, severe depression, dementia, crushing fatigue and gastric problems, are often labelled with other conditions, and depending on where they live, and the parameters being used can remain undiagnosed and therefore untreated for many years. Upon diagnosis, some will not tolerate current NHS treatments well and will be poorly managed. These patients have become well on other, more old fashioned, thyroid hormone preparations but have now been told by their clinicians that they can no longer prescribe these perfectly legal treatments, or they may face serious consequences. Said Dawn Wood, from Thyroid-Disease.Org.Uk, “undiagnosed thyroid disease, and poorly controlled patients are more likely to develop, diabetes, cancer, heart disease, infertility, glaucoma, stroke, dementia and depression. In addition, patients often find it impossible to work and cope with their family lives creating an unnecessary burden on the NHS and UK resources. By limiting access to choice in treatment and diagnosis, many of them will go on to develop life threatening and costly disease and the autoimmune component of the condition has been completely ignored in the diagnosis, with antibodies not being tested, as they would be for other autoimmune disorders. This is a poor decision and does not fall in line with clinical practice in other countries, which have reduced the reference range, nor the illness prevention ethos the NHS is supposed to follow. The impact of thyroid disease on health is often belittled by the NHS, when it was in fact listed as the 3rd most fatal illness in the western world in 2003 by the AACE, this decision reflects that thought. Over the past few years, government and charity initiatives have funded education in consumer awareness of heart disease, mental health issues and diabetes, alerting patients to seek prompt advice and assessment – sadly in thyroid disease, directly linked to these life threatening conditions, is once again the “poor relative” when it comes to assessment and individualised management. Said Dawn, a long time thyroid disease sufferer and campaigner, “ I went to my doctor with chronic fatigue, weight gain, depression, mental confusion and hair loss, to be told it was possibly early menopause, or ME” as I was ‘normal’ according to blood tests, but would have been diagnosed in others countries which have reduced the TSH upper level, and even parts of the UK as the reference range isn’t consistent– several years later, and having finally gone out of area to be diagnosed, with help and support I am now being treated for hypothyroidism, using natural thyroid replacement as I cannot tolerate thyroxine, and finally doing well. If this decision stands, with the diagnostic range even wider, how many more patients like me will wait years for treatment that might help improve quality of life and prevent future health problems! And how long before I, and they, become unable to work again once forced to take a medication that doesn’t work for us. The organisationThyroid-Disease.Org.Uk is calling for an urgent review of this decision, in the interests of its 1700+ members, and potentially millions as yet undiagnosed sufferers of thyroid disease in the UK. However despite the RCP receiving many letters and over 100 references, such as those showing that those with a TSH level of 3.5 are 50% more likely to have heart problems, they have ignored this research, instead increasing the TSH reference range to 10, and have refused to answer the questions asked, citing just 6 examples, mostly written by those making this decision, as to their reasoning for it and causing many lives to be put at risk For further information/interviews please contact: Dawn Wood Chair, Thyroid-Disease.Org.Uk 0113 243 9140 This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ENDS Notes to editors Our letter to the RCP challenging this decision http://thyroid-disease.org.uk/index.php?option=com_content&task=view&id=144&Itemid=88 There have been many research studies showing those with a TSH level of 3.5 are 50% more likely to develop heart disease than with a level of 2.5, so the reference range has been reduced elsewhere, but these latest guidelines state people shouldn’t be treated before their TSH level hits 10 causing serious damage to their health, which may be irreparable
http://www.hkcfp.org.hk/article/2001/05/20010506.pdfReferences Endocrine Abstracts (2007) 13 P316 Does synthetic thyroid extract work for everybody? Gautam Das, Shweta Anand & Parijat De Hassan MM, et al "Association between hypothyroidism and hepatocellular carcinoma: a case-control study in the United States" Hepatology 2009; 49: 1563-70. Long-term hypothyroidism may nearly triple the risk of developing liver cancer, researchers found
Åsvold BO, Bjoro T, Nilsen TIL, et al. Thyrotropin levels and risk of fatal coronary heart disease. The HUNT study. Arch Intern Med 2008; 168:855-860. Iervasi G, Molinaro S, Landi P, et al. Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med 2007; 167:1526-1532 Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 2005; 165:2460-2466. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005; 165:2467-2472. Crapo LM. Subclinical hypothyroidism and cardiovascular disease (editorial). Arch Intern Med 2005; 165:2451-2452 Effect of Levothyroxine Replacement on Lipid Profile and Intima-Media Thickness in Subclinical Hypothyroidism: A Double-Blind, Placebo- Controlled Study F. Monzani, N. Caraccio, M. Kozàkowà, A. Dardano, F. Vittone, A. Virdis, S. Taddei, C. Palombo and E. Ferrannini Department of Internal Medicine and National Research Council Institute of Clinical Physiology, University of Pisa, Pisa 56126, Italy The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study Bjørn O Åsvold1,2, Lars J Vatten1, Tom I L Nilsen1 and Trine Bjøro3 Are serum thyrotropin levels within the reference range associated with endothelial function? Henry Völzke1,*, Daniel M. Robinson2, Thomas Spielhagen2, Matthias Nauck3, Anne Obst1, Ralf Ewert2, Birger Wolff2,4, Henri Wallaschofski2, Stephan B. Felix2 and Marcus Dörr2 Bone mineral density in premenopausal women receiving levothyroxine suppressive therapy. Nuzzo V, Lupoli G, Esposito Del Puente A, Rampone E, Carpinelli A, Del Puente AE, Oriente P.Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy. Carefully monitored levothyroxine suppressive therapy is not associated with bone loss in premenopausal women. Marcocci C, Golia F, Bruno-Bossio G, Vignali E, Pinchera A. Istituto di Endocrinologia, Università di Pisa, Italy Suppressive doses of Thyroxine do not accelerate age-related bone loss in late postmenopausal women.Fujiyama K, Kiriyama T, Ito M, Kimura H, Ashizawa K, Tsuruta M, Nagayama Y, Villadolid MC, Yokoyama N, Nagataki S. First Department of Internal Medicine, Nagasaki University School of Medicine, Japan A slightly suppressive dose of L-Thyroxine does not affect bone turnover and bone mineral density in pre- and postmenopausal women with nontoxic goitre. De Rosa G, Testa A, Maussier ML, Callà C, Astazi P, Albanese C. Institute of Endocrinology, Catholic University School of Medicine, Rome, Italy The effect of thyroid hormone on skeletal integrity. Greenspan SL, Greenspan FS. Division of Bone and Mineral Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. The Clinical Significance of Subclinical Thyroid Dysfunction Bernadette Biondi and David S. Cooper Department of Clinical and Molecular Endocrinology and Oncology (B.B.), University of Naples Federico II, 80131 Naples, Italy; and Sinai Hospital of Baltimore (D.S.C.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21215 Increased cerebrospinal fluid levels of 3,3',5'-triiodothyronine in patients with Alzheimer's disease.Tan ZS, et al "Thyroid function and the risk of Alzheimer disease: The Framingham Study" Arch Intern Med 2008; 168: 1514-1520. |
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