Hello everybody I'm dr. Renée. I'm back for my weekly look - thank you for
joining me. So today I'm going to talk about
hypothyroidism, which is an underactive thyroid. It's a big problem. Lots of
people suffer. And I need to declare at the very start of this video that I have
a vested interest in this particular topic, because I lost my thyroid to a
very nasty lump about 17 years ago. And across that time I have built up lots
of experience, done lots of research and been through the mill. So some of this video
is going to be geared towards what I've experienced and some of that is controversial.
So if you don't like controversial, turn away now. If you do, keep watching!
So what is the thyroid? The thyroid is a gland that produces hormones. It sits
here at the front of the neck, in front of the windpipe. It's butterfly-shaped
shaped , so it has two lobes either side of the windpipe. And it's a really important gland
and I'll explain why just now. It produces hormones; two of them in the
main, there are some others but the main ones are thyroxine or T4 and this is the
less active of the two main hormones it produces. And then T3, which is
triiodothyronine, and that's the more active. So what do the hormones do? Well
essentially, once you get down to every single cell level in your body, thyroxine,
in its active form T3, controls the metabolism of all cells. So that means it
controls how fast your nails grow, your hair grows, your heart beats, your brain
functions and your ability to think, your skin grows your bowels work. Basically
everything! So you can consider your thyroid gland to be the engine or motor
of your body; that's why it's so important. Because when it goes wrong,
when it acts too quickly or too slowly, the symptoms can be awful. And at points
life-threatening! So as I said, I'm going to talk today about an underactive thyroid.
And the thyroid can go wrong in two ways it can work too quickly and this is
called hyperthyroidism and it can work too slowly and this is called
hypothyroidism or underactive thyroid. The majority of patients we see as GP's
have an underactive thyroid that's the most common scenario, and it happens for
many many reasons. So who gets thyroid issues? So it's definitely a woman's
problem, I'm one of them! 1 in 50 women have a thyroid problem, so it's big. And 1
in a 1000 men, not so big. And it increases with age whether you're a man
or a woman. So what are the causes of an underactive thyroid? Well they're vast
and lots of them are actually a vlog in their own right so I won't go into the
whys and wherefores but I will tell you what they are. So sometimes in an
autoimmune condition called Hashimoto's the thyroid actually gets attacked
within the body and starts to be destroyed and therefore stops working or
gradually gradually stops working. Sometimes it's genetic so you can be
born without a thyroid. And that's a medical emergency and that's why babies
have the heel prick test when they're born, to test their thyroid. It can be as
a result of pituitary failure. Now Pituitary failure is a gland in the brain
that sends out a hormone called thyroid stimulating hormone to the thyroid to
tell it how quickly or slowly to work, how much thyroid hormone to make. If that
doesn't work properly then the thyroid won't work properly. Sometimes
when people's thyroid becomes overactive we have to treat it to try and get it
back to normal and we do that through surgery, through medications, and through
radioactive iodine. The aim is to get it to normal, but quite often it's a difficult
science, you can't get it exactly right and lots
of people end up hypothyroid after that treatment.
And now, more controversially,
and I did warn you! Sometimes people just don't respond very well to T4 (levothyroxine), they
have a resistance to it, so that means it doesn't matter how much medication we
give them they just don't seem to absorb it very well, or use it as they would
their own thyroxine. And it happens at cellular level, in every cell in the body
and if people stop doing that and that's what happened to me and I'll talk about
it later then they've become quite sick. It's controversial, because it's not
recognised universally within the medical arena that this actually happens!
So what are the symptoms of hypothyroidism? Well they are absolutely
vast and before I list some of them, and I couldn't possibly list all of them,
it's important to recognise that lots of these symptoms can be caused by lots of
other conditions. So just because it is a sign of hypothyroidism doesn't mean
that's what the cause is and that's why it sometimes takes a GP time to unpick
what's really going on. But to give you just a few, or quite a few! So if your
thyroid isn't working so well, you'll be putting on weight but actually have no
appetite and not be eating much, you could be cold all the time when other
people are hot, you'll be sleeping (over sleeping) but still not feeling refreshed,
your periods could become different to how they normally are so they'll become
heavier and closer together and that was always the first sign for me that my
thyroid medication wasn't quite right. It can cause infertility, so a massive issue.
It can cause dizziness and breathlessness. It can actually cause
loss of libido or sex drive, muscle and joint pain, hoarseness, dry or gritty eyes.
Hair loss, particularly to the eyebrows and outer parts of the
eyebrow; that's quite a classic sign of hypothyroidism. Difficulty swallowing.
Constipation. Changes in how you're feeling mood wise...
so depression is quite a common sign of hypothyroidism but is sometimes
misdiagnosed and lots of women are put on antidepressants when actually it's
their thyroid which is actually the problem. So as you can see there are lots
and lots of symptoms and you may get some of these, all of them, one or two, and
everybody as always is unique. And as I said before, lots of these symptoms can
be caused by other things so it's really important to have proper investigations. So
what are those investigations and how will your GP diagnose hypothyroidism?
Well it's a blood test and that blood test in the UK, following UK guidelines,
generally looks at thyroid stimulating hormone (TSH) which is the one I mentioned
from the pituitary gland in the brain. And T4 which is the main but less active
thyroid hormone. And the reason we look at thyroid stimulating hormone is
because if your thyroid stops working so well your pituitary gland picks that up
on a negative feedback pathway and it starts to produce more TSH to try and
stimulate the thyroid to produce more hormone. So the theory goes that if the
TSH is raised it means that your thyroid isn't working so well, so that's an
indicator that things are not quite right. If you get your blood test back
and your TSH is raised but your T4 is within the normal blood ranges
that's called subclinical hypothyroidism.
And you won't necessarily be treated at that point, you'll be asked to have
another blood test in about six months. Now in the UK, if you don't have any
symptoms and that's what your blood show we will allow the TSH to go as high as
10 before we treat. Now for some people, lots of people I would imagine actually,
a TSH of 10 could make them feel absolutely awful! A TSH of 4 makes me
feel awful so I think that's a really important thing to know.
Just because you're within the range for 'watch and wait' doesn't necessarily mean
that's right! And if you've got symptoms, any of those symptoms, you need to go
back and have a discussion. If your T4 is low and your TSH is high
that's hypothyroidism and you should be treated. And your GP will manage these
results quite well that's what we do, you know, that's what we're trained to do but
we are trained within these guidelines. A lot of people don't sit within those
guidelines, but I'll come on to that.
Your GP will manage you or refer you to an
endocrinologist. And generally they'll refer you to an endocrinologist if you
had a scan of your thyroid, an ultrasound scan, which shows
any lumps or masses, because they'll need to be investigated. If you've just had a
child or if you're pregnant. If you're taking any medications that can affect
the thyroid or if you're a child you should get referred to an
endocrinologist. But otherwise your GP is perfectly placed to treat you. So, what is
the treatment for hypothyroidism in the UK? Around the world? So you'll be
given a synthetic hormone, of T4, it's called levothyroxine. And you take it in
the morning on an empty stomach with a glass of water and you shouldn't have
any iron or calcium containing supplements with it and you shouldn't
have any caffeine or food for an hour after taking it. Now I don't know about
you, but I need a cup of tea as soon as I step out of bed in the morning! So I have
a decaffeinated tea. You could have a decaffeinated tea or coffee, and that
doesn't affect my thyroid levels at all, so that's how I convince my brain
that it's getting it's cup of tea in the morning! Now, your GP will start slowly,
probably starting on 25 micrograms of T4, and then retest your Bloods every four
to six weeks. And it's important to start slowly because it can affect your heart
and it can cause palpitations or arrhythmias. So that's why we go nice and
slowly and it takes about four to six weeks for your
blood levels to change. So that's why we wait for those blood tests. And for the
majority of people T4 works very very well indeed. BUT, and this is where I'm
going to become really controversial, so you might want to switch away you might
want to listen! Some patients never feel well on T4 alone. They just never get
back to their normal selves. And alongside this, the bloods that their GP are doing
for them appear in range the TSH is in range and the T4 is in range and they'll
be told by their GP that that's fine but they still don't feel well. Some people,
and this is the really controversial bit, don't convert T4 to T3 .The UK guidelines
tell doctors, and we get taught this at medical school, to only look at
the TSH and T4 and not to use anything else. Not to make a judgement. But I think
we need to make a judgement, and I have lots of experience as to why. There's no
routine measurement of T3 in the blood in the UK. Some labs won't even do it!
Sometimes my bloods get sent off with a T3 and the lab don't do it, they ignore
it. But it is important and I'm going to take you through why. The reason for
these guidelines is that the evidence is equivocal. So they're studies to say
that patients are much better on a combination of T4 and T3, there are
studies that say it makes no difference and there are studies that say patients
are worse. So because there isn't enough evidence from the studies, the guidelines
we have at the moment are as they are. So, T3 is this the answer for the minority
of patients that don't get on with T4 alone? Well let me tell you my story. I
got on fine with T4 for about six years. I was absolutely fine, I didn't have any
problems, my bloods were in range, my TSH was always very low, always, from the very start; that's how I reacted to synthetic T4. However, I went through a stressful
time. I was taking my medical final exams actually, and they started to feel
rubbish. I was sleeping all day, which wasn't good
for studying! I was swelling up and bloating, I couldn't think, my mood was
poor. Things were not right. I started to see my endocrinologist
and she kept increasing my T4 Nothing was changing, just my T4 was going up. So
she then did some T3 bloods and my T3 was below range. So even with my
increasing T4 for my T3 wasn't changing. So fortunately for me I had an
endocrinologist who was quite happy to step outside of the guidelines. And she
said to me "you have stopped converting T4 to T3. You need some T3". So she added
in some T3, and it's always a much lower dose than T4, because it's much
more powerful (about five times more powerful). And I take it twice a day,
whereas the T4 I take once a day, because it has a much shorter half-life.
From that moment I began to feel well and within a month I was back to my
normal self. Now the results of this in my blood tests was that my T4 and T3
were within the normal range. My TSH however, was below the normal range. It
was what we call suppressed. And lots of GP's and other doctors get nervous about
that but my endocrinologist is happy that that's my response. He examines me
all of the time and says that I am you euthyroid. That means normal thyroid. I
don't have any signs of being hyperthyroid. And we've now been on that dose,
or I've been on that dose, of T3 and T4 for 11 years and it works beautifully
for me. My mood is good, I can think, I'm not swollen (I hope) as you can see. I'm
not sleeping all day and i'm back to my normal self. And there are lots and lots of
patients anecdotally who feel the same; that they never felt right until they
had T3. And so it sounds easy doesn't it just give the patient T3, but it's not
that easy. But what I would say is if you're on T4, you're not feeling well, you
think you've got symptoms; in the first instance see your GP. Ask for a T3 blood
test. See if they can do it.If more thyroxine is added and you still don't
feel well ask to see an endocrinologist and discuss this T3/T4. There's a lot of
information about this on Thyroid UK's website which is www.ThyroidUK.org.uk. But I will put this up after the video. But there's a there's
vast amounts of information and message boards so it's a really great place for
you to actually get more information than I can give in this VLOG. So there's
a bit of a T3 scandal going on at the moment because five years ago T3 in the
UK was 19 pounds a month. And that's how much it still is in Europe but
unfortunately in the UK it's now about £260-£280 a
month and as a result lots of CCGs, they're the governing bodies that run
local GP's, don't want to pay for it. And they're putting on black lists so in
some areas of the country now you can't get T3! I'm fortunate that I'm in an area
where I still can but I am terrified that that will change at any point and I
can't buy it over the counter and where will I get it?
Well that's the dilemma that many many people are facing and they're scared, I'm
scared, because I know what happens when I don't
have it. And it's already happening in some areas of the country.
Now also, NHS England is running a consultation soon looking at over-the-counter medicines that either don't work very well are very cheap.
and they added T3 to the list of 10 drugs that they're looking at, which is odd because it's not
available over-the-counter and you have to have a prescription for it. They say
that it is clinically effective but there are cheaper alternatives. Well the
cheaper alternative is T4 and we know that that doesn't work for a lot of
people. So we need to tackle this, we need to speak to NHS England, we need to take
part in the consultation, and we need to campaign with the various campaign
groups that there are currently looking at this very thing on behalf of their
patients. Bear in mind that one in 50 women are affected by this. Many cannot
function without T3. I certainly am one of them! So 260-280 pounds a month is
expensive, but it would be much more expensive if I wasn't functioning in
society.... if I couldn't work. I'm a GP, surely I'm more valuable than 260 pounds
a month as on most women who are working, looking after children, looking after
relatives. You know, it's ridiculous that women are being affected in this way and
it is mainly women. So what to do? Well if it affects you, if it affects a member of
your family, someone you love, make an appointment to see your MP, that's what
I'm going to do, and talk to them about it. Ask them to raise it for you. You can
write to NHS England to Simon Stevens he's the Chief Executive .You can take
part in the consultation. You can sign the petition that's currently underway
and I'll put that on here after this as well so you can look it up and I'll put
the information for the thyroid UK and some of the information I've mentioned
in the video, because it's a lot obviously to take in. But it's really
important, it's really important to me. I won't be able to make these videos if I
don't have T3, because I won't be able to think. I certainly won't be able to
write them. So please, if you have a thyroid that you think isn't working
very well just go and be tested. It may be that you just need T4 which
works brilliantly for lots of people. If you're already on T4 and you're still
not feeling well go back to your GP and speak to them. And
if you're not getting anywhere and you really feel strongly about it ask to see
an endocrinologist and discuss T4/T3 with them.
And hopefully this has been really really helpful, it's not been too much about me, I'm sorry if you think it has,
but I think I represent lots of people out there who are suffering like I did.
And thank you for watching and again post any questions afterwards and
suggest any videos for the future. I've got lots of good suggestions but I'm
quite happy to take more.
Thank you for your support!