Opinions are divided. There’s me and some dead guys, and everyone else. Everyone else thinks it’s a solved problem.
By the way, the people who you insist on calling “fat, tired, and with dry skin” are in subset three. They exhibit clinical symptoms of hypothyroidism.
They absolutely do! Back in the day, they would have been referred to endocrinologists on suspicion of hypothyroidism, who would have (if they were very sophisticated and modern endocrinologists) used Billewicz’ test to sort them into definite, definitely not, and ‘therapeutic trial’ groups. His test didn’t rate these three symptoms, or lethargy or stupidity, because most everyone he saw had them, so he would look at all their other symptoms to make the diagnosis, looking for things like slow reflexes that are characteristic of hypothyroidism, and weight them to get a score. It really is a very careful piece of work, that test.
He would treat the ‘definites’ without further ado, send the ‘definitely nots’ off to people who were into diabetes etc, and be careful with the rest. Including all sorts of unreliable lab tests and therapeutic trials.
Luckily the therapeutic trials are not difficult to do, because with desiccated thyroid/T3 you seem to get either get a fairly rapid improvement, or you get hyper symptoms. (you might get both of course, in which case dose probably too high)
Other popular ways of trying to work it out involved cholesterol and basal metabolic rate.
Broda Barnes thought waking armpit temperature beat all this and just handed it out to anyone who woke up cold.
And the fact that it has been sprayed around at random for a hundred years without anyone having a word to say against it implies that it’s pretty damned safe. If you give yourself a massive overdose, then sure, you can probably give yourself a heart attack, but you’d need to be way way more criminally careless than I can imagine any (modern) doctor being.
Osteoporosis and atrial fibrillation (both ghastly things) are associated with low TSH, so it’s doubtless not a good idea to induce hyperthyroidism in people. And I think we should be careful not do that.
Barnes might have been deluded. I certainly started off thinking that he was, but one thing he was into was records and statistics. He thought his patients healthier than the general population. Including low rates of heart trouble. Which is just bizarre if what he was seeing was today’s CFS etc population, who seem to be really ill and then go on to be even more ill. Unless his treatments actually helped.
Hell, let’s do all four! If there’s a subset of fat tired stupid lethargic CFS patients with dry skin and high Billewicz scores, low basal metabolic rates, high cholesterol, and low waking temperatures all at the same time, then let’s run the Scottish trial on them and see what happens. That should be enough to break the TSH test, at which point, I imagine there will be an absolute explosion of research.
I couldn’t agree more that it’s really really important to understand mechanism. I’m into ‘explanations’ and ‘causes’. I think you are too. I get the impression that they’re a bit out of fashion in medicine.
Well, it’s pretty clear that it will help some people
Ooh, is it me and you and some dead guys now? Welcome! Sorry some of us aren’t that talkative. Damnit, that means I need another opponent. Devil’s advocate isn’t good enough. It needs to be someone who hates the idea.
Dies at noon.
Oh dear, poor Charles. The English crown was a bit of a poisoned chalice for the Stuarts wasn’t it? Still, he made it to 53 and they did call him the Merry Monarch. Anyone who dies in office of excessive mistress-related-activity hasn’t had a totally wasted life.
Opinions are divided. There’s me and some dead guys, and everyone else. Everyone else thinks it’s a solved problem.
They absolutely do! Back in the day, they would have been referred to endocrinologists on suspicion of hypothyroidism, who would have (if they were very sophisticated and modern endocrinologists) used Billewicz’ test to sort them into definite, definitely not, and ‘therapeutic trial’ groups. His test didn’t rate these three symptoms, or lethargy or stupidity, because most everyone he saw had them, so he would look at all their other symptoms to make the diagnosis, looking for things like slow reflexes that are characteristic of hypothyroidism, and weight them to get a score. It really is a very careful piece of work, that test.
He would treat the ‘definites’ without further ado, send the ‘definitely nots’ off to people who were into diabetes etc, and be careful with the rest. Including all sorts of unreliable lab tests and therapeutic trials.
Luckily the therapeutic trials are not difficult to do, because with desiccated thyroid/T3 you seem to get either get a fairly rapid improvement, or you get hyper symptoms. (you might get both of course, in which case dose probably too high)
Other popular ways of trying to work it out involved cholesterol and basal metabolic rate.
Broda Barnes thought waking armpit temperature beat all this and just handed it out to anyone who woke up cold.
And the fact that it has been sprayed around at random for a hundred years without anyone having a word to say against it implies that it’s pretty damned safe. If you give yourself a massive overdose, then sure, you can probably give yourself a heart attack, but you’d need to be way way more criminally careless than I can imagine any (modern) doctor being.
Osteoporosis and atrial fibrillation (both ghastly things) are associated with low TSH, so it’s doubtless not a good idea to induce hyperthyroidism in people. And I think we should be careful not do that.
Barnes might have been deluded. I certainly started off thinking that he was, but one thing he was into was records and statistics. He thought his patients healthier than the general population. Including low rates of heart trouble. Which is just bizarre if what he was seeing was today’s CFS etc population, who seem to be really ill and then go on to be even more ill. Unless his treatments actually helped.
Hell, let’s do all four! If there’s a subset of fat tired stupid lethargic CFS patients with dry skin and high Billewicz scores, low basal metabolic rates, high cholesterol, and low waking temperatures all at the same time, then let’s run the Scottish trial on them and see what happens. That should be enough to break the TSH test, at which point, I imagine there will be an absolute explosion of research.
I couldn’t agree more that it’s really really important to understand mechanism. I’m into ‘explanations’ and ‘causes’. I think you are too. I get the impression that they’re a bit out of fashion in medicine.
Ooh, is it me and you and some dead guys now? Welcome! Sorry some of us aren’t that talkative. Damnit, that means I need another opponent. Devil’s advocate isn’t good enough. It needs to be someone who hates the idea.
Oh dear, poor Charles. The English crown was a bit of a poisoned chalice for the Stuarts wasn’t it? Still, he made it to 53 and they did call him the Merry Monarch. Anyone who dies in office of excessive mistress-related-activity hasn’t had a totally wasted life.