...avoidance of thyroid hormone treatment of euthyroid individuals, a robust defence of the biochemical basis for the diagnosis of hypothyroidism and institution of replacement with synthetic thyroxine as the standard, rather than Armour thyroid extract.Maybe at some point, he will share with us exactly how he defines "euthyroid," and whether doctors should ignore clinical evidence in favor of robustly defending the lab values as the sole diagnostic tool. And maybe by then, someone will have done some tests to clearly demonstrate why synthetic thyroxine should be standard, instead of relying on marketing literature for their arguments.
In the meantime, Weetman says, that as doctors, "...we should retain our own sense of perspective, scepticism and humility." Sounds like he should start by taking his own advice.
Talk Back to Tony
DOCTORS: Doctors, do you disagree with Tony Weetman? Write to him, and please share your thoughts with me as well, for publication! Patients need to hear that there are reasonable, caring thyroid practitioners out there.
PATIENTS: And thyroid patients....do you disagree with Weetman? Write to him now and let him know what you think of his somatoform disorders theory, or perhaps he needs to hear that patient empowerment and "Healthism" isn't going away in his lifetime!
Tony "AP" Weetman
Email him now: a.p.weetman@sheffield.ac.uk
Write, call or fax:
School of Medicine & Biomedical Sciences
University of Sheffield
Beech Hill Road
Sheffield, United Kingdom S10 2RX
Telephone: 44 (0)114 271 2357
Fax: 44 (0)114 271 3960
UPDATE!! THU MARCH 23, WEETMAN RESPONDS!
Weetman read the article, and sent me the following email late last night:
Sorry but you have missed at least one crucial point - somatoform disorders are neither hypochondriacal nor psychiatric - I make the point that future research will show that there is basis for these that currently eludes us.I responded with the following. (No response back from Weetman yet, almost 24 hours later.)
If somatoform disorders are neither hypochondriacal nor psychiatric, then much of the medical literature clearly is not in agreement with you.Emedicine's online medical journal: "... somatoform disorders represent a psychiatric condition because the physical symptoms present in the disorder cannot be fully explained by a medical disorder, substance use, or another mental disorder. "
EmedicineMerck Manual: "Somatoform disorder is a relatively new term for what many persons refer to as psychosomatic disorder."
Merck ManualBy every definition I've seen, somatoform disorders include Somatization Disorder (which used to be called "hysteria"), Hypochondriasis, Pain Disorder, Conversion Disorder, and Body Dysmorphic Disorder. These are all psychiatric diagnoses.
Are you working off a new interpretation or definition of somatoform disorders that is a departure from the current understanding in medical literature? Because here in the U.S., somatoform disorders are diagnosed and managed by psychiatrists, and discussed in psychiatry coursework and textbooks, and somatoform disorders are sometimes considered "synonymous" with hypochondriasis.
Also, if the fact that there is some sort of basis for somatoform disorders in people who believe they have thyroid problems is relevant, it was lost in your assertion that symptoms can be disregarded in favor of tests.
You say, and I quote: "The majority of patients who demand thyroid hormone treatment for multiple symptoms, despite normal thyroid function tests, have functional somatoform disorders..."
However you choose to interpret somatoform disorders, your article completely bypasses a critical issue: If a patient demanding thyroid treatment is seeing a physician who follows the "old" recommended TSH range of .5 to 5.0, and that patient's TSH falls into the 3.0 to 5.0 category, and the doctor says the thyroid tests are normal, does that patient then have functional somatoform disorders?
And if the patient goes across the hall to another doctor, who follows the new .3 to 3.0 normal range guidelines, and with that same TSH level, the patient is told "you are hypothyroid and I recommend thyroid hormone replacement treatment," then what happened to the functional somatoform disorders diagnosis?
Before declaring all "normal" blood test patients who still believe they have a thyroid problem as having somatoform disorders, you owe it to the patient community to answer a number of critical questions:
