The Mail
London, UK
9 January, 2008
The wake-you-up pill ...how a controversial thyroid supplement could help tiredness
The first sign of a problem was excessive tiredness.
"I started needing a short nap in the afternoon; but eventually I was sleeping for four hours during the day," says project manager Ina Whitlam.
"It wasn't refreshing sleep, it was horrible and restless. But I couldn't function without it."
Her condition gradually worsened, so eventually she was having to sleep most of the day.
The otherwise fit and healthy 63-year-old had to give up her job with Age Concern, but even then she couldn't throw off the feelings of chronic exhaustion.
"One day I tried to go to the shops but I couldn't manage more than a few steps," she recalls. "I had to give up and go back inside. I sat down and cried."
Ina was also suffering from chronic constipation, as well as very dry skin and thinning hair.
Specialists were unable to help; her GP simply dismissed her problem as chronic fatigue syndrome.
Then four years ago - six years after her symptoms started - she saw a doctor who suggested the problem was her thyroid, the tiny gland just below the Adam's apple.
He prescribed an artificial form of thyroid hormone, thyroxine. The benefits were almost immediate, says Ina. "Within four days my brain had begun to clear and I was able to start sorting out some papers," she says.
"Gradually, all my other symptoms cleared up. It was a complete transformation. I now sleep fine and get up at 7.30am.
"At the moment, I'm renovating a property - even doing the plastering myself. Without hormone treatment I'd be confined to bed."
A veritable "good news" health story? In fact, last November, the doctor - Dr Gordon Skinner - appeared before the General Medical Council charged with reckless prescribing and was in danger of being struck off.
This is because he'd been prescribing thyroxine contrary to NHS guidelines; these state that patients should be given hormone treatment only if blood tests show their levels of thyrotropin (a thyroid-stimulating hormone) are outside the "normal" range.
The problem is that Dr Skinner disagrees with the official definition of what is "normal." He believes that many patients, whose blood tests show up as in the normal range, in fact need thyroxine.
He also refuses to rely on a blood test alone, but looks instead at other factors, including symptoms.
His approach is highly controversial and is rejected by mainstream doctors in the UK. However, he points out that in America the official guidelines have recently been revised - as a result patients who would be classified as normal in the UK would be given treatment in America.
According to some estimates, as many as a million Britons suffer from poor thyroid function. The thyroid's job is to produce a number of hormones that keep the body's various functions working at the right pace.
If it produces too much of its hormones, everything goes too fast - you lose weight, can't sleep and your heart races; but if it makes too little your systems slow down - you suffer fatigue, dry skin, constipation and can have difficulty concentrating.
The causes can include an infection or the body's own immune system attacking the gland.
Although the condition is more common in women, men can also be affected. Ina initially suspected an underactive thyroid (also known as hypothyroidism).
"But when the endocrinologist got my blood test results back he said coldly: 'You can put that idea out of your head. Your levels are normal.'"
After that she had a variety of tests - a colon examination, a 36-hour test for sleeping problems, and an investigation for skin cancer because her dry skin was cracking so badly. But all proved negative.
"In the end my GP told me I had chronic fatigue syndrome and said exasperatedly: "What more do you expect me to do? You'll have to live with it." Then he offered me antidepressants.
"I suffered four more years of misery. My brain felt as if it was wrapped in fog, I could barely get out of bed. I couldn't work, so I had no money and eventually ran up a £15,000 bill on my credit card.
"I had to sell my 18th-century country cottage to pay it off."
Then, in July 2003, she saw Dr Skinner. "He was the first person to see my symptoms as a whole picture and he gave me tests for several of the thyroid hormones. He said my body needed more thyroid hormone than the official guidelines said and put me on a replacement, thyroxine."
Ina Whitlam was just one of many hundreds of patients who sent testimonies to the General Medical Council investigation in Dr Skinner's support.
A dozen more patients appeared before the panel itself and told similar stories. Among them was Della Rhodes, a business woman and the head of a large company.
She described how, despite always playing sport, she'd suddenly put on 30lb, and had begun to feel extremely tired, while finding it increasingly hard to make vital decisions at work.
Her doctor had told her to join Weight Watchers and a gym. "Dr Skinner was the first person to really listen to me," she said. "Within two weeks of starting thyroxine my symptoms began to clear up."
Paul Shopland gave a harrowing account of how his son Chris, diagnosed at the age of nine with chronic fatigue syndrome, lost ten years of his life.
"Some of the time he couldn't leave his bed," said Paul. "Chris was effectively confined to home. He couldn't go to school so his education came to a stop and he was virtually friendless."
During that time the only treatment he was offered was "pacing" - gradually increasing the amount of activity he did.
Last year, however, after seeing Dr Skinner and being prescribed thyroxine, he went rock climbing in the Cheddar Gorge; a year after starting hormone therapy his symptoms had gone.
It seemed a bizarre situation: a doctor who was in danger of having his career ruined because he had helped hundreds of patients who, until they found him, feared there was no help for their condition.
And yet, according to Professor Tony Weetman, president of the British Thyroid Association and one of the expert witnesses testifying against Dr Skinner, what most of these patients were really suffering from was "somatoform disorder," meaning that their symptoms were largely psychological. They just thought they were ill; the thyroxine acted as a kind of placebo.
Furthermore, the evidence shows that treating patients whose tests are normal makes no difference, says Dr Colin Dayan, a consultant senior lecturer in endocrinology at the University of Bristol.
"And we are worried that giving them thyroid replacement therapy when they don't need it could put them at risk of stroke, heart problems and osteoporosis later on."
Professor Weetman agrees it can be dangerous to treat those in the normal range: "Many people in their 50s and 60s may experience fatigue and weight gain, so the blood test has been invaluable in diagnosing those who have thyroid problems and those who haven't," he says.
"Doctors who collude with these patients and treat them for an illness they don't have could overlook a genuine and more serious diagnosis such as cancer or liver disease."
But this assumes that everybody reacts in the same way to their thyroid levels; Dr Skinner and his patients believe they don't.
What's more, the "healthy" levels for other body chemicals such as cholesterol have been changed recently.
In fact, whether you are found to be inside or outside the normal range can depend on where the test is being done.
One of the patients who testified for Dr Skinner had been declared in Germany to have an underactive thyroid but was "healthy" in the UK.
The difference between the test levels in the UK and America is even more striking.
The test for low thyroid measures levels of thyroid stimulating hormone. In the UK "normal" levels are defined as between 0.5 and 5. In America the range is 0.3 to 3, which means more Americans are diagnosed as hypothyroid.
The situation has been made even more confusing by the result of Dr Skinner's hearing. Even though he was found guilty of "reckless prescribing" and "impaired ability to practice" the General Medical Council has decided that he should be allowed to continue treating patients in the way he has been.
The main limitation that has been put on him is that he can take on new patients only if they have been referred by a GP. His clinical procedures also have to be checked by the Council every six months for the next three years.
A major factor in this decision was undoubtedly the emotional testimonials of his grateful patients.
In her summing up, the chairlady of the panel hearing the case said: "It is clear that you are a caring and compassionate doctor whose overwhelming concern is the care and well-being of your patients, many of whom have pleaded that you should be allowed to continue to practice."
Since the hearing, new research has suggested that patients with levels of 1.4 to 4.99 (officially "normal" in the UK) were at a greater risk of developing thyroid cancer.
Giving a thyroid supplement reduces these levels - but this won't be happening under current UK guidelines.
Dr Dayan says the key is more research. "I wouldn't treat outside the normal levels myself. But provided patients are made fully aware of the risks, and if blood tests were taken and they were monitored properly, I think there may be a case for it."
Thyroid Patient Advocacy-UK:
www.tpa-uk.org.uk;
British Thyroid Foundation:
www.btf-thyroid.org;
Thyroid UK:
www.thyroiduk.org
http://www.dailymail.co.uk/pages/li...ticle_id=506717
The wake-you-up pill ...how a controversial thyroid supplement could help tiredness
One of the specialists who treats me, however, didn't agree with her, so he ordered a special test that measures all of the thyroid hormones separately. The test showed that I did have plenty of T4, the hormone that is usually measured, but I had almost no T3. He convinced my doctor to increase my L-thyroxine, and I felt better immediately! 
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