Testimony by Thyroid Scientist John E. Midgley to the Scottish Parliament Public Petitions Committee, June 15, 2017
“Nearly 50 years ago my wife was a technician at the University of Newcastle upon Tyne In the Department of Medicine and Professor Reginald Hall who at that time was an authority on thyroid function test development and diagnosis.
And after a while she began to feel ill. She was running the test for thyroid stimulating hormone, the first test to be developed in this country, and she started feeling ill, and the professor said it was … shall we say … she was doing the tests and she fell ill, and there was a suggestion, that after a while she put her [own] serum sample into the test run.
And lo and behold, there she was, TSH – okay sky high. She was suffering from Hashimoto’s Thyroiditis, which ultimately destroyed her thyroid.
I was a lecturer in Newcastle University on something else altogether different, and of course naturally I became interested in the thyroid and how it worked and how it was treated.
And by a series of coincidences, later, I got into the position of being able to invent the thyroid function tests which are now used worldwide for free thyroxine [FT4] and free triiodothyronine [FT3].
And over the next 40 years from the late nineteen seventies, I’ve taken interest in the development of the testing and treatment and diagnosis of thyroid patients.
I must say that I’ve become increasingly unhappy about the way in which testing has proceeded.
I think that it is unfortunate that the test I have already mentioned, Thyroid Stimulating Hormone, has become an all-overreaching test which is supposed to be successful in diagnosing both the onset of disease (that is under- or over- function, for which it is perfectly suitable), but it has been extended the control of treatment, for which it is totally unsuitable.
And this unsuitability has led to a significant number of patients being wrongly diagnosed and wrongly treated or not treated at all.
So I’d just like to make some general statements to the committee which are written down here I’m afraid for my memory (sometimes I lose it at my age).
So I hope to convince you that the current paradigm of thyroid deficiency treatment is insufficient, wasteful of medical time and resource, the wrong test to control treatment.
It commits the sin of categorization.
By categorization I mean it puts you or, the diagnosis and treatment is aimed putting you into the normal range —
Now the normal range is a wide range. And you as individuals each of you [have an] individual position in that range. And you might differ (just looking at the number of people here) — there’ll be somebody, shall we say, very much different from the average.
And it’s not sufficient just to put somebody in the range. You’ve got to put them in the range in the position where that optimum health is to be found.
And since you don’t know what that value was when they were well (because they were never measured), there’s a lot of flailing about going on to find out what the best solution will be.
That’s what I mean about the sin of categorization: Just shoe-horning people into the normal range of saying that’s okay, job done.
That is wrong.
And then the next problem is the promotion of biochemical markers (the measurement of thyroid hormones in blood), over patient presentation.
At the moment, the chemistry dominates the presentation of symptoms by the patient.
That’s the wrong way around; the presentation of symptoms by the patients should dominate over biochemical parameters, which should be suggestions and Indicators, but not dictators of the situation. That is very important.
And all this, therefore, has been to the detriment of the health, well-being and the economic activity of mainly female patients – about eighty to ninety percent of thyroid sufferers are female – and therefore shall we say as males, perhaps therefore we are a little less aware of the situation than women are in this respect.
For one or two percent of women at least at least two percent have got thyroid problems, and that’s quite a significant number when you think of the population.
So in short I believe there should be a unbiased review of present protocol for treatment and diagnosis in the light of new evidence which shows that the single use of thyroid stimulating hormone as a test for thyroid deficiency and for treatment is unsuitable and misleading.”
CHANGING THE PARADIGM
The gaps that I alledged in knowledge are in fact refusal to acknowledge the fact that there is evidence which in fact flies in the face of current actions.
Because the medical profession is by definition a conservative one, and having, shall we say, conducted a petition, a way of diagnosing and treating people for thirty five years is not going to take kindly to being told or indicated that they’ve been doing the wrong thing for all that time.
It will take an enormous amount of pressure to bring them to reading and understanding the rather complicated (I’ll have to say the rather complicated) papers which now show that what was being done over the last 35 years or so is suboptimal and has actually caused harm to patients.
Now that is a very big thing for the medical profession to have to swallow, but swallow it one day they’ll have to do.
THE MEDICAL PROFESSION
Yes my belief is, from what I read of people’s experience is that in general, General Practitioners are woefully ignorant of how to deal with thyroid function, thyroid dysfunction shall we say, in patients and their treatment.
They seem to have become used to what I call computer thinking, were you looking to a blue screen where there is advice given to you, and you simply follow that advice in a rigid and mechanical fashion.
And that means, as I said earlier, that the biochemical numbers which are displayed on that screen from the pathology laboratory seem to become paramount over the appearance of the person in front of you.
That is the great — in my opinion the great error that has been created — that the patient is now subordinate to the chemistry, and that’s not right. It cannot be right, because the chemistry is a guide and not dictated.
But I can’t leave the fault of the general practitioners because they only behave in the way they’re instructed to Behave.
See, I could go on for ages about this. But the individual patient is an anecdote. There they are in front of you, they’ve got their parameters, and they’re unique within or without the normal range, depending on how they are. That’s one thing.
The normal range is obtained, for health, statistically.
And there is a tension between statistics and individuality.
The individual is a place within those statistics, but to use the statistics backwards and say that individual is in there and therefore okay wherever they are, it is complete error.
So I’m saying really that the general practitioners are not given the proper method of discriminating the individual from the ranges they are given to place that individual [in].
The individuality of the patient is lost, and therefore misjudgments are continually made as to the success of the treatment.
This applies also I’m afraid to Endocrinologists, who can be just as guilty of the same errors as the General Practitioners. So this is a matter of Education. .
I think clinical training has to change very very very much. Because there are an awful lot of misapprehensions about how you treat numbers and how you relate them to patient presentation.
I think that the behavior of the opinion formers, in the entire augment is — Well, it’s verging on disgraceful.
They refused to allow desiccated thyroid to be licensed or used in this country for a very strange reason.
And the strange reason is that it doesn’t have the right content or thyroid hormones which are appropriate treatment.
Now I scratch my head on that because if you give thyroxine only to patients which is a normal treatment — that’s about as UN-physiological as you can do, and it’s far more un-physiological than giving natural desiccated thyroid, so long as the content of that product is regulated and controlled (which I believe it is, according to the pharmacy papers).
So there is no real evidence and no reason not to be quite liberal in the choice of treatments that you offer patients according to their requirements and according to their responses to the treatments.
I can’t see why there should be just narrow tram lines of suggestions and recommendations in the light of the fact that physiology in individuals is so widely defined and so widely corrected when wrong.
I simply cannot see this narrow behavior having any logic in it whatsoever.
The dogma is always take the thyroxine, normalize your TSH thank you madam or sir, go away,you are properly treated, that’s the end of it.
And if you feel ill, well that’s something else: you’re depressed or you’ve got a cold or something, well, you haven’tgot a thyroid problem.
I’m afraid the ignorance in that is — it’s quite astounding really.”
Scottish Thyroid Petition testimony – Cleaver & Midgley, 2017Video on Youtube at https://youtu.be/y99UDJIxdz8