I’d like to announce the update our website’s overall theme (layout and navigation) and share the contents of our new “Vision” page within this post.
We have a new static Home page with new content at our domain https://thyroidpatients.ca. That page now summarizes what it means to “optimize our therapy” — it means that we collaborate with our physicians to discover what our individually optimal FT3 and FT4 levels are.
The new features of our website layout (applying the free theme called “The Minimal” by Rara Themes in WordPress) include a thinner header image at the top, and many places where you can access the search function, and a slightly reorganized menu. The site map is now renamed “Browse by category,” since site map is not a common term for most users. That’s where you can see all our pages and posts organized by topic and subtopic.
The only technical glitch so far is that most of our blog posts will have 2 header images at the top (featured image + the same image pasted into the top of the page). This has to be changed on each post manually, and it will take a while to make this cosmetic change.
So, here is a copy of our new “Vision” page, with room for comments. If I make any edits or updates to that page, they’ll be at https://thyroidpatients.ca/home/vision/
This page describes the ideal future for thyroid healthcare that I, Tania Sona Smith, envision as president of Thyroid Patients Canada. I believe that a large-scale paradigm change is needed and desired by most thyroid patients around the world. Many of us are struggling with “TSH idolatry” and rigid beliefs that dosing LT4 and adjusting T4 hormone is the primary way of normalizing TSH.
In the best version of the future, which I believe is already happening here and there in some doctors’ offices, I envision a move away from the old and current TSH-T4 paradigm to the new science-based T3 paradigm. A new set of fundamental presumptions and practices are needed to help thyroid patients all over the world access the kind of healthcare that would aim to “optimize our therapy.”
Our new “Vision” page
What kind of future are we building at Thyroid Patients Canada?
Page contents:
Our call:
“Renew the paradigm. Optimize our therapy.”
— Thyroid patients everywhere
But first…
To optimize therapy, we will need a new paradigm for thyroid diagnosis, testing, and treatment.
— Tania Smith, Thyroid Patients Canada
Our Vision for diagnostic testing
We look forward to a science-informed healthcare system in which no patient is stereotyped as being unequivocally “euthyroid” just because their TSH concentrations fall within the reference interval of their local laboratory.
In our vision of the future, physicians and healthcare administrators will be much better informed that an isolated normal TSH cannot confirm euthyroid status. See our science reviews such as “Can a normal TSH rule out thyroid disease?
Given the rise of AI applications in health care, laboratories may easily implement tools that enable clinicians to interrogate the TSH response by using FT3 and FT4 data. These tools already part of a free endocrinology research app: See “Analyze thyroid lab results using SPINA-Thyr.”
Once the idolatry of the TSH reference interval is undermined by science and reason, and once clinicians rediscover the usefulness of FT3 and FT4 data, we may see changes to laboratory flowcharts that now overrule clinical judgment and dictate the cancellation of FT3 and FT4 tests whenever TSH is normal.
Our vision for the patient-physician relationship
We work toward a world in which physicians and thyroid patients collaborate and engage in dialogue during diagnosis and treatment. Both parties will openly discuss how they hope to achieve their shared goals: 1) minimizing the subjective symptoms and the objective signs of hypo- and/or hyperthyroidism and 2) minimizing health risks.
Ideally, more physicians will earn their patients’ respect by treating patients with respect and compassion. More physicians will consult their patients’ preferences, priorities, and past experiences. The best clinicians will refuse to be shamed by science articles that ridicule them for giving in and listening to thyroid patients’ pleas and suggestions.
In the future we are building together, physicians will no longer stigmatize or stereotype thyroid patients as having “unreasonable expectations,” or being “difficult” or “demanding” when patients seek T3 tests or T3 treatments beyond the traditional TSH-idolizing, LT4-obsessed paradigm. See our series “2019 ATA article engages in patient-blaming and doctor-shaming.”
In the best patient-physician professional relationships, both parties will admit they are not immune to “confirmation bias” — the tendency to seek only the evidence that confirms one’s own beliefs while ignoring or rationalizing evidence that contradicts those beliefs. See our article on true “Evidence-based thyroid therapy.”
In an ideal future, more thyroid patients seeking optimized therapy will prepare themselves for medical appointments by trying to understand the science behind their condition and its treatments, and trying to understanding the professional constraints their physicians face.
If science-based thyroid patient peer support communities can grow and train other thyroid patients to be mentors and leaders, they can play a key role in supporting healthier patient-physician relations.
Evidence-based patient support groups can provide links to accurate and complete information, correct misinformation, and offer cautions, practical tips, and encouragement.
Our vision for thyroid science
Informed thyroid patients envision a future in which the best thyroid scientists challenge clinicians to question the standard paradigms and the sufficiency of what they learned in medical school.
Too many physicians — and patients — imagine that thyroid diagnosis and treatment is easy. Many have unreasonable expectations about the efficacy of simple step by step processes that guide thyroid healthcare.
A key role of thyroid science is to keep physicians and patients humble and awed by the complexity and power of the thyroid hormone system. The best of scientific work in the future will not just shed light on new discoveries, but will help us acknowledge our continued ignorance and respect our doubts.
In our best future, scientists will expand thyroid knowledge by performing research that questions the presumptions underlying institutionalized practices. Certain areas of thyroid clinical research will no longer be neglected or discouraged because of traditional presumptions about what causes risk or benefit.
Our vision for thyroid healthcare systems
In our ideal future, healthcare systems will not necessarily be wealthier, but wiser. Their drive to minimize economic costs and inefficiencies will no longer overshadow the importance of accurate thyroid diagnosis and individually-optimized thyroid treatment.
In this future, some optimally-treated thyroid patients who understand the value of their own FT3 and FT4 test results will be healthy enough to rise into the ranks of healthcare leadership.
Through the benign influence of narratives of patient harm and benefit, healthcare administrators will realize that the long-term costs of institutionalized thyroid ignorance and TSH-normalized treatment failures can outweigh the short-term savings of population-wide FT3 and FT4 test cancellation policies.
As a result, in the ideal future, administrators will relax these lab test cancellation flowcharts and permit more exceptions based on clinical judgment.
Colleges of physicians and surgeons in this healthier future will no longer persecute and punish physicians who set aside thyroid guidelines and use scientific evidence instead to guide their innovative yet effective clinical practice. Physicians will no longer presume that their peer is being anti-scientific, uninformed, and putting their patients at risk. They will take more seriously the disclaimer about the limitations of guidelines at the opening of an important set of American Thyroid Association guidelines: See 2012 ATA thyroid guidelines ask for clinicians’ independent judgment.
In the past, healthcare systems and clinicians found the old TSH-T4 paradigm persuasive because it oversimplified and cheapened a lot of thyroid health care for the masses. It enabled endocrinologists to put supposedly “simple” cases of thyroid disease in the care of general practitioners at a lower pay grade. It enabled a large number of endocrinologists to shift their attention to diabetes instead of thyroid.
As a result, in the ideal future, administrators will relax these lab test cancellation flowcharts and permit more exceptions based on clinical judgment.
Scientists have been uncovering the complexity and diversity of thyroid disorders. Therefore, a better future involves a healthcare system that respects that complexity and allows thyroid diagnosis and treatment to be as complicated as it must be in certain cases.
How do we get to this new, ideal future?
Well, we can each play a part in bringing our ideal future into being, in many different ways.
Thyroid Patients Canada does something unique on our website by publicly critiquing the old paradigm and publicly explaining how science supports the paradigm shift of thyroid therapy that patients — and good thyroid doctors — hope for.
Another way we move toward this future is through our science-based peer support group on Facebook. That’s where we as patients share other scientifically fact-checked information about thyroid. We also share our frustrations with “old paradigm” thyroid therapy and our personal experiences with different aspects of diagnosis and treatment. Most importantly, we offer lab data analyses and practical tips that may be useful to our fellow thyroid patients who are facing diagnosis & treatment challenges.
Support our vision…
Help us make this future possible. We can’t do much alone, but we can do a lot together.
Some of our posts about paradigm change
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