The BTA has formulated and foisted a sham consultation process onto the RCP, and it must be exposed for its duplicity. It has ignored swathes of patients who have repeatedly been unable to prosper on just levothyroxine; personal experience indicates that this RCP, BTA protocol is misguided in the extreme and it will continue to cause inadvertent deaths in unsuspecting patients, improperly advised as to the alternative therapies.

The RCP, BTA joint statements violates the guideline authorship standards of care in "Concise Guidance to Good Practice" also written and promulgated by the RCP. This guideline adversely affects the health and well being of those patients who have non-thyroid deficiencies in the peripheral metabolism of T4 to T3 or the hormone reception of T3, and it violates the protocols found in the "Concise Guidance to Good Practice" by the Clinical Effectiveness and Evaluation Unit of the RCP: I will list these violations separately.

1. G/lines should be discrete so they can be considered in isolation. the diagnosis is not complete, the therapy is not adequate.
2. The 'conclusions' don't improve quality of patient care.
3. Lack of definitions doesn't clarify. However, the certainty that was produced by a wide variation of practices existed because there were a wide variation of causes, most ignored in the guideline.
4) Encouragement of objective methodology is misdirected. This only deals with thyroid gland deficiencies, not deficiencies existing between the thyroid gland and the symptom producing cells.
5) Literature search could not have been complete or was selective as there are many articles on peripheral metabolism and peripheral cellular hormone reception
6) There are no references, particularly for the lack of therapy for those with 'normal' hormone levels and continuing symptoms.
7) No evidence offered, so it's not available to the reader, hence we cannot "decide on the reliability of the guidline". By the logic in court cases dealing with enforced guidelines, they are not voluntary, but mandatory.
8)There was not patient representation.
9)…no stakeholder involvement statement
10)…no list of members or their areas of expertise.
11)…no rigor in the development with respect to patient with deficient peripheral metabolism or deficient hormone reception.
12)…no criteria for selecting evidence
13) With regard to post thyroid deficient patients, the health considerations were not made or addressed. In fact for them, the statement is quite depraved - insuring them a life of misery.
14) The conclusions do not correspond to the statement body of text.
15) There is evidence of potential funding issues and consequently the lack of independence.
16) It doesn’t meet the RCP goals - to serve patients well.
17) It doesn’t champion the values or ethics of the medical profession regarding post thyroid deficient patient
18) For these patients, the guideline makes diagnosis and treatment worse.
19) It is not patient centred and doesn’t support ethical physicians
29) For those patients, it is a stain on the name of RCPs.
21) Myth of Physician Independence

A comparison between the objectives of the RCP with the patients’ experience should be demanded.

The RCP, BTA has failed to consult those patients in diametric opposition to their guideline in the UK e.g. Thyroid Patient Advocacy-UK (www.tpa-uk.org.uk) and Thyroid-UK (www.thyroiduk.org) to mention just two, who represent tens of thousands of UK patients. They have not been approached for their views. The RCP, BTA has, in fact, tried to discredit and denigrate those very people who oppose them, first, by silence, then by riding roughshod over their desperate need for a cure, and to use their 'collective' power to terrorise doctors into submission, even when these doctors know that the suggested protocol is wrong.

There is only one conclusion – once this statement goes beyond the scope of ‘primary hypothyroidism’ and trespasses upon exo-endocrine functions, symptoms, and therapies, it contradicts medical science. The problem then becomes this question, “…what human frailties created a contradiction with well-known and established medical science?” Indeed, what has caused the failure to recognise the failure of the levothyroxine sodium only therapy for the past half century?

Article 29: Magna Carta “No Freeman shall be taken or imprisoned, or any other wise destroyed . . . but by lawful judgement of his Peers, or by the Law of the Land.”

Patients with symptoms of hypothyroidism are being destroyed without proper judgements.

The earliest case occurred in the 17th Century. It was the RCP (London) –v- Dr. Bonham. The RCP didn’t want non members practicing medicine in competition so they charged him with unlawful practice of medicine in spite of his greater training than most practitioners of the healing arts of that day - including the fellows of the RCP. After imprisonment by the RCP, the Archbishop secured his release. Dr. Bonham and his attorney filed a suit against the RCP for false imprisonment. Chief Justice of the Court of Common Pleas, Sir Edward Coke, found the RCP couldn’t be a judge in matters in which it had a financial interest.

Coke believed that no man, even the king, is above the law. That should be the case today.

In a survey of 1500 hypothyroid patients undertaken by Thyroid Patient Advocacy-UK (TPA-UK) in 2005-2006, the dissatisfaction of many patients is highlighted. This survey has very good credentials that it points to inconsistencies within the data presented by the BTA as being 'definitive'. Why has the RCP and BTA et al., chosen to take no account of these statistics when a copy was sent to Professor Anthony Weetman in 2006 (then President of the BTA) and every member of the BTA Executive Committee. No response or acknowledgement has ever received from them. This hypothyroid survey should be held up as valid, contradictory evidence to the RCP/BTA joint guideline.

Of 1500 respondents to this survey, 93.8% (n=1407) had not been told of medicines other than L-thyroxine by their medical practitioner. 38.8% (n=768) felt they had “not been dealt with very well” or “not very well at all” by their doctor whilst seeking a diagnosis of their symptoms; 233 (15.5%) had given up paid employment; 300 (20%) had taken time off work as a result of thyroid illness; 500 (33.3%) felt their close relationships had been affected by thyroid illness and 632 (42.1%) had stopped or altered their exercise routines as a result of their symptoms. When asked of those patients undergoing L-thyroxine therapy, “Do you feel that you have fully regained your optimal state of health?” 1176 (78.4%) Answered “NO”. What did the BTA say in reply –ABSOLUTELY NOTHING!

Needless to say, the BTA chose not to pass this information to the RCP or anybody else. One wonders why.