On the 22nd May, the following message was sent to all who commented on the RCP. BTA et al. 'guidance'.

"Further to my  email of 6th April, the comments and materials received by the College have been reviewed.

This position statement or guidance (not a guideline) was produced on behalf of the Royal College of Physicians, in particular its Patient and Carer Network and the Joint Specialty Committee for Endocrinology and Diabetes; the Association for Clinical Biochemistry; the Society for Endocrinology; the British Thyroid Association; the British Thyroid Foundation Patient Support Group and the British Society of Paediatric Endocrinology and Diabetes and is endorsed by The Royal College of General Practitioners.

The President has asked me to let you know that this review has not resulted in any changes to that statement.  It should be noted that it is about the treatment of primary hypothyroidism and does not preclude other treatments for exceptional cases by specialist endocrinologists who can make clear to patients any associated risks.

References supporting the statement are listed below.

Yours sincerely

[Snipped by Administrator]

  
• Diagnosis and treatment of primary hypothyroidism. BMJ 2009;338:b725

  
• Vaidya B, Pearce S. A Clinical Review of the management of hypothyroidism in adults.  BMJ 2008;337:a801. This contains references for 35 articles and states that Armour thyroid is of no proved additional benefit to levothyroxine.

  
• The Lancet, Volume 363, Issue 9411, Pages 793 - 803, 6 March 2004.  This covers the history, epidemiology, pathophysiology, and clinical diagnosis and management of hypothyroidism and is written by Caroline GP Roberts and Paul Ladenson of Johns Hopkins University School of Medicine, Baltimore, USA.  This review, which references 164 clinical articles, states that the treatment of choice for hypothyroidism is levothyroxine sodium (thyroxine) and does not refer to Armour thyroid.

  
• Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126.

  
• Association of Clinical Biochemists BTA, British Thyroid Foundation. UK Guidelines for the use of thyroid function tests. http://acb.org.uk/docs/tftguidelinefinal.pdf

  
• Surks MI. Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-238".

I have again asked the President to provide a list of the names of those people involved in the authorship of the original 'guidance' and a list of those people involved in the review of the 'guidance'.

I will not hold my breath. If no such list is forthcoming, we can only assume the authors of the original 'guidance' are also the reviewers of their own 'guidance'. That would not be fair.

The RCP, BTA et al. should take note of the following statement made by Dr Anthony Toft - Royal College of Physicians (Edinburgh):

"Guidelines which were designed principally for their educational value are in danger of assuming a medicolegal importance far beyond that which was ever intended by their protagonists. Simply because no two patients present in the same manner, guidelines, by their very nature, are the antithesis of the art of medicine."

www.rcpe.ac.uk/.../B_Editorial.pdf