Pulse CPD for GPs into diagnosing hypothyroidism or hyperthyroidism.

[ThyroidThora]

The following URL is a link to the CPD for GPs to help them diagnose hyperthyroidism and hypothyroidism. It states that...

"Since release of TSH from the pituitary is controlled by negative feedback by thyroid hormones, TSH measurement can be used as an index of thyroid function.

• TSH reference range – 0.34-5.60(mU/l.)

In thyrotoxicosis, TSH will be suppressed and in overt hypothyroidism, TSH will be elevated by more than twice the upper limit of the reference range.

In subclinical hypothyroidism, the free T4 may be normal and the TSH may be between the reference interval and twice the upper limit of the reference interval".

pulse-learning.co.uk/clinic...

Make no wonder people with hypothyroidism cannot get a diagnosis when the CPD states that the TSH for a patient has to be twice that of the reference range. The reference range is useless as a diagnostic tool to determine hypothyroidism as many of us with hypothyroidism are hypothyroid with a TSH upper limit far less than the doubled up value mentioned in the article.

TT

[shaws]

The saying goes that if something doesn't make sense it's all nonsense. That's what the above is.

[ThyroidThora in reply to shaws]

Unfortunately, it's Continued Professional Development (CPD) for GPs and an inexperienced GP would believe all what's in the training because it counts towards their training points.

[diogenes Remembering]

This is a silly argument. The TSH normal range like any other is a statistical statement. That is, as you go from the middle of the range towards the extremities, the probability of abnormality increases. That is, though the actual probability may be low, nevertheless the doctor should be aware of the increasing possibility of illness even within the reference range. This is why we have "grey areas" within the normal range close to the end of the ranges in which "one is not sure and the patient needs close followup". Once upon a time that was the protocol for the best diagnoses but seems to have been lost in the "all or nothing" rigid application of the reference range for TSH. Nowadays you are either in or out.

[ThyroidThora in reply to diogenes]

Too true!

[helvella]

Strikes me that it is a bit limited.

For example, if your pituitary is pushing out too much TSH, you can have a high TSH and high free T4.

Similarly, if your pituitary is pushing out too little TSH, you can have a low TSH and low free T4.

Maybe somewhere in the CPD it explains that you need always to be aware of the possibility of secondary or tertiary disorders?

It is also ludicrous that they say anything about Free T4 and TSH in subclinical hypothyroidism when we know so many do not get their FT4 tested.

[ThyroidThora in reply to helvella]

Yep, too true. All they seem to test is TSH and when they do test for Free T4 they haven't a clue what it is anyway.

[Glynisrose]

I wonder how many GP's (or endos for that matter) know the number of 'subjects' in the clinical tests, or if they care!!

[shaws in reply to Glynisrose]

It is so easy for those who stick rigidly to the guidelines, and particularly to an Endocrinologist who exclaimed in the ATA Conference 20123 that patients whose TSH is now 'in range' but are still dissatisfied with levothyroxine (even though their pain is real!) have a 'Somatization Disorder'.

[shaws]

I can see you would just love to meet ? him and let him know of your experience with Soma.

[Angel_of_the_North in reply to shaws]

We should just feed them on carbi until they went hypo, but had TSH less than 10 ...

[shaws in reply to Angel_of_the_North]

That might be a worthwhile experiment.

[ThyroidThora in reply to Angel_of_the_North]

This sounds like a worthwhile experiment and see how they like it!

[Angel_of_the_North]

I'm the same. All in reference range, but bottom end.

[ThyroidThora]

Whoops!! My post seems to have put the cat amongst the pigeons, but, at least it starts a debate and helps us to get things off our chests within the community that cares.

TT xx.

[Barb1949]

I would love to come along and witness this experiment!! xx

[ThyroidThora in reply to Barb1949]

I think it might have to be a ticket event cos so many people would turn up, lol!

[Barb1949 in reply to ThyroidThora]

I'd pay! Lol

[Nickinoo1 in reply to ThyroidThora]

Can I offer up my GP for this experiment as one who sticks rigidly to the ranges. My thyroid surgeon could be the alternative. I see sacrifices!

[ThyroidThora]

I'd offer up my endocrinologist after my appointment with him today. He was being 'cocky' in front of his new, female junior doctor but I cut him dead when I reminded him that my TSH had gone up after starting on the low dose of Armour thyroid and that I am aware that I am still under medicated. Need less to say, he was quick to get me out of his consulting room for my blood tests and that he will see me again in 4 weeks time. I'm going to ring on Thursday for my blood results and then we'll see what will happen next. No more Mrs Nice Guy, the boxing gloves are going on now as I don't appreciate being ridiculed in front of strangers.

[Nickinoo1 in reply to ThyroidThora]

I like the idea of boxing gloves. I have my consultant appt with surgeon on Monday for core biopsy results - my GP won't tell me this time I have asked. If anything like last appt will be in there all of 5 mins, be told it's all in my head, my 2.77cm nodule is very small and off you go'.

Boxing gloves sound great. Alternatively might take my friend with me - she's fierce.

[ThyroidThora in reply to Nickinoo1]

I had a calcified nodule that turned out to be follicular variant of papillary thyroid cancer. It's removal caused me to go hypothyroid hence now seeing an endocrinologist and I wished I'd been wearing boxing gloves on many occasions but, to be honest, cutting them dead with medical knowledge is better as they find it hard to spar with an equal!!

[Nickinoo1 in reply to ThyroidThora]

Must work on my memory for that to happen. Have read so much it's mashed up in my head but clear thoughts are happening so I will prevail.