Every day I receive an alert telling me about new papers in PubMed "thyroid" somewhere. The numbers vary, the quality varies, the relevance varies, but what doesn't vary is the accumulation of evidence that thyroid isn't simple thing but is enormously complicated.
Sometimes I have sympathy with doctors, especially ordinary GPs, who simply cannot keep up with the torrent of papers. I have far, far less sympathy with and understanding of the whole of clinical endocrinology. It appears that this torrent flows past them, like someone holding onto a lamp-post in a flood. Once it has passed, they dry themselves and forget all about it. They don't tell everyone else so that others can gain from this torrent, use the information, apply it to patients.
Today's alert identified 26 papers, and I have put abstracts together in a PDF (as available):
My GP is very good and reads what he can. Last time he told me he had been reading about thyroid disease and talked about block and replace for hyperthyroidism. He seemed keen to share. He probably reads more about thyroid than some endocrinologists.
Thanks! I know they have a lot to read, by that doesn't excuse the flat out dismissal of their patients. I would have far more respect for someone who admitted they didn't know everything but were prepared to listen & learn.
Thanks for the pdf Helvella. Sadly, I think you're probably right about the endocrinologists.
Thanks Rod for highlighting this.
Who is responsible for reading newly published papers and deciding whether any need further evaluation? Is that down to the RCP or Endocronology or both? Professor of Endocronology?
With regard to changing 'guidelines', only the RCP can do this and presumably after consultations with Endocronology?
Or do the RCP have 'experts' who decide what needs changing?
This appears to be part of the problem. So far as I am aware doctors have a whole raft of measures in place to ensuring continuing professional development. To this end there are "courses" of many sorts including on-line "read something then answer some questions", and lectured courses, seminars, etc. A large proportion of these are put out by pharmaceutical companies at least partly for their own ends (even if individual events do not have anything overtly biased).
When it comes to research, consultants are expected to read new research but I have no idea if there is anything that checks up that they do. Given the torrent, I suspect that they only read a modest proportion of the papers - and maybe they all get their eyes turned to the same few?
I am not aware on any systematic review of new papers. Yes, such a process would be sensible. I strongly suspect that papers from some countries, or in some publications, are more of less dismissed.
I guess that anything in Zhonghua Bing Li Xue Za Zhi from China and in Chinese will likely be missed.
Similarly, anything in Journal of the Society of Physicians and Naturalists
and Medical-Surgical Journal of Iasi, Romania will likely be ignored.
Dr Haraku Hashimoto's original paper languished in a German language journal for years before being re-discovered. It is not a new problem.
Thanks for this link too. You always come up with excellent research.
Next time someone has an unsatisfactory consultation, they should ask how up-to-date they are with research papers and when was their last read. The patient first having researched their particular problem and run off the paper.
Thanks for this Helvella, I was particularly interested in the one about the link between thyroid antibodies and Fibromyalgia. I've booked a double appointment with my GP in early June, it might give me a little ammunition in asking for a an endocrinology referral. Best wishes MariLiz
If you follow the link below, you will see a total of six papers which refer to thyroid peroxidase antibodies and fibromyalgia. No abstracts, I am afraid, but sometimes if you follow through to the journal's own site you get a bit more information:
Thank you very much for these helvella, I really appreciate you sending me the info. Not sure if my GP will listen when I see her for my double appointment, but I can but try. Best wishes MariLiz
You must be wrong the arrogant twerp I was referred to said thyroid was simple! I said the treatment is not and he did not respond. So I asked to see an open minded endo !
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