Standardization of FT4 and harmonization of TSH measurements - A request for input from endocrinologists and other physicians

Fell across this abstract. The bit where it says a fact which has not been emphasized indicates to me that the authors have NOT been reading this forum. The standardisation of testing has been repeatedly emhphasized.

Mind, we need to be circumspect. We do want standardisation, but only if done properly and with the highest quality of work to back it up. It is quite possibly better to have a rag-bag of various inconsistent test ranges than to have standardised ranges which do not reflect reality.

Thyroid. 2015 Sep 28. [Epub ahead of print]

Standardization of FT4 and harmonization of TSH measurements - A request for input from endocrinologists and other physicians.

Thienpont L1, Faix J2, Beastall G3.

Ghent University, Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences , harelbekestraat 72 , Ghent, Belgium , 9000

2New York, United States ; jfaix@montefiore.org.

3Glasgow, United Kingdom ; gbeastall@googlemail.com.

Author information

Abstract

Given the prevalence of thyroid disorders and the subtle signs and symptoms which may accompany subclinical disease, reliable laboratory testing for serum TSH and free thyroid hormones is important for both primary care physicians and endocrinologists. The laboratory community has recognized the need for standardization of thyroid function tests to achieve comparability of measurement results between methods. This applies particularly for free T4 tests, which may be considered controversial in terms of clinical and analytical validity. But there is also variability in TSH testing - a fact which has not been emphasized in ongoing discussions regarding lowering of the upper limit of normal and/or common decision limits to start treatment for hypothyroidism.

PMID:

26413772

[PubMed - as supplied by publisher]

ncbi.nlm.nih.gov/pubmed/264...

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  • Helvella, apart from realistic standardisation of analysis and ranges, I'd like endos to acknowledge that thyroid symptoms are often present before a patient is subclinically hypothyroid and more trialling of Levothyroxine in symptomatic patients to see whether symptoms resolve or progression slows.

  • Subclinical OUGHT to mean off-kilter bloods but no clinical symptoms rather then "you feel terrible, have all the symptoms, but your bloods are in range, so go away".

  • What shocks me is that the whole notion of what the ranges mean is very fuzzy. for most thyroid tests you can expect to be seriously ill if you're outside the range. For lots of other tests, like a full blood count, it seems like you need to be multiple times higher than range in order to have difficulties.

    I think it's very confusing for doctors, who don't know much about it.

  • As patients we could probably give them all the reliable chapter and verse they need about their pointless TSH test and the rest! Why don't they ever think of asking us???

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