The guidelines were completed in June 2006. Comments on their accuracy and
relevance are invited during the first year after publication and should be directed to
gbeastall@gri-biochem.org.uk
It is intended that a full review will take place after three years.
It is now over ten years since the document was published. Clearly no review has taken place.
The document is deficient in several ways. There have been numerous papers published referring to thyroid + tsh + assay - quite a number of which are likely to have some impact on any review of these guidelines.
2007 409
2008 424
2009 394
2010 470
2011 420
2012 445
2013 492
2014 503
2015 537
2016 377
Total 4471
The document has an obvious typo in it which should be corrected. I even managed to contact the named contact gbeastal who fully accepted that this mistake exists and expressed surprise that no-one else had noticed such an obvious, but potentially misleading, mistake. He had, I believe, retired so was unable to actually pick this issue up properly.
There is no mechanism in place to manage reports of issues with the document. Any mistakes, whether simple typos, or issues with the possibility of causing more serious issues, cannot readily be raised. There are no other contact details within the document.
The BTA and BTF should be challenged as to why they continue to refer to this unmanaged and unmaintained document as active guidelines. It is unacceptable. It appears to show disregard for the well-being of thyroid patients. If that were not the case, there would be a fully managed and maintained document available.
Written by
helvella
Administrator
To view profiles and participate in discussions please or .
Having joined the group of people with thyroid problems that are seriously neglected by the medical profession quite recently, I am horrified by this blatant disregard for us. Is it because the majority of us are women? I can't imagine men allowing this to continue. Prostate cancer gets a huge amount of coverage and research. I really am bewildered and shocked by the poor quality of treatment and knowledge of thyroid problems.
Prostate cancer has also had its share of poor quality diagnosis and treatment. Is the Prostate-Specific Antigen a good initial screening test? Or does it produce too many false negatives and false positives?
These guidelines do very clearly recognise central hypothyroidism:
Rare situations include diagnosis and monitoring treatment for central hypothyroidism, end-organ thyroid hormone resistance and TSH-secreting pituitary adenomas.
We may suspect that the frequency is greater than that seems to imply.
(These are NOT the guidelines to treating hypothyroidism.)
The reason I read about the British Tinnitus Association today was because it was referenced in Pulse Online. They (this version of the BTA) have produced the first ever guidance for doctors on the subject of tinnitus :
It seems a bit unfair to be going on about that as these guidelines are actually somewhat better than some in recognising that TSH-only is often inadequate.
A strategy of first-line TSH may be cost effective for a wide range of clinical purposes including screening and case finding, but it may be inappropriate in patients being tested for the first time, and in some specific clinical settings. Throughout these guidelines we have highlighted the clinical situations where measurement of both serum TSH and FT4 is required; these are principally where the pituitary-thyroid axis is not intact or is unstable. These situations include relatively common situations such as optimising thyroxine therapy in newly diagnosed patients with hypothyroidism, diagnosing and monitoring thyroid disorder s in pregnancy and monitoring patients with hyperthyroidism in the early months after treatment. Rare situations include diagnosis and monitoring treatment for central hypothyroidism, end-organ thyroid hormone resistance and TSH-secreting pituitary adenomas. It is the responsibility of the requesting physician to provide clinical information to guide the laboratory in the selection of the most appropriate TFT but if clinical details are not available that allow the identification of the above categories of patient, then it may be prudent for laboratories to measure serum TSH and FT4 on all specimens rather than embark on a first-line serum TSH testing strategy followed by a cascade to include FT4 and FT3 if indicated.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
CCG response.
