Criticism of UK Guidelines for the Use of Thyroid Function Tests

[helvella]

The British Thyroid Association and the British Thyroid Federation continue to refer to a document known as:

UK Guidelines for the Use of Thyroid Function Tests

Which is available here:

british-thyroid-association...

The document itself contains this statement:

6 Mechanism for updating

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

[e-mail]

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.

[amala57]

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.

[helvella Administrator in reply to amala57]

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?

About 75 out of every 100 men who have an

abnormal PSA test result do not have prostate

cancer. This is called a false positive result.

About 15 out of every 100 men who have

a normal PSA test result do have prostate

cancer. This is called a false negative result.

gov.uk/government/uploads/s...

And how effective is the treatment, even when a positive test is accurate?

[mistydog in reply to amala57]

It's not without the bounds of possibility. (You are absolutely correct).

[helvella Administrator]

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.)

[mstp]

Who can we contact about this if we want to make our thoughts known?

[helvella Administrator in reply to mstp]

The BTA, the BTF and the Association for Clinical Biochemistry.

[humanbean in reply to helvella]

Just for info, I came across another BTA today - the British Tinnitus Association.

[helvella Administrator in reply to humanbean]

You rotter! As soon as I read that I started thinking, then looking, and found this - a double-hit alternative:

British Triathlon Association, the former name of the British Triathlon Federation

[humanbean in reply to helvella]

Hahahaha.

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 :

tinnitus.org.uk/guidance-fo...

[helvella Administrator in reply to mstp]

I tried ringing the BTA - their number just diverts to BTF answering machine...

[helvella Administrator]

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.