Lumping everyone together

[diogenes]

This is a study using meta-analysis to show that on the average no symptoms in subclinical hypothyroidisim are allievated by T4 therapy. Again, a study showing that MOST patients do not benefit. Categorisation. If most do not benefit, none can, by this assumption. This study blurs out those relatively few who will benefit by subsuming them into the majority who won't. Its like all studies of this kind. If the overall conclusion makes a decision, then all must comply. Patient individuality is ignored yet again. It's these kind of studies that elevate diagnosis of the individual into diagnosis based on the mass.

Clinical ThyroidologyVol. 30, No. 11

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI

Tim I.M. Korevaar

Published Online:14 Nov 2018doi.org/10.1089/ct.2018;30....

[Baobabs]

I see what you are saying about all or nothing conclusions, however is this not the experience of a very significant percentage of people on this forum? Incidentally diogenes, who funded the study?

[diogenes Remembering in reply to Baobabs]

There's no mention of support financially. Actually, reading this article closely, I'm struck by the admission that the conclusions don't stand on really firm ground, and that they can't be applied to everyone. They weasel out by saying that patient presentation and symptom assessment must be considered in making decisions on therapy use. More and more, I'm concluding that what is missing is measurements of FT4 and FT3 before thyroidectomy, and again immediately afterward before therapy starts, in order to find out how much T3 the thyoid was actually contributing. I would suppose that those with a bigger contribution plus high range normal FT3 are those who, when the thyroid is lost, are going to be in difficulties if T4 only is offered. We have got a longterm programme in hand to try to get this essential data which would give a firm basis of prediction as to which patients would best benefit from combined therapy.

[humanbean in reply to diogenes]

If FT4 and FT3 are not measured before thyroidectomy then this strongly suggests that people with secondary or tertiary hypothyroidism are having their thyroids removed unnecessarily. That is barbaric!

[Hidden]

No real look at why most patients are not benefitting either. Just lumping someone of a bit of levo is a very simplistic treatment. Has their ferritin . vit D etc been taken and at good levels. How are their adrenals? You could only really see if levo is going to be helpful if you have made sure everything else is tip top too.The reasons for lack of benefit not thought about, just another excuse to deny treatment on mass.

[Jazzw]

All based on TSH results again too, I think? Which isn’t exactly the best place to look...

[MiniMum97]

Yes whenever I’ve looked at these studies they never seem to look at TSH, T4 and T3 together and they don’t seem to be trying to get the patient’s T4 and T3 towards the top of the reference range. Pointless exercise!

[TSH110]

I can’t see why subclinical hypothyroidism should be good for anybody are these hormones there just for fun? It is ill conceived rubbish dressed up as scientific research

[Hpbr]

Using one size fits all means that a certain proportion of patients do not receive appropriate therapy which would alleviate symptoms. This is quite evident with the liothyronine debacle. Thyroid care should be individualized, person centred and appropriate to alleviate symptoms to make patients feel well. I feel that the profession is attempting to simplify something which is quite complex. This is leaving people being unwell and having to accept it.

[SilverAvocado]

Wow, this is lumping everyone together taken to ridiculous extremes. Just one claim that can be distilled from the paper I found rather extraordinary:

Thyroid hormone therapy for between 3 and 12 months, with treatment giving a TSH between 0.5 and 3.7, does not improve BMI in patients with subclinical hypothyroidism.

The patients who only had 3 months of treatment didn't get much chance to lose weight! They also state in the Background that most patients are asymptomatic, but then spend the w whole paper quibbling about whether their symptoms have improved. If they didn't have any symptoms to begin with, its hardly surprising they didn't show any improvement!

This just comes across as very scruffy. It reminds me of my experience earlier this week trying to shove bundles of paper cut out snowflakes into envelopes. Not as simple as I thought it was going to be!