Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers

[helvella]

Somewhat pie-in-the-sky to imagine thyroid patients who are treated according to this: Monitoring also needs to be vigilant, and the targets for treatment reassessed continually.

Nonetheless, patients not numbers is a welcome phrase.

Lancet Diabetes Endocrinol. 2019 Feb 20. pii: S2213-8587(18)30371-1. doi: 10.1016/S2213-8587(18)30371-1. [Epub ahead of print]

Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers.

Jonklaas J1, Razvi S2.

Author information

1 Division of Endocrinology, Georgetown University, Washington, DC, USA. Electronic address: [e-mail].

2 Department of Endocrinology, University of Newcastle, Newcastle, UK.

Abstract

Although assigning a diagnosis of thyroid dysfunction appears quite simple, this is often not the case. Issues that make it unclear whether thyroid function is normal include transient changes in thyroid parameters, inter-individual and intra-individual differences in thyroid parameters, age-related differences, and ethnic variations. In addition, a statistically calculated distribution of thyroid analytes does not necessarily coincide with intervals or cutoffs that have predictive value for beneficial or adverse health outcomes. Based on current clincial trial data, it is unclear which individuals with mild thyroid-stimulating hormone elevations will benefit from levothyroxine treatment. For example, only a small number of patients with thyroid-stimulating hormone values of more than 10 mIU/L have been studied in a randomised manner. Even if therapy is initiated for abnormal thyroid function, not all treated individuals are maintained at the desired treatment target, and therefore might still be at risk. The consequence of this is that each patient's thyroid function needs to be assessed on an individual basis with the entire clinical picture in mind. Monitoring also needs to be vigilant, and the targets for treatment reassessed continually.

Copyright © 2019 Elsevier Ltd. All rights reserved.

PMID: 30797750

DOI: 10.1016/S2213-8587(18)30371-1

ncbi.nlm.nih.gov/pubmed/307...

[Nanaedake]

At least it advocates continual and close monitoring.

[jgelliss]

It's about time that thyroid patients be treated via Symptoms instead of some paper . Are you going to treat the *Paper* or the *Symptoms* ?????? Lab values are a Snap Shot of the moment the BW was done .

We Have been saying this all along ????? Finally Someone is Listening . Hopefully .

[Hidden in reply to jgelliss]

Best results comes from specialists. Endocrinologist is the best to have for your concerns. However even with that, there is a process that must occur.

If you are not feel well, you should let them know.

I have run into problem with that. It is not a good experience. I have had to change doctors on occasions!

[TSH110]

TSH of 10+ might be normal so needs further testing....give me strength!

[helvella Administrator in reply to TSH110]

In the full paper, that might not look quite the same.

[Angel_of_the_North in reply to TSH110]

It's quite unlikely that anyone would even get their thyroid tested if they had no symptoms, as they wouldn't have been to the doctor in the first place.

[TSH110 in reply to Angel_of_the_North]

Sadly also quite unlikely they would get tested if they did have symptoms and had been to the doctor ☹️

[Angel_of_the_North]

Sounds more like an excuse to deny treatment " it is unclear which individuals with mild thyroid-stimulating hormone elevations will benefit from levothyroxine treatment. For example, only a small number of patients with thyroid-stimulating hormone values of more than 10 mIU/L" I wouldn't call that a mild rise and I bet that they mean "don't allow a low TSH" when they say "not all treated individuals are maintained at the desired treatment target, and therefore might still be at risk."

[SilverAvocado in reply to Angel_of_the_North]

I was thinking the same. Its hinting that patients whose blood tests look wrong might still not warrant treatment. Whereas what patients would prefer is some whose blood tests don't look too bad night still need treatment.

[TSH110 in reply to Angel_of_the_North]

I agree the absurdity of suggesting a person with abnormal readings would not benefit from an attempt to render them normal. We may as well say that abnormal is actually normal - doublespeak or what? Why in the field (predictive txt just changed that to fiend not as daft as it seems) of Endocrinology is such rubbish glibly trotted out as a tenable statement.

[Hidden]

If they are not specialized in that areas, that should be looked at!