When science fails the patients

[vocalEK]

*Sigh* When I read this description of "science-based" treatment of hypothyroiodism, I was ready to bang my head against the wall.

sciencebasedmedicine.org/ov...

The title of the article was "Overtreating the Thyroid"

Among other things, it described a study that set out to discover whether there is any benefit to treating "sub-clinical hypothyroidism".

In the first place, the scientists seem to have trouble understanding precisely what "sub-clinical" means. Every definition I have found online revolves around the patient having zero symptoms of disease. And yet the outcomes for the study apparently assumed several symptoms commonly suffered by the hypothyroid community: "There were two primary outcomes: thyroid-related quality of life scores, and tiredness scores, measured using standardized tests (from 0-100 with a significant difference being 9). Secondary outcomes included general quality-of-life tests and several other measures, including grip strength" Hello? Doctors are you listening to your patients? Don't you observe a commonality to their complaints? Are you blind? Deaf?

OK, and if that wasn't bad enough, the study was designed purposely to undertreat the subjects. For this, I have to blame the yo-yos who decided that the range of values for thyroid hormones should be standardized based only on the people the doctors sent to be tested for suspected thyroid problems. Few doctors would send a perfectly healthy patient for thyroid testing. Thus the "reference range" on the whole contains only sick subjects.

As we well know, there are still places in the world (e.g., the United Kingdom) where a TSH of 10 mIU/L is the minimum requirement to receive thyroid treatment.

"The average age of participants was 74.4 and about half were women. After one year, the average thyrotropin level had decreased to 5.48 mIU/L in the placebo group and 3.63 mIU/L in the treatment group, with a median daily dose of 50 μg of levothyroxine. In short, the levothyroxine did exactly what was expected, which was to bring the thyrotropin down to the normal range. "

Normal range? Try under 2. Or even better, under 1.

"Despite this, the investigators found no difference in the mean change of thyroid-related quality of life scores or tiredness scores between the two groups. There were also no meaningful differences in any secondary outcomes either. In short, treating this “subclinical hypothyroidism” had no effect on any relevant patient-reported or objective measure."

Gee, what if the researchers had increased the dosage until TSH was less than 2? Less than 1? Would there have been some differences? I think so.

[Fruitandnutcase]

I’m afraid I started to read the report, got so incensed or maybe it was depressed that I stopped shortly after the ‘TSH of over 10 being considered under-active’ comment. I’m afraid I just couldn’t finish reading it all so depressing.

[Christabel in reply to Fruitandnutcase]

The below the line comments are equally nonsensical and smug.

[dizzy864]

Classic case of scientists knowing the outcome before they started and were determined to make it so. Do they not have any feeling for the human beings they're meant to be helping?

[Hidden]

All I can say is "GRRRRRRRR"

[Greekchick]

This study is an example of what happens when “evidence” overtakes careful observation and common sense. Patients must be observed and treated with what symptoms they present with. It is a poorly designed study, with a structure and small sample that leads to a specific predetermined outcome. Thyroid disease is often undiagnosed and under treated because it is confused with depression, anxiety disorder, and other assorted diseases.

[Greekchick]

I hit send too soon - sorry. This is a shameful state of affairs. I had normal blood work and needed surgery because my symptoms were so severe and was thankful that my endo had common sense. Please let’s teach common sense and observation of symptoms again in medical schools and not blind reliance on tests. We will all be better off.

That’s my rant for today. Thanks for listening! Positive thoughts to all .

[LindaC]

Thank you for this. Since the TSH [as if their ranges are even worth a candle!] was moved up from 4 in the UK [when 3.3 in the USA] it became a joke.

THIS IS NOT SCIENCE, IT IS POLITICS - DIRTY, FILTHY POLITICS [as if we haven't seen enough of late!]. Shame on these charlatans - all of them - of course, not the good guys!

[Brumlady]

I guess the equivalent to the above is 'lab results!' I get both the TSH and T4 actual figures as I think we are all different and what works for one may not for another. From conversations with Thyroid Consultants/GP's I look for TSH 0.something and T4 about 17/18 or 19 which seems to be about right. I have been Hypothyroid for the last 40 years (following partial thyroidectomy) so take Levothyroxine daily occasionally needing to tweak the dose. Have been both under and over in the past and think what should be taken more seriously is how difficult coping with the side effects of this can be. Plus having to push GP's to have more than one blood test per year without being considered neurotic! I do suffer from anxiety anyway and do not understand why a simple blood test cannot be automatically offered to make sure there is nothing physical amiss - such as hypo or hyper.