This new paper was written to examine the current standard of care for hypothyroidism, underlying causes for the prominent dissatisfaction expressed by thyroid patients, and opportunities for improvement. This paper is intended to include a strong patient’s perspective. It expands on previous work, and reviews the total thyroid process.
It was written by three people who have never physically met, each with different backgrounds, and living in three different continents, but with a common goal of trying to make things better for thyroid patients.
Thanks for bringing this to our attention Scotty. There's no date on the page as far as I could see. And is it published anywhere else, or was it written specifically for the TUK website?
"Although considered as a sensitive biochemical marker, the guidelines3 recognize that “TSH levels vary diurnally by up to approx. 50% of mean values and with more recent reports indicating up to 40% variation on specimens performed serially during the same time of day.” With the availability of a sensitive test for TSH, a remarkable shift was made to the clinical diagnostic process: the evaluation of patient symptoms was largely superseded by thyroid function testing3–6"....//...
"A guideline is not intended to take the place of physician judgment in diagnosis and treatment of particular patients. We encourage medical professionals to use this information in conjunction with their best clinical judgment.”3
Authors: Mel Rowe, Rudolf Hoermann, Peter Warmingham
Many thanks to all three of you for this new paper
I'm very pleased to see this variability in TSH emphasised near the beginning of this new paper.
I see it as one of the most obvious proofs of the idiocy of looking at TSH in isolation.
I used to make fitted covers for circular tents (with conical roofs) that have a deliberately variable diameter... which changes the circumference... which changes the shape of the cone on top.... Yes , you could just prevent the variability by fixing the diameter, but then you would lose the adaptability....and a degree of adaptability in diameter is very useful.. it means you can put your tent up on ground with big rocks in, and lots of ground has rocks in.
The way around the problem of.... "what circumference to make the wall canvas so you still meet at the door posts without wasting expensive canvas ,while still allowing the fitted roof to be shallow or steep enough to cover the diameter ?"..... is experience and judgement.
If i was not allowed to use my experience and judgement, and had to work from a single measurement of diameter taken from putting a yurt up on only one occasion..... then a lot of people would be living in very draughty tents.
Is it too much to expect the same use of professional skill and judgement to be given to my vitally important and naturally variable thyroid system as i gave to people who live in houses made of sticks and string ?
This is a great paper, but what it needs is corroboration from respected doctors. Thyroid patients' views are sadly mostly ignored by the medical professionals, including those whose role is to create effective guidance on the diagnosis and treatment of thyroid disorders.
as Im sure Dr Hoermann fully understands the paper would carry more weight if it was put out for consultation or even peer review. From my view point it is clear and logical and should alert the endocrinology community of its existence.
even send o copy to the BTA and the BTF for their comments
Patients can then tell Endos of its existence and that it was put out for consultation.
Patient dissatisfaction has been recognised and things are starting to move. Even The Endocrine Society is taking notice and changing their position. See: endocrinenews.endocrine.org...
Their internet-found T3 example was a mislabelled thyroid support product which shouldn't have contained T3. Which I see as an odd choice - ignoring those who positively choose to self-treat with T3.
And they completely fail to recognise the number of patients told by their endocrinologists that they should source their own T3 from the internet. That might be significantly a UK-based phenomenon (due to pricing of liothyronine).
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