You might be interested in how the authors defined the various subclinical, and euthyroid states in the analysis of their work. It doesn't take too much thinking to drive a coach and horses through their argument and decision making.
1) Only FT4 and TSH was measured. No FT3 anywhere
2) These are the arbitrary ranges and cutoffs for the above
For all studies, the reference ranges were defined as 0.3–4.8 mIU/L for serum TSH and as 13–23 pmol/L (1.01–1.79ng/dL) for fT4. Five clinical strata of thyroid function at baseline were used to classify participants: overt hypothyroidism (TSH >4.8 and fT4 < 13), subclinical hypothyroidism (TSH >4.8 and fT4 within reference range), euthyroidism ( TSH 0.3-4.8, fT4 within reference range), subclinical hyperthyroidism (TSH <0.3 and fT4 within reference range), and overt hyperthyroidism (TSH <0.3 and fT4 > 23).
No prizes for discerning the great hole in their logic. Statistics over personal experience. Arbitrary cutoffs. Also different instruments were used, each having their own ranges - it is incorrect to amalgamate results like this unless you can prove equivalence at all points - which won't happen.
PS Paper lodged with Lyn Mynott for interested people to read at will.
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diogenes
Remembering
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We need experts like yourself to point out the extreme failures of those who are 'supposed to be knowledgeable' and who the patients look to for help and relief of clinical symptoms but who find that they may be worse off.
when you know how much fT4 ranges vary between labs/ over time , you surely can't get away with amalgamating all fT4 results to a [13-23 ] range. I've got TSH 0.5 and fT4 19 [7.9-14], but since fT4 19 is within their [13-23]cut off they would presumably class me as Euthyroid.... which is very far from my GP's opinion on my status...
That is the trouble with any paper is there is always the question as to - Is it ever going to be bias free? Again, these meta analysis productions are never going to be worthy unless the parameters of all the included works and studies are thoroughly picked apart for ‘flaws/bias’ beforehand and checked for compatibility. No study or piece of research should be accepted on the basis that it is still in existence. Knowledge changes over time and this should be reflected in any new publication. But I suspect most of these rehashed papers are actually instigated and designed to maintain the status quo. Making out there is ‘new and consolidating’ evidence of the status quo. Medical practice that is static is not medical practice.
Thank you so much, diogenes. Many of us may - should we live long enough - be affected by this. Dealing with them in the 'outside world' is more than bad enough, as opposed to in their clutches aka hospital or worse. This hardly bears thinking about. Surely with age some of us will require the same, even more, hormonal treatment!?
This lot never ceases to amaze. Stats, using the appropriate test and methodology can yield good approximations... not so with individual humans and where endocrinology seems to have really put itself right out there on a limb... aka, these days, becoming 'The Untouchables'!
This was not what the NHS was set up for; certainly not for little cabals of mini-dictators... to flourish on the rubbish that a reasonable A Level Stats student could pull them apart on. SMH.
In addition, all the quoted reference ranges are 95% (including 95% of the data). What, pray is the situation and choice of category for the low and high 2.5% outside the range? Toss a coin?
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Please review my results, as I promised I'd post from earlier post. 
Hypothyroidism: The difficulty in attributing symptoms to their underlying cause
My 10 year old has Autoimmune thyroid.
