This paper agrees with all we have been saying and reporting

[diogenes]

Over the last 10 years or so, our group has been emphasising the importance of treating thyroid (or any) patients as individuals, increasing the value of the personal patient's interview symptoms over the mere application of biochemical markers. This paper reinforces what we have been saying. At least there are some people who listen.

dx.doi.org/10.1136/postgrad...

[Fruitandnutcase]

Thank you for that Diogenes, looks like there might be a glimmer of hope out there when it comes to ‘normal’ and ‘range’. Hearing a doctor say “your results are within the range” or “your results are normal” when you clearly still don’t feel well makes my heart sink.

So thank you. A lot of people will be grateful to the authors of that paper.

[helvella in reply to Fruitandnutcase]

The author's email address is on the paper - members could thank him/them directly.

[Fruitandnutcase in reply to helvella]

Good idea - Wonder if his inbox could cope if everyone who agrees with him emails him?

[Fruitandnutcase in reply to Fruitandnutcase]

Hmm - hope so, I sent one earlier on and he’s out of office . He’ll be cursing those of us who thank him.

[helvella in reply to Fruitandnutcase]

I was imagining the delight of coming in to work after a holiday (or whatever) and receiving emails appreciating what we had written three or more years ago. Out of the blue.

It should really help him/them to realise it is worth the effort.

[Fruitandnutcase in reply to helvella]

Oh dear - you’re making me feel even worse - clogging up his inbox. I’d email and apologise but probably better not to. Poor guy. Quite worrying that he wrote it three plus years ago and doctors still haven’t cottoned on. Sort of confirms what we all feel.

[helvella in reply to Fruitandnutcase]

Well I am pleased I emailed - even if his inbox does fill up! (Unlikely these days, in reality.)

[Cariad123 in reply to Fruitandnutcase]

It works the other way too l was feeling wonderful happy and well and GP included thyroid test in a-range of bloods without telling me . I had taken my NDT at 7 am and bloods where taken 3 hrs later .as upsurge of t3 was taking effect

When l have bloods for my levels with Medicheck its no food no NDT that morning and bloods taken at 5am

Needless to say l am being perused at the moment by a not listening who do you think you are you will get heart disease a plethora conditions - your hyperthyroid now ( didn’t use overmedicated ) l have an adrified thyroid due to Hashis thydroritus

( sorry about any spelling mistakes )

[tattybogle]

".....and so we must take care that the reference limit is not confused with a decision limit. "

indeed.

[jimh111 in reply to tattybogle]

Very much so. TSH = 10 is a decision limit but is always (mis)interpreted as a cut off point. TSH 10 is the point where given no other information (such as symptoms) there is a balance between having and not having primary hypothyroidism. So, roughtly speaking if someone has TSH 10.0 there is a 50 / 50 chance they will have primary hypothyrodism. TSH 9.0 a little less likely and TSH 11.0 a little more likely.

With other information such as signs or symptoms the TSH decision limit is much lower or even non-existant i.e. irrelevant.

[PaulRobinson]

Very useful and of course makes complete sense to everyone with a bit of a brain.

Hopefully, some of the endocrinologists and doctors will actually read it and all your terrific published work!

All the best, Paul

[Tythrop]

Just googled Choose Wisely; correct me if I'm wrong, but their emphasis seems to be on limiting medical intervention/not prescribing.

[diogenes Remembering in reply to Tythrop]

I think Choosing Wisely in this context is not about withdrawing medicines but rather about using patient appearance rather than biochemistry as the first and primary step, and then being more able to home in on the best solution in treatment. NB everything on the table: T4,T3, NDT, T3/4 combination.

[Tythrop in reply to diogenes]

Thanks.

[DippyDame in reply to diogenes]

Revisiting the days when face to face clinical evaluation (as soon as the patient entered the surgery door) was a major part of diagnoses rather that reliance on numbers on a screen ...which today seem all important.

[DippyDame]

Thank you, as ever diogenes ....

Funny isn't it, we the patients already understand this, but how are the professionals to be convinced!

It makes no sense.

Do they fear falling off their perches if they listen to the wise words of others who do clearly understand.

We live in hope!

[knitwitty in reply to DippyDame]

That of course is the really important question, I think the change will come VERY slowly, because if the medical profession were to backtrack they would have to admit that maybe they got it wrong in the past and left people unwell and untreated. I personally cannot see that happening overnight but maybe there will be a slow change as the years go by.

I have noticed in recent years that GP's are a little less likely to push patients into taking statins when their cholesterol is on the high side , so maybe there is a glimmer of hope for us thyroid patients in the coming years.

[LindaC]

Thank you so much, diogenes - as some of us well know, how could it be any other way?

[Hidden]

It has sometimes been suggested that a doctor will actually reduce levothyroxine when the patient gets older as the "normal" TSH for the elderly increases with age. I find this totally unacceptable as the actual health of a patient will naturally decrease with age.At age 74,I don't want the "normal" health of an elderly person, I want the health of an Olympian athlete!

Just to think - I would have got much better treatment a century ago for my lack of a thyroid gland than I do now!

If you remain ill for any reason, make sure to emphasise your misgivings about your own treatment, how you disagree with the flawed reasons for that treatment and how an alternative treatment may help.