Int J Endocrinol Metab. 2021;19(3):e115948. doi: 10.5812/ijem.115948.
In this is a debate about treatment or not in two cases discussed in detail. It's interesting that it shows up the logic or lack of it in reaching a decision in this difficult situation. It still however categorises patient groups via statistical TSH ranges i.e. subclinical has a range of about 5-9 TSH. It still falls into the error of thinking one can so neatly box a patient into a TSH-based decision process. But it's worth a read to see how decisions are made in this field.
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diogenes
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Personally I think something is missing (after a speed read). Clearly "treat" refers to allopathic treatment eg levo. But I believe that a decision not to treat SCH that way yet should include a referral to a naturopathic practitioner for non-allopathic treatment. At that stage, it is possible that the patient may not progress beyond SCH. It's a pity there is no relationship between both treatment types probably because of the arrogance of allopathic practitioners.
I certainly agree TSH should not be the sole determinant but it's level for the above referral should be nearer 2.5.
I find this maddening: " The treatment goal is to normalize TSH level."
How about a treatment goal of causing the patient to feel well again? Oh, wait! Can't have that! Must make the doctor feel good because the lab report pleases him.
Were we to agree that a normalized TSH is some sort of an indication or way of determining good treatment (and I am 100% we don't believe that!), surely the goal absolutely has to be wellness of the person?
I saw a GP recently , his request about another routine matter .
TSH came up in the consult, I stood my ground but sadly I felt he made his mind up that I was a ignorant women rather than engaging in a discussion as to why I reported I was well as a result .
..and what happens if the tsh has been downregulated by the body due to an illness ? here tsh monitoring is of no value, t3 is the one to watch surely?
My immediate reaction to the headline post is to say treat the patient if they are feeling unwell whether ‘subclinical’ or not. So, yes, I agree with previous posts.
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