Yesterday I posted some encouraging material on advances in thinking about diagnosis and treatment from Bianco's lab. But do not get too excited - there are still nonsense papers published. For your entertainment here is one, with my colleague Johannes Dietrich's comments:
Again and again, it is surprising what gets accepted. The paper in the attachment, yesterday published by Thyroid Research, is an example for this kind of nonsense. The authors conclude that TSH is better for discriminating hypothyroidism from euthyroidism than T4. But, first of all, they have compared subjects with subclinical hypothyroidism with euthyroid subjects. So it is not surprising that they found what they had previously defined. Secondly, they measured total T4 rather than free T4, which, of course, doesn’t contribute to high selectivity. Additionally they pooled longitudinal results from single patients and cross-sectional data from included subjects, so that they also fail to recognize the ergodicity of the homeostatic system. In summary, we learn exactly nothing from this paper. It is a good example for the idiocy and the circular arguments that dominate today’s thyroidology.
Thyroid Research (2022) 15:19
doi.org/10.1186/s13044-022-...
Interpretation of TSH and T4 for diagnosing minor alterations in thyroid function: a comparative analysis of two separate longitudinal cohorts
Stig Andersen 1,2* , Jesper Karmisholt1,3 , Niels Henrik Bruun4 , Johannes Riis1,2 , Paneeraq Noahsen1,5 , Louise Westergaard 2 and Stine Linding Andersen1,6
Conclusion A 20% difference in total T4 was accompanied by a 466% difference in TSH. This amplified response in TSH to small changes in T4 led to separate distributions in TSH while total T4 showed considerable overlap between the two participant groups. Hence, the sensitivity and specificity of TSH vastly exceed that of T4 for detecting devious deviations in thyroid function. Our data illustrate the higher diagnostic power of TSH compared to T4 in the individual patient, emphasise the strength of the statistical above the epidemiological approach to biochemical parameters for individual patient diagnosis, and ease the interpretation of thyroid function tests with minor alterations in thyroid function. Thus, TSH is illustrated to be the most sensitive and accurate index of thyroid status of an individual
It's depressing that this is from the lab of a "good" thyroidologist.