Don't get too excited - there are still idiots about!

[diogenes]

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.

[Gingernut44]

Oh no, when will it ever end 😱

[carorueil in reply to Gingernut44]

just posted my 'experience' with my endo last week 😩

[Musicmonkey]

Thank goodness this nonsense can be challenged by the real thyroid experts.

[diogenes Remembering in reply to Musicmonkey]

I hope I don't annoy people here by showing things like this. I do it only to infiltrate proper reasoning and relation to truth or otherwise into the TUK experience. It's important to gain some reasoning on a scientific basis to confront doctors and endocrinologists with information they cannot avoid other than showing disdain.

[Joyya in reply to diogenes]

Your post and critique is essential for others, including clinicians such as myself, to be able to refute nonsense based on 'research.' This area is new for me, and I have learned a great deal over the years by reading just such réfutations on the same type of nonsense, in other fields. I would have caught the TSH / T4 aspect, but not the total T4 / free T4 one as I am too new to learning in this area. Having it pointed out is extremely useful as I learn, so thank you.

[LindaC in reply to Joyya]

What a Breath of Fresh Air 💚💛🍀 Thank you!

[JGBH in reply to diogenes]

I doubt people would be annoyed by someone who is on their side by exposing the utter ‘research’ rubbish that is accepted to be published as a serious paper! So THANK YOU so much for doing what you do for us all.

It makes one feel rather concerned about the quality of teaching of medics/researchers and the standards expected of them. Of course there are excellent medics and researchers, unfortunately not as many as second rate ones. Why are such people allowed to publish such nonsense? Who actually read such papers before allowing for publishing?

[wellness1 in reply to diogenes]

Not at all. Your posts and your patience with questions are a treasured part of TUK. We are very fortunate to have your contributions adding to our knowledge base.

I'm not familiar with this publication, but many medical journals publish a Letters section. It would be wonderful if Professor Dietrich's comments were published in reaction. I fear you and your colleagues would exhaust yourselves submitting corrections.

[Musicmonkey in reply to diogenes]

I think I worded my reply badly 😢 Sorry if I made you feel I was being critical - not my intention at all!! Quite the opposite in fact. I meant thank goodness we have people like you and Bianco to challenge misleading studies like this one.

[LindaC in reply to diogenes]

So welcomed. 💚🎶💛🔍 Thank you, once more.

[Titaniumfox]

It's very important to show these poor papers and explain why that's so, for people with no scientific background or much thyroid knowledge. It's a shame that research like that gets accepted for publication, though!

[klr31]

My TSH remained the same despite me reducing my thyroxine by 75mcg so not a very sensitive indicator in my opinion! It's still hardly budged even though I've been on a lower dose for a few years now. My doctor is annually worried even though I have no signs of being over-medicated. It's a battle I have with them to not lower my dose too much.

Karen

[diogenes Remembering]

Just a little post to prove how bad this paper is.

First they sort patients out into subclinical hypo (hyperthyroid) according to TSH levels, comparing them with true hypothyroids. That is, patients with clinical hypothyroidism. Then they say that TSH discriminated better than FT4. But that's obvious, because if you separate two groups by TSH levels first, then by that definition, FT4 is bound to come off worst - a total nonsensical artefact of argument.