New thoughts on treatment

[diogenes]

This is a soon to be published opinion piece from the USA. For copyright reasons I won't divulge the authors: it's in two parts because of length

First part

Enhancing the Patient Voice: Quality of Life, Satisfaction, and Preference during Treatment of Hypothyroidism

Satisfactory treatment of chronic diseases can be challenging for a number of reasons, including widespread manifestations of the disease, difficulties with adherence to therapy, the burden of a chronic disease, quality of interaction with the relevant health care provider, and lack of perfectly targeted therapy. A condition in which this is particularly true is hypothyroidism (1, 2). Further accentuating treatment difficulties is the protean effects of thyroid hormone deficiency, with no cell type or organ system left uninfluenced by the effects thyroid hormone (3). The traditional mainstay for monitoring hypothyroidism therapy is biochemical measures of thyroid function, including thyroid stimulating hormone, free thyroxine, and total triiodothyronine measurements (1). Most clinicians are familiar with treated hypothyroid patients who have within-range thyroid function test results, but are dissatisfied with their therapy (4). In addition to assessment of success of therapy being based on biochemical and physical parameters, patient-reported outcomes (PROs) examining quality of life (QOL) and symptoms, patient satisfaction, and patient preference for therapy may be used to judge efficacy of therapy (5, 6). A range of validated, thyroid-related PROs have been used to assess QOL (7, 8) and treatment satisfaction (9, 10) in patients with hypothyroidism. However, there are currently not well-established measures for assessing patient preference for therapy in a thyroid-specific manner. Reports of a patient's thyroid status that are directly expressed by the patient, such as the measures described above, may be helpful for refining hypothyroidism therapy with improvement in patient outcomes. In the article by Perros et al in this issue of Thyroid (11), the authors examined patient experiences with their therapy for hypothyroidism utilizing a survey drawing its components from three sources: the short version of the ThyPRO39 measure for QOL (12), somatic symptoms from the Patient Health Questionnaire 15 (PHQ 15) (13, 14), and the Picker question bank (15). In addition to gathering demographic data, details about diagnosis and treatment of hypothyroidism, comorbidities and physical activity from patients, the areas probed included persistent symptoms and perceived underlying causes, experiences with their healthcare team, impact of hypothyroidism on everyday living, personality traits, and use of internet and social media for gaining access to information on hypothyroidism.

[Musicmonkey]

Let's hope this is received well by the clinical community

[DippyDame]

Thank you diogenes

Further accentuating treatment difficulties is the protean effects of thyroid hormone deficiency, with no cell type or organ system left uninfluenced by the effects thyroid hormone

Bingo!

I wonder how many medics know and understand this!

My problems today now seem certain to be the result of this lack of knowledge amongst the medical community over many decades....cellular rather than glandular hypothyroidism!

Off to read Part 2 now!

[LindaC in reply to DippyDame]

Exactly! They look to fatally flawed numbers, when staring the hard evidence [ill patient] in the back of the neck!