Varying lab ranges accroos the counry

[JaneChapple]

Hiya

Ive just discovered the North Bristol have changed their thyroid ranges from November 2022, which if other areas decide to follow will mean less thyroid patients being treated in future. I have put Exeter's up as a comparison:

North Bristol

TSH 0.38 - 5.33, FT4 7.9 - 14.4, FT3 3.8 - 6.0

Exeter

TSH 0.27 - 4.2, FT4 12 - 22.0 FT3 3.1 - 6.8

I feel this really needs to be flagged up in Parliament (question for Lord Hunt?) as a matter of urgeency, as it really will have a detrimental affect on thyroid patients both now and for future generations. Ive posted on ITT Improve Thyroid Campain Group. Im furious!

Janexxx😒🤓❤

[Lalatoot]

Jane the thyroid ranges are dependent on the equipment being used and also based on the local population. So they do vary across the country.Also when a lab recalibrates or changes its equipment the ranges may change as a result. This is normal. So we can assume that Exeter and Bristol use different testing labs.

As for the results they should be a similar percentage through the ranges whatever range is used.

Regarding TSH many doctors wait till it is at 10 regardless of range.

[helvella in reply to Lalatoot]

As you so rightly point out, ranges vary.

So how can anyone regard "10" as equivalent across labs/hospitals/areas?

Arrogant nonsense.

[JaneChapple in reply to helvella]

Perhaps Im just too suspicious but its no wonder really?!🤓❤

[JaneChapple in reply to Lalatoot]

Yes indeed whiich is why there are so many ill and undiagnosed patients in the UK probably tsking up unnecessary hospital beds if they were treated properly for their thyroid condition - it really is scandalous. Drs and endos who refuse to treat us properly should be very ashamed of themselves!😒🤓❤

[Lalatoot]

healthunlocked.com/thyroidu... will find recent discussion about it here too

[tattybogle]

in theory :

if you sent the SAME blood sample to both labs:

(taken from a person who had a slightly lower level of T4 and a slightly higher level of TSH when compared to 95% of the healthy population)

Bristol lab TSH would come back at about 5.4 and Exeter lab would come back as about 4.3

Bristol lab fT4 would come back at about 7.5 and exeter would come back as about 11.7

When your lab buys a different machine from a different manufacturer , calibrated to different ref rage settings ( 95% population ref ranges) , then you ALSO get different numbers for the 'RESULT '

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

North Bristol

TSH 0.38 - 5.33, FT4 7.9 - 14.4, FT3 3.8 - 6.0

Exeter

TSH 0.27 - 4.2, FT4 12 - 22.0 FT3 3.1 - 6.8

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The "% through range" of both results 'ought' to be more or less the same from both labs ,, (give or take a bit for the small % variation the accredited labs are allowed between tests anyway)

obviously the only way to check if the theory holds true and they are not just pulling the wool over our eyes is to take two blood samples from the SAME test tube sample and run then through the two different machines (with no other confounding factors ~ like one waited in van for longer than the other on a hot day , etc etc )

[Charlie-Farley]

Hi Jane 😊

It is difficult to deduce anything from comparison of Exeter with Bristol. But do you know the previous ranges for Bristol ? 😉.

If you do, post the before and after because whilst the calibration of instrumentation is a factor for changes in a range - I would be extremely suspicious if only the top end had moved.

There is such a drive to save money in the NHS, increasingly we see financial considerations being passed off as medical ones.

I’m reading NICE guidelines with obvious contradictions emblazoned and wondering who the hell the committee is? I would be embarrassed to be part of any committee that on the one had says the hormone profile of NDT is different to that of humans and adverse effects can not be known whilst the current paradigm pushes mono therapy. Doh! Some really blunt tools in the box. 🙄

[helvella in reply to Charlie-Farley]

The human hormone profile they refer to seems often to be the FT4 to FT3 ratio in blood.

Whereas the porcine profile is T4 to T3 in porcine thyroid tissue.

You have to work through things in much greater depth to answer the real question. Including the absorption of the desiccated porcine thyroid. And whether a higher amount of T3 actually matters?

Will the patient in front of me do better on desiccated porcine thyroid than T4-monotherapy or any ratio of T3 to T3 as levothyroxine and liothyronine?

[Charlie-Farley in reply to helvella]

Really interesting 🤔 so in reality if these things are not easily measured by testing- once again we come back to symptoms. Which ever route they try to take, whether they like it or not, it all comes back to symptoms.

[helvella in reply to Charlie-Farley]

In the end, does anything else ever matter? Tests can guide, can help in maintaining an even keel, can point whether someone has more (or less) than last test.

If you imagine someone taking 100 T4 and 20 T3. That initially appears as 5:1.

But (and this is out of the air numbers) maybe the person absorbs 80% of the T4 and 100% of the T3. That results in 80 T4 and 20 T3 - 4:1.

Then you have to consider that the T4 remains in the blood longer than the T3.

And that I am not aware of any good data on T4 and T3 absorption from desiccated thyroid.

And on and on...

[Charlie-Farley in reply to helvella]

Yes the variables seem endless and the only direct (if qualitative measure) that always gives an honest result is symptoms. We can sit tapping away on our computers discussing this, unpacking it all and the researchers with notable exceptions keep bashing out research that neatly avoids all this and upholds the flawed science underpinning it all TSH. How many deaths from co-morbidities seeded in the mismanagement and half lived lives can these egos live with on their consciences - seemingly an endless number.

[Lalatoot]

If you read the supplementary materially online by the Trust it says that they have new equipment:will be moving to a new suite of analytical equipment, produced by Beckman Coulter UK (BCUK).

[tattybogle in reply to Lalatoot]

That makes sense . Beckman Coulter make one of the machines that have 'factory setting' of something like 7 -14 ish for it's fT4 range . (and that factory setting gets tweaked a bit by the lab to take into account their local population samples( .. or at least i think that's roughly how it works.. sort of .

eg my area which i had assumed is also a beckman coulter machine. has [7.9-14] instead of [ 7.9 - 14.4 ]

mind you my area also has TSH [0.57 -3.6] so now i'm not so sure they are using a beckman coulter after all.

I think ? the other manufacturer that makes machines with a 'factory' fT4 range of abut 7-14 ish is Abbott ?

[JaneChapple]

Hiya

Further to my above post regarding reference ranges Ive come across this paper from 2022. Not sure sbout the positive bias and our endos and drs discussing this though. Also still using healthy patients data and small amount of people?

academic.oup.com/jalm/artic...

Janexxx😒🤓❤

[tattybogle in reply to JaneChapple]

yes ... i think that paper was discussed on here recently ... while looking for who posted it, i found this from diogenes which is also relevant:

healthunlocked.com/thyroidu...

if i find the post about yours i'll add it in a bit

[tattybogle in reply to tattybogle]

haven't found it yet , but this one is interesting too (about fT4 ranges) healthunlocked.com/thyroidu... .. diogenes has some choice words about Abbott machines.

[tattybogle in reply to tattybogle]

ah here it is ... Aurealis posted it ;

healthunlocked.com/thyroidu...

[JaneChapple]

linda96