Results in the 2nd Whickham Survey

[diogenes]

In 1995 a group of thyroidologists examined the incidence of hypothyroidism in a particular group near Newcastle-on-Tyne. Among their findings was this remarkable sentence:

Clin Endocrinol (Oxf) 1995 Jul;43(1):55-68.

 doi: 10.1111/j.1365-2265.1995.tb01894.x.

The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey

M P Vanderpump 1, W M Tunbridge, J M French, D Appleton, D Bates, F Clark, J Grimley Evans, D M Hasan, H Rodgers, F Tunbridge, 

A logit model indicated that increasing values of serum TSH above 2mU/l at first survey increased the probability of developing hypothyroidism which was further increased in the presence of anti-thyroid antibodies.

This doesn't seem to have been taken in by doctors - ie that patients with TSH above 2 should be followed up routinely over a long period to detect hypothyroidism when it is finally clearly existing. And this is even more true for patients with antibodies. And yet patients are dismissed if their TSH is less than 10. Seems to be a gap in logic here, in view of patient treatment outcomes..

[helvella]

Ignored to the extent that testing for antibodies seems very rare until TSH at least goes above the reference interval.

Am I right that they only did Thyroid Peroxidase antibodies? (Not Thyroglobulin antibodies.)

The full paper is behind a paywall.

[diogenes Remembering in reply to helvella]

I think so. Antibody testing at that time was severely limited in that only Barts Hospital in London could do one. I presume it was the TP variety.

[helvella in reply to diogenes]

Thanks.

[Hidden]

My immediate response was hearing the tune to ‘What’s love got to do with it’ but thinking what’s logic got to do with it!🙄

[PaulRobinson]

The ineptitude that is actually out there and being routinely exhibited by both GPs and Endocrinologists is really hard to take in. I am convinced it is worse now than it was around 35 years ago when I was first diagnosed.

I worked with a lady the other day whose endocrinologist (quite a senior chap but I won't say which hospital he worked at), told her that her thyroid labs were completely normal.

She had overt symptoms of hypothyroidism and has to sleep for 3 hours in the middle of the day to cope (she was struggling to stay awake during our meeting). She has extremely high TPOAb autoantibodies - well over 100. Her TSH is between 2 and 3 admittedly but her FT3 is low and her FT3 is at the 5 percentile of the reference range. We all know here that the Normal Range is a statistical term i.e. Gaussian and it does not mean you are normal.

She had paid for the private consult with the apparently well known endocrinologist and was just sent away to shrivel up and fade away. I gave her my best advice. Hopefully, she'll be feeling like her old self within some months.

The situation is frighteningly bad.

Thanks for the information Diogenes as always.

Best wishes to you, Paul

[greygoose]

Logic is an alien concept to most doctors.

[jgelliss in reply to greygoose]

👏👏👏👏

[LindaC in reply to greygoose]

The limited straight sciences required to study medicine seem archaic now. Worse still, they seem to have so little understanding of the History of Science and The History of Knowledge, the full 'range'. of statistics/methodology = how many beans just might make 4.85 out of 5 - let alone the huge arena of human behaviour, with all of its social nuances within this thing we call life. Some are simply ill-equipped to be anywhere near patients. We NEED A NEW WAY.

[greygoose in reply to LindaC]

Totally agree! Doctors seem to live on another planet to their patients - or maybe in ivory towers. And, I always think that medicine is a delicate balance between science and art. Most doctors are neither scientist nor artist! More like computer technicians.

[LindaC in reply to greygoose]

Yes, I like that - more like technicians of... and some sort of artist or another! Shocking in this 21st C that people are exposed to this.

[jade_s in reply to greygoose]

Gah! Don't insult computer technicians, they are more clever than that! 😂 If a computer technician ignored the computer's symptoms and instead went by CPU temperature or something else equally ridiculous, they'd not last long. I don't know of any profession that is less interested in troubleshooting and getting to the root cause of things... I'm trying to think of others but I can't think of any right now. Chimney sweeps? 😜

[greygoose in reply to jade_s]

Sorry. I'm really no insulting computer technicians - I wouldn't dream of it. I used to teach them and they're very clever people. I only said that because doctors seem to spend more time looking at their computers than at their patients! And, god forbid they should have to touch one! Patient, that is, not computer. Perhaps body technicians might be a better description. But, even then, they'd have to touch them, and they don't like doing that! 🤣

[jade_s in reply to greygoose]

I know, I didn't mean it that way 🥰 Ah I understand now 😂😂 Well said 👍

[greygoose in reply to jade_s]

😁

[diogenes Remembering in reply to greygoose]

The best medicine happens under the title "The Art of Medicine". Before chemical tests for thyroid function were invented and standardised, patients were prescribed according to their presentation and some basic physical tests and observation of external features. Chemical tests, for which I am as guilty as anyone in their development and use, are helpers to decide from the whole picture what is the best way going forward. They are NOT an infallible substitute for the art.

[greygoose in reply to diogenes]

Totally agree. Medical science is heading in the wrong direction by relying more on blood tests and less at actually looking, and listening to, patients.

[LindaC]

Dr P and Dr S, TSH above 2 - keep an eye on [depending on individual, treat] once over 2.

Frankly, anything to do with 'Newcastle Endocrinology' avoid like the plague... indeed that would be better!

[arTistapple in reply to LindaC]

Whilst I am certain my undiagnosed hypothyroidism started way before 1995, I attended a cardiologist in Newcastle upon Tyne 2001. A thyroid test was done and seems it was never referred to. I certainly was never informed. TSH 2.40 and T4 at 37%. I was so blooming ill with heart symptoms they never got to the bottom of and heart attack followed. MINOCCA? it seems to be called these days. So research was available locally and they still could not diagnose it/find it! Newcastle allegedly has a fabulous reputation worldwide for its research……. What use is it if no-one pays any attention to it? They still are not paying attention. I get treated like a complete hypochondriac by my GP practice.

We have so much to be angry about. Tythrop has a post today covering a different angle in the same way!

[LindaC in reply to arTistapple]

Newcastle University, much of its Medical Research and Specific Hospital Departments are AMAZING [my uni ]. I'll leave it there!

[jimh111 in reply to LindaC]

Whey aye man!

[Brightness14]

Chock full of Vikings.

[UrsaP]

Just the one 'gap in logic'!! lolWhere did the magic figure 10 come from?