research suggesting it’s better to undertreat hypothyroidism and check for other causes of hypo to minimise cognitive deterioration. Yawn!

[bikebabe]

not sure how accessible this is but essentially says that (mostly) women tend to be over treated for hypothyroidism and any subsequent ?mild hyperthyroidism is associated with cognitive disorder. So that’s another line of attack the naysayers will be using to reduce treatment. Don’t know about you guys but I’m far slower mentally when hypothyroid not when marginally hyperthyroid.

medscape.com/viewarticle/99...

[Star13]

I don’t know about you but I’m getting increasingly irritated by so called “studies” that are based on analysis from searching data bases or patient records looking for a specific hit. They then make a conclusion that does not take into consideration any other co-factors or comorbidities. Before long they will be conducting these studies using AI and then you can imagine the conclusions they will come to!

It’s time a spade was called a spade - these are NOT research studies! This is a really dangerous and slippery slope.

[Forestgarden]

Yet another retrospective study looking at just tsh, with no consideration of t4 or t3.

[jimh111]

Need to see the full paper. My first thought is this is most likely reverse causality. Some people with a damaged brain will likely secrete less TSH. Added to this is that patients with cognitive impairment are likely to receive higher doses of thyroid hormone. Without determining fT3 and fT4 the 'study' is worthless.Additionally, the brain relies on type 2 deiodinase converting T4 to T3. Levothyroxine monotherapy gives a lower T3:T4 ratio and a lower TSH for the same fT3. This lower ratio is likely to reflect reduced type 2 deiodinase in the brain with associated cognitive reduction.

[DippyDame]

Agree Star13...

This article is nonsense, it's not a research paper it's just bad medical journalism. The author, a journalist, starts with a quote from a medical journal and then makes a hash of trying to explain it's questionable content.

If you are hypothyroid it is almost physically impossible to become hyperthyroid.....you may be overmedicated with over range hormone levels but that is different to being hyperthyroid.

The brain needs a lot of T3 so if this is low, cognitive function may/ will become impaired.

It has nothing to do with being a woman, and all to do with wrong diagnosis and wrong medication

If we express something concerning our health, far too many medics are too quick to think we are depressed ....rather than suffering from a thyroid disorder.

[humanbean in reply to DippyDame]

it's not a research paper it's just bad medical journalism

I completely agree.

This is (probably) the author :

verywellhealth.com/karon-wa...

The paper the article was based on is this one :

jamanetwork.com/journals/ja...

but as per usual it is behind a paywall apart from the Abstract.

[DippyDame in reply to humanbean]

I'm struggling a bit here humanbean !

Conclusions and Relevance In this cohort study among patients 65 years and older, a low TSH level from either endogenous or exogenous thyrotoxicosis was associated with higher risk of incident cognitive disorder. Iatrogenic thyrotoxicosis is a common result of thyroid hormone therapy

Are they confusing low level overmedication with the more severe form of thyrotoxicosis?

Since they are using low TSH as their focus their results and conclusions are questionable and probably owe more to wrong diagnosis, analysis of test results and medication

Is thyrotoxicosis, as discused here, diagnosed solely on low TSH?

In the abstract we cannot see if FT4 and FT3 were factored in....somehow I doubt it

They admit that lactogenic thyrotoxicosis is a common result of thyroid hormone therapy which means it is usually the result of a mistake made in treatment.

No surprise there then!

Meaning - Practice patterns favoring aggressive case detection and treatment with thyroid hormone in older adults should be reconsidered in light of the frequency of overtreatment and the potential for harm associated with excess thyroid hormone.

Why are patients overtreated?

If they are looking at TSH alone rather than along with FT4 and FT3 how can they be certain the patient is wrongly or overtreated

So they appear to be suggesting that this type of thyrotoxicosis is not the fault of the hormone replacement per se, but most often by mistakes made in the way in which it is used!

Without full thyroid testing how can they be sure that low TSH is the cause of cognitive impairment rather than the result of undermedication and, importantly, low (cellular) T3.

Have I missed something?

Based on their analysis, as someone aged 78 with an undetectable TSH, the result of a supraphysiological dose of T3 required for RTH my cognitive function should be severely impaired!!

I'm not there ...yet!!

I rest my case.

[humanbean in reply to DippyDame]

Are they confusing low level overmedication with the more severe form of thyrotoxicosis?

It looks like it.

Is thyrotoxicosis, as discused here, diagnosed solely on low TSH?

I don't know.

To me, thyrotoxicosis is something I associate with hyperthyroidism, not hypothyroidism. But I think it is the same old nonsense they come out with... They don't acknowledge that a low TSH can be caused by lots of things including hyperthyroidism, over-medicated primary hypothyroidism, central hypothyroidism, and primary hypothyroidism when someone is taking T3. I'm sure there are other things causing low TSH too.

Why are patients overtreated?

They seem to believe that older people with healthy thyroids should have much higher TSH than younger people with healthy thyroids. But that is not borne out by the table below the graph in this thread :

healthunlocked.com/thyroidu...

Males with healthy thyroids who are under 40 have a median TSH of 1.40

Males with healthy thyroids who are over 80 have a median TSH of 1.80

Females with healthy thyroids who are under 40 have a median TSH of 1.30

Females with healthy thyroids who are over 80 have a median TSH of 1.70

The fact that TSH has risen in the older people is practically irrelevant because the TSH has risen so little. But doctors now seem to believe that TSH in the elderly should be allowed to rise to 6 - 10 while still classifying them as healthy. And an elderly person with thyroid disease and a TSH much below 2 is probably going to be classified as "over-treated". It's the usual sadism inflicted on thyroid patients.

Incidentally, the table I referred to came from a paper which has recently been put behind a paywall, after years of being free access.

If they are looking at TSH alone rather than along with FT4 and FT3 how can they be certain the patient is wrongly or overtreated

I don't believe they can determine over-treatment or wrong treatment with TSH only, and it never has been possible.

Have I missed something?

I don't think so.

However, doctors have buried their heads in the sand about hypothyroidism in all sorts of ways for years now, and it is actually getting worse, since now they rely totally on TSH, and won't even acknowledge that T4 and T3 should even be tested under any circumstances.

[DippyDame in reply to humanbean]

Thank you humanbean

Absolutely agree....the TSH debacle is causing misery.

[Bertwills]

There has been a huge range in fake “research” papers apparently. The medical journals are being swamped by them. It’s due to the way that doctors are paid in some countries with extra pay based on the number of papers published. There was an article in the Guardian not long ago. It’s upsetting the basis of genuine medical research publishing. AI is of course making the whole situation much worse. We’re likely to see many more rubbish papers.

[Bertwills]

Here’s the article

Guardian Page

[humanbean]

For those who don't know...

Patients age 65 and older who receive thyroid hormone therapy and experience low thyrotropin are at increased risk for dementia and other cognitive problems, according to new research published October 23 in JAMA Internal Medicine.

Thyrotropin is an alternative name for TSH i.e. Thyroid Stimulating Hormone, which is produced by the pituitary, not the thyroid.

[Star13 in reply to humanbean]

Sounds like yet another plot from those over the pond to get us all off our meds. No wonder many GPs roll their eyes 🙄when we mention a study that’s actually useful!

[1Cazza]

What a load of rubbish, anything to stop us feeling well and living longer.. My mother was terribly under treated and yes she also got dementia, and AF so that's that myth dealt with.

[serenfach]

Blame the patient, and if female, blame them again.

Makes me think of all the photos of women in mental hospitals in early 1900s, all with huge goitres.

[bikebabe in reply to serenfach]

yes i often wonder whether my grandma who apparently ended up in asylum (very briefly) aged 17 had thyroid issues.

[Star13]

I’m starting to think about my poor grandmother who I was very close to. I grew up with her until I was 9.

The first thing my very first private Endo said to me when I was first diagnosed was”so who in your family has thyroid problems?”. I don’t know because my poor grandmother died in a mental hospital at 60 having caught pneumonia after being left in a cold bath. She was there because she had a nervous breakdown, or so I was told. I’ve tried to get both her and my mother’s medical records as she too died at 54 but failed, but I am convinced that my grandmother had thyroid disease. I remember my mother telling me that her breakdown was caused because no one believed her because of the symptoms she was suffering. That was 60 years ago - are we going back to that again?

[bikebabe]

I wonder that too - in some political circles, they'd be happy to take us back to the 'good old days' of poorhouse/workhouse/asylum/debtors prisons

[humanbean]

I wonder if the authors who think under-treating or not treating hypothyroidism is a good idea have ever seen this article from the BMJ published in 1949.

ncbi.nlm.nih.gov/pmc/articl...

[serenfach in reply to humanbean]

Site not found...

[humanbean in reply to serenfach]

Odd. It works for me.

Try this one :

europepmc.org/backend/ptpmc...

[serenfach in reply to humanbean]

That works - thanks.