Why only test TSH?

[BenLabrador]

Only testing the TSH level is, in my opinion, like being in command of a battle and not visiting the front lines and seeing what is happening - that is measuring the T3 level to understand how the cells are functioning - but only responding to requests for logistics. Or why should head office spend money to find out the facts on the ground when they can just analyse reports and customer complaints? Any comments?

[helvella Administrator]

There is a super-simple basis for testing all three:

Discordant results

deranged thyroid function tests

healthunlocked.com/thyroidu...

You can only have discordance/derangement if there are at least two results which appear in conflict as to what they represent.

All causes of discordance/derangement are immediately missed and ignored if you make but a single measurement.

If all three point in the same direction, are harmonious, then the likelihood of entirely missing an issue is much reduced.

Given that now even Patient Information Leaflets are advising about possible test interference (e.g. from biotin), how can the medical establishment continue to do TSH-only?

[DippyDame]

thyroiduk.org/testing/histo...

TSH obsession exists because it's quick, cheap and based on ignorance!!

It is an unreliable marker especially after thyroid hormone (s) are introduced.

Little wonder so many people are wrongly diagnosed and wrongly medicated

T3 is the most important result followed by FT4

As someone who depends on a supraphysiological daily dose of T3 which I have to self source I find the whole debacle an utter scandal

Yet, the protagonists persist in burying their heads in the sand and ignoring the science in favour of adhering to established but erroneously held beliefs with little or no firm scientific fact

To quote our greatly missed diogenes/ Dr John Midgley..

For the moment mechanical thinking has traduced medical diagnosis.

It makes no sense!

[BenLabrador]

I look forward to the day when prescription of T3 is considered as cost-saving preventative medicine, given the damage done to our bodies and minds and the resultant costs to the NHS of its non-prescription.

[helvella Administrator]

One of diogenes' papers.

TSH Measurement and Its Implications for Personalised Clinical Decision-Making

Rudolf Hoermann, John E. M. Midgley

8. Summary

The current mainly statistically based use of TSH in thyroid function testing has some severe limitations, including the problem of nonexisting agreed reference limits, a lack of consideration of individual set points, and a prognostic heterogeneity in different populations. In the light of recent molecular and clinical evidence, revised and more refined modelling of the interrelations of TSH and thyroid hormones appears to be both a physiological requirement and a promising avenue towards an overdue reevaluation of TSH as an exclusive diagnostic standard and therapeutic target. Based on studies on the FT4-TSH relationship including our own work and a review of the molecular mechanisms described in the literature we propose a complex non-linear model and hierarchical structure of the thyroid hormone TSH interaction. We promote the interpretation of TSH results in close correlation to the thyroid hormone milieu to reduce the uncertainty of interpretation. While a few smaller studies could demonstrate a conceptually higher accuracy, compared to the standard diagnostic procedure, a possible broader application of such concepts awaits further methodological and clinical evaluation.

onlinelibrary.wiley.com/doi...

[Catseyes235]

cost. The NHS needs to save money. In the case of many TSH is good enough but a substantial minority neeed further investigation. Anyone who has a normal or low TSH but still has hypo symptoms should be entitled to further testing. However some doctors think TSH is some gold standard and thus the conflict begins. Trouble is if your hypo you’re not best placed to fight your corner!

[arTistapple]

I really like your description and it’s a recognised issue about war, often discussed in literature, both in fact and fiction writing. Very apt for us.

I have been involved now with a number of doctors re: my hypothyroidism and other co-morbidities and now other autoimmune ‘stuff’ - not sure if they are classed as co-morbidity.

Doctors really don’t like the patient discussing issues with them at all; they would just so much rather you just did as you were told. However I feel I can now attest that the mention of hypothyroidism being a factor in anything at all (including hypothyroidism itself) is a complete anathema. Most importantly (whilst they think us a bunch of time wasters) I am convinced it’s because of their extremely poor education around hypothyroidism. This is the message they get from their own establishment

Even really bright doctors bring the curtains down sharpish at the mention of hypothyroidism. There is a mountain to climb, but few doctors seem aware of this mountain - even although it’s in plain sight!

[BenLabrador in reply to arTistapple]

The analogy can be taken further as the soldiers in the field are calling for two types of weapon i.e. T4 and T3 but the commander refuses to send anything other than the cheapest available i.e. T4. He denies they need other weapons, dismisses their reports and has shut his ears to their cries for help. He says he knows the whole situation but is, in fact, wilfully ignorant of the reality faced by the soldiers

[dealsgap]

The "insurance model" that most doctors have to abide by encourages ignorance. They answer to a book of codes and not patients symptoms or their cause. You really can't diagnose much in the 5 minutes they spend with them and then on to the next one. Thyroid patients are complicated and take some digging to help. Much easier to just go by 1 lab (TSH) and not go down the rabbit hole of T3/T4/RT3/antibodies/etc. not to mention adrenals (if they even know how they impact the thyroid).

[Astlebridge]

have just had blood tests .5 different forms I was expecting a good rundown but all I got was tsh