TSH Measurement and Its Implications for Personalised Clinical Decision-Making

Back in November I posted this blog:

thyroiduk.healthunlocked.co...

Same authors have now posted a review article all about TSH. Well worth reading - and the full paper is available for free. Some of it very much agrees with what many here regularly say - e.g. that TSH is being misused and misunderstood.

Journal of Thyroid Research

Volume 2012 (2012), Article ID 438037, 9 pages

doi:10.1155/2012/438037Review Article

TSH Measurement and Its Implications for Personalised Clinical Decision-Making

Rudolf Hoermann1 and John E. M. Midgley21Department of Nuclear Medicine, Klinikum Luedenscheid, Paulmannshoeherstraße 14, 58515 Luedenscheid, Germany

AbstractAdvances in assay technology have promoted thyrotropin (TSH) measurements from participation in a multi-analyte assessment of thyroid function to a statistically defined screening parameter in its own right. While this approach has been successful in many ways, it has some grave limitations. This includes the basic question of what constitutes an agreed reference range and the fact that the population-based reference range by far exceeds the variation of the intraindividual set point. Both problems result in a potential misdiagnosis of normal and pathological thyroid function in a substantial proportion of patients. From a physiological perspective, TSH plays an integrated role in thyroid homeostasis. Few attempts have been made to adopt physiological insights into thyroid homeostasis for medical decision-making. Some emerging novel findings question the widely assumed log-linear TSH-FT4 relationship over the entire thyroid function spectrum. This data favours more complex hierarchically structured models. With a better understanding of its role in thyroid homeostasis in thyroid health and disease, TSH can be revisited in the context of thyroid regulation. This, in turn, could help overcome some of the limitations arising from its isolated statistical use and offer new prospects towards a more personalised interpretation of thyroid test results.

<full article available for free at link>

hindawi.com/journals/jtr/20...

Full citation:

Rudolf Hoermann and John E. M. Midgley, “TSH Measurement and Its Implications for Personalised Clinical Decision-Making,” Journal of Thyroid Research, vol. 2012, Article ID 438037, 9 pages, 2012. doi:10.1155/2012/438037

Rod

9 Replies

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  • Thank you! This is very interesting.

  • I found this very interesting, not least because of the emphasis on the need for consideration of the individual rather than reliance on statistics.

    I have thought for a long time that unless they test people at regular intervals throughout their lives, they have no idea what is normal for them. I sometimes wish I had been tested when I was well ( before I was diagnosed with thyrotoxicosis at 13) - that would have been a great 'reference range'!

    I know that a child's TSH varies even more than an adult's but it would give a starting point in terms of a comparison with the average. Not many people have thyroid disorders as young as 13 (or even younger, since that was when I was diagnosed, not when I started being ill) so it would be a very useful tool for later reference, if someone starts to experience symptoms of thyroid disorder.

  • I don't even remember a single paper about how an individual's TSH would be expected to change (or remain the same) over a full lifetime. And that would itself be a start in possibly understanding things.

    Clearly a lot of people end up either being ignored despite symptoms or being treated. So they are effectively to be ignored in terms of "normal" lifetime pattern. But few who do not have symptoms and are not treated are likely to have the required number of tests to make anything of them.

  • Thank you for drawing out attention to this article and also this site. So much suffering is behind these words:

    "....shifted the focus of TSH from its reactive and interactive role with thyroid hormones to an exclusive statistical parameter whose value is assumed to define the functional state of the subject."

    Exactly.

  • Thanks very much for this Rod. It's just what I need to show my GP, when I get enough info to grapple with him, as my non-treatment by the NHS (I have a private doctor) has hinged on my fluctuating TSH level. No other paper I have come across sums it up so succinctly and in normal language.

  • Have you looked at the BMJ article recently? Up to 27 rapid responses the other day.

  • Could you give me the link again, Rod, I seem to have lost it.

  • Have just found it! I think I will print it out plus the original comment by Des Spence, who often sounds off in Pulse magazine too.

  • Shame I did not have it today when I went to see my endocrinologist who is quite reasonable though not able to act outside the system too much. But he said he likes informed patients and wants to be pushed. No problem with that from me 8-) he will get this article and some others next time.

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