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Thyroid & other test "normal" ranges in the news
Article published on-line today from MD talking about how the "normal" ranges Dr's use are flawed. And SPECIFICALLY used Thyroid as an example!
The following is the cut & paste from a portion of the article.
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Who decides what's 'normal' in medicine?
Exclusive: Dr. Lee Hieb reveals how deceptive your doctor's standards can be
Read more at http://www.wnd.com/2013/04/who-decides-whats-normal-in-medicine/#3ASV0WXMpjJr6khX.99
When you go to the doctor and he does tests, ever wonder how “normal” is determined?
Ideally normal should be “optimal.” But, what is optimal for you is not always optimal for me. And, sadly, how we determine “normal” in standard medicine has nothing to do with what would make our bodies’ the healthiest.
Take thyroid levels for example. When labs “norm” the studies, they get volunteers – many times hospital and/or lab employees, ask them if they are well that day and make them part of the random sample. Now, of the 50 or so employees used to norm the test, some may not be normal. In fact, due to genetic drift, lack of iodine in the diet, bromine exposure and other factors, a great number of people’s thyroids are not working normally, and they are actually hypothyroid, but haven’t been diagnosed as such. Nevertheless, these abnormal people become part of the pool of people to determine the normal range of thyroid. Therefore the “normal” range actually is skewed to the abnormal.
Continuing with the case of thyroid, TSH is a measure of thyroid function, and as the thyroid fails the TSH gets bigger, We know from studies in the heart as well as bench analysis that if the TSH is above 1, the thyroid function – its effects on different body tissues, is abnormal. Cardiac output, the ability of the heart to pump blood diminishes with a TSH above 1. Yet our lab range of “normal” continues to be 0.4 to 4.5 – a range so broad as to include a lot of sick people.
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Maybe finally something will start to be done about the faulty test and ranges!
The following is the cut & paste from a portion of the article.
- - - - - - - - - - - - - -
Who decides what's 'normal' in medicine?
Exclusive: Dr. Lee Hieb reveals how deceptive your doctor's standards can be
Read more at http://www.wnd.com/2013/04/who-decides-whats-normal-in-medicine/#3ASV0WXMpjJr6khX.99
When you go to the doctor and he does tests, ever wonder how “normal” is determined?
Ideally normal should be “optimal.” But, what is optimal for you is not always optimal for me. And, sadly, how we determine “normal” in standard medicine has nothing to do with what would make our bodies’ the healthiest.
Take thyroid levels for example. When labs “norm” the studies, they get volunteers – many times hospital and/or lab employees, ask them if they are well that day and make them part of the random sample. Now, of the 50 or so employees used to norm the test, some may not be normal. In fact, due to genetic drift, lack of iodine in the diet, bromine exposure and other factors, a great number of people’s thyroids are not working normally, and they are actually hypothyroid, but haven’t been diagnosed as such. Nevertheless, these abnormal people become part of the pool of people to determine the normal range of thyroid. Therefore the “normal” range actually is skewed to the abnormal.
Continuing with the case of thyroid, TSH is a measure of thyroid function, and as the thyroid fails the TSH gets bigger, We know from studies in the heart as well as bench analysis that if the TSH is above 1, the thyroid function – its effects on different body tissues, is abnormal. Cardiac output, the ability of the heart to pump blood diminishes with a TSH above 1. Yet our lab range of “normal” continues to be 0.4 to 4.5 – a range so broad as to include a lot of sick people.
- - - - - - - -
Maybe finally something will start to be done about the faulty test and ranges!
Don't hold your breath until that happens. LOL Recall that over 10 years ago the AACE finally acknowledged the very problem mentioned by the doctor. Accordingly, they purged their TSH test data base and removed data from patients that were suspect for being either hypo or hyper, and recalculated the reference range. It changed drastically, from .5 - 5.0 down to .3 - 3.0.
Yet, after all this time, what do we still see used as TSH reference ranges from most labs and doctors. You got it --- the old range. Even worse, the AACE seems adamantly opposed to even consider changing the ranges for Free T3 and Free T4, which were, of course, established using the same erroneous method as the original range for TSH. Functional ranges for Free T3 and Free T4 would be more like the upper half of the current ranges.
All this really wouldn't matter if the AACE and ATA would fully recognize that reference ranges should really be used as guidelines within which to adjust Free T3 and Free T4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels. In other words, clinical treatment, as it was done before the advent of the TSH test.
But I can't see that happening. After all these years they will never admit being wrong about TSH being the best diagnostic, along with their use of "Reference range Endocrinology" to treat hypo patients. Especially since they carefully cover themselves in the way they word the guidelines for treating hypo patients. When pushed they say that their guidelines don't say that TSH and T4 meds are the only ways to diagnose and treat patients. Just the best way in most cases. So they leave themselves an out.
Unfortunately, I think if you surveyed doctors, I'd bet that 90% of them were trained according to AACE guidelines, and still believe that TSH and T4 meds are all that is required for diagnosis and treatment. Especially among the Endocrinologists, who you would think should have more thyroid knowledge and experience than other doctors, and would have realized the limitations of current practice.
Yet, after all this time, what do we still see used as TSH reference ranges from most labs and doctors. You got it --- the old range. Even worse, the AACE seems adamantly opposed to even consider changing the ranges for Free T3 and Free T4, which were, of course, established using the same erroneous method as the original range for TSH. Functional ranges for Free T3 and Free T4 would be more like the upper half of the current ranges.
All this really wouldn't matter if the AACE and ATA would fully recognize that reference ranges should really be used as guidelines within which to adjust Free T3 and Free T4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels. In other words, clinical treatment, as it was done before the advent of the TSH test.
But I can't see that happening. After all these years they will never admit being wrong about TSH being the best diagnostic, along with their use of "Reference range Endocrinology" to treat hypo patients. Especially since they carefully cover themselves in the way they word the guidelines for treating hypo patients. When pushed they say that their guidelines don't say that TSH and T4 meds are the only ways to diagnose and treat patients. Just the best way in most cases. So they leave themselves an out.
Unfortunately, I think if you surveyed doctors, I'd bet that 90% of them were trained according to AACE guidelines, and still believe that TSH and T4 meds are all that is required for diagnosis and treatment. Especially among the Endocrinologists, who you would think should have more thyroid knowledge and experience than other doctors, and would have realized the limitations of current practice.
COMMUNITY LEADER
I agree that I don't see anything changing, any time soon. Labs and doctors switching to the new TSH range is a good indication that they really aren't listening to anyone, especially patients.
"Unfortunately, I think if you surveyed doctors, I'd bet that 90% of them were trained according to AACE guidelines, and still believe that TSH and T4 meds are all that is required for diagnosis and treatment." Too true. I recently discussed with my pcp about him taking over my thyroid treatment and he declined because he's not familiar with the medications I'm on, though there's nothing unusual about them (Tirosint and generic T3) and wouldn't feel comfortable prescribing them. Nor does he understand how to interpret the FT3/FT4, because he was taught TSH.... If I were to let him manage my thyroid, I'd be back to synthroid only and he'd be trying to adjust my TSH, rather than alleviate symptoms.
"Unfortunately, I think if you surveyed doctors, I'd bet that 90% of them were trained according to AACE guidelines, and still believe that TSH and T4 meds are all that is required for diagnosis and treatment." Too true. I recently discussed with my pcp about him taking over my thyroid treatment and he declined because he's not familiar with the medications I'm on, though there's nothing unusual about them (Tirosint and generic T3) and wouldn't feel comfortable prescribing them. Nor does he understand how to interpret the FT3/FT4, because he was taught TSH.... If I were to let him manage my thyroid, I'd be back to synthroid only and he'd be trying to adjust my TSH, rather than alleviate symptoms.
Still the more coverage this gets, the better chance that this will change.
I talk to more and more people and they are all coming to the conclusion that they have to step up and educate themselves and become a much stronger advocate for themselves. Because they see more and more Dr's who seem to not be interested in healing them, only getting them to some comfort zone for the DOCTOR to feel safe in and they could care less about how the patient feels.
people are starting to get sick and tire of LITERALLY being sick and tired. And are starting to take more steps to demand they get answers.
Unfortunately I believe that any additional government or even insurance take over of the medical industry will result in more of the bureaucratic reference range endocrinology type philosophy. Test and treat to a range of numbers on a lab report. Yet not a single person has a clue as to how the range was established or if it is even correct. They don't care as long as if they put the patient into that range they won't get sued....NEXT! person on the conveyor belt.
I talk to more and more people and they are all coming to the conclusion that they have to step up and educate themselves and become a much stronger advocate for themselves. Because they see more and more Dr's who seem to not be interested in healing them, only getting them to some comfort zone for the DOCTOR to feel safe in and they could care less about how the patient feels.
people are starting to get sick and tire of LITERALLY being sick and tired. And are starting to take more steps to demand they get answers.
Unfortunately I believe that any additional government or even insurance take over of the medical industry will result in more of the bureaucratic reference range endocrinology type philosophy. Test and treat to a range of numbers on a lab report. Yet not a single person has a clue as to how the range was established or if it is even correct. They don't care as long as if they put the patient into that range they won't get sued....NEXT! person on the conveyor belt.
COMMUNITY LEADER
"Still the more coverage this gets, the better chance that this will change." We can always hope.............
"Unfortunately I believe that any additional government or even insurance take over of the medical industry will result in more of the bureaucratic reference range endocrinology type philosophy. Test and treat to a range of numbers on a lab report." I see it all going back to testing only TSH, which IS, after all, the gold standard (sarcasm intended....lol). Look at our members in UK who are under the NHS; getting FT3 and FT4 is nearly impossible under their guidelines and many people have to go private to get adequate treatment. Let's just hope we don't step back that far.
"Unfortunately I believe that any additional government or even insurance take over of the medical industry will result in more of the bureaucratic reference range endocrinology type philosophy. Test and treat to a range of numbers on a lab report." I see it all going back to testing only TSH, which IS, after all, the gold standard (sarcasm intended....lol). Look at our members in UK who are under the NHS; getting FT3 and FT4 is nearly impossible under their guidelines and many people have to go private to get adequate treatment. Let's just hope we don't step back that far.
OH, I think we WILL go back as far as the UK folk and probably further on other medical issues. Government is inefficient at doing EVERYTHING. That is a fact.
That is the reason in the USA the framers of the Constitution attempted to strictly limit the federal government at to only doing a few limited and strictly listed things. (22 to be exact listed in Article 1 Section 8 of the Constitution). Yet somehow "they" have found a way to meddle in just about everything and every part of our lives. And "we the people" have let it happen right in front of our faces too busy watching TV and playing on our our smart phones.
I am sincerely concerned about the progress in medical field. Have you ever noticed that new medical procedures and other advances in medicine and pharmaceuticals no longer come from those countries that have national, or universal, or single payer governmental health care systems in place? That is because the government controls everything. And government and bureaucracy like strict rules, regulations and guidelines. There is no incentive to advance. Only remain within the "standard of care". Government established payments and reimbursements and price standards prevent any incentive to work harder or find new treatments etc. So the Dr's just run a conveyor belt system following the government established guidelines. nothing more, nothing less.
So if the government can save money by simply testing ONLY TSH and then minimally prescribing medication that keeps people from being treated at all, or sufficiently to relieve them of symptoms they don't care. They met the gov't guidelines and that is all they are required to do and there is no incentive to do an ounce more.
This is what we are facing. Next year it is going to really hit the USA. Businesses are now told that insurance rates ARE going to rise between 50% and 100% because of this legislation. This so that we can cover more people who could not afford medical insurance BEFORE these major increases in price. So it has all the indications that this will hurt more people than it ever helped. It appears that it is going to be a disaster. Many politicians, even co-authors/sponsors of the Obamacare bill are now calling this a train wreck about to happen. So I'm not sure what that all means. Other than unless something is done, and done fast. This could be a real mess in a real hurry.
That is the reason in the USA the framers of the Constitution attempted to strictly limit the federal government at to only doing a few limited and strictly listed things. (22 to be exact listed in Article 1 Section 8 of the Constitution). Yet somehow "they" have found a way to meddle in just about everything and every part of our lives. And "we the people" have let it happen right in front of our faces too busy watching TV and playing on our our smart phones.
I am sincerely concerned about the progress in medical field. Have you ever noticed that new medical procedures and other advances in medicine and pharmaceuticals no longer come from those countries that have national, or universal, or single payer governmental health care systems in place? That is because the government controls everything. And government and bureaucracy like strict rules, regulations and guidelines. There is no incentive to advance. Only remain within the "standard of care". Government established payments and reimbursements and price standards prevent any incentive to work harder or find new treatments etc. So the Dr's just run a conveyor belt system following the government established guidelines. nothing more, nothing less.
So if the government can save money by simply testing ONLY TSH and then minimally prescribing medication that keeps people from being treated at all, or sufficiently to relieve them of symptoms they don't care. They met the gov't guidelines and that is all they are required to do and there is no incentive to do an ounce more.
This is what we are facing. Next year it is going to really hit the USA. Businesses are now told that insurance rates ARE going to rise between 50% and 100% because of this legislation. This so that we can cover more people who could not afford medical insurance BEFORE these major increases in price. So it has all the indications that this will hurt more people than it ever helped. It appears that it is going to be a disaster. Many politicians, even co-authors/sponsors of the Obamacare bill are now calling this a train wreck about to happen. So I'm not sure what that all means. Other than unless something is done, and done fast. This could be a real mess in a real hurry.
"We know from studies in the heart as well as bench analysis that if the TSH is above 1, the thyroid function – its effects on different body tissues, is abnormal. Cardiac output, the ability of the heart to pump blood diminishes with a TSH above 1."
Anyone found the studies Dr Hieb is referring to?
45 million uninsured, 26 100 people aged 25 to 64 died for lack of health coverage in 2010 (72 deaths per day, 3 an hour), 62% of all personal bankruptcies due to medical bills....the train wreck happened years ago.
Anyone found the studies Dr Hieb is referring to?
45 million uninsured, 26 100 people aged 25 to 64 died for lack of health coverage in 2010 (72 deaths per day, 3 an hour), 62% of all personal bankruptcies due to medical bills....the train wreck happened years ago.
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