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Immaculate TSH/ Reference Range Endocrinology
I have started this new thread in order to keep this discussion from interfering with other members' threads. This is in response to moonlight0.
Well, that is good. I suspected that you might be in the medical field. Understand, that none of what I have said was intended to do anything other than to get you to question your "Immaculate TSH Belief" and your use of "Reference Range Endocrinology". We do that because of our personal experiences and that of the thousands of members on the Forum.
The reason that the majority are members here in the first place is that they have been unsuccessful in getting adequately treated by their doctors and are still suffering with hypo symptoms. The reason for that is that their doctors had a similar approach to what you currently believe is correct. As fellow members we always question anyone who posts recommendations that we have found not to work for our members and also recommendations that are in conflict with voluminous scientific data that we search for and post on an ongoing basis.
So let me suggest to you that you keep an open mind and we will provide reams of statistically valid scientific data that support what we say about treatment of hypothyroidism. On the other hand we ask that if you are going to continue to post here and say the same things about TSH and reference ranges, then it is incumbent on you to provide supporting scientific data for that. Otherwise, it will be a waste of all of our time, since just continuing to post the same things about TSH and reference range endocrinology is not going to impress anyone here.
What I am asking you to do is to stop and question what you have been taught about TSH and the thyroid test Reference Ranges, and ask how you can really be sure that is correct. For example, here is a direct quote from a site about thyroid issues.
"The overwhelming majority of physicians rely on what they have learned in medical school and on consensus statements by medical societies, such as the Endocrine Society, the American Association of Clinical Endocrinologists or the American Thyroid Association, to direct treatment decisions. Historically, relying on a consensus statement to treat or not to treat a particular patient has been shown to result in poor care and, as such, society consensus statements and practice guidelines are considered to be worst level of evidence in support of a particular therapy or treatment."
So, what proof is there that TSH should be the definitive test for thyroid issues? Since we are trying to fix patient symptoms, what proof is there that TSH levels correlate with hypo symptoms? None that I can find. What proof is there that TSH even correlates well with Free T3, or Free T4. The best data that I can find show an inadequate correlation of TSH to Free T4, and even worse for Free T3.
I could go on with this, but unless you are in agreement to suspend disbelief and consider scientific data that we can provide, and for you to provide scientific study data to try and convince us of the validity of your own current beliefs, then we are both wasting our time. So it is up to you from here.
Well, that is good. I suspected that you might be in the medical field. Understand, that none of what I have said was intended to do anything other than to get you to question your "Immaculate TSH Belief" and your use of "Reference Range Endocrinology". We do that because of our personal experiences and that of the thousands of members on the Forum.
The reason that the majority are members here in the first place is that they have been unsuccessful in getting adequately treated by their doctors and are still suffering with hypo symptoms. The reason for that is that their doctors had a similar approach to what you currently believe is correct. As fellow members we always question anyone who posts recommendations that we have found not to work for our members and also recommendations that are in conflict with voluminous scientific data that we search for and post on an ongoing basis.
So let me suggest to you that you keep an open mind and we will provide reams of statistically valid scientific data that support what we say about treatment of hypothyroidism. On the other hand we ask that if you are going to continue to post here and say the same things about TSH and reference ranges, then it is incumbent on you to provide supporting scientific data for that. Otherwise, it will be a waste of all of our time, since just continuing to post the same things about TSH and reference range endocrinology is not going to impress anyone here.
What I am asking you to do is to stop and question what you have been taught about TSH and the thyroid test Reference Ranges, and ask how you can really be sure that is correct. For example, here is a direct quote from a site about thyroid issues.
"The overwhelming majority of physicians rely on what they have learned in medical school and on consensus statements by medical societies, such as the Endocrine Society, the American Association of Clinical Endocrinologists or the American Thyroid Association, to direct treatment decisions. Historically, relying on a consensus statement to treat or not to treat a particular patient has been shown to result in poor care and, as such, society consensus statements and practice guidelines are considered to be worst level of evidence in support of a particular therapy or treatment."
So, what proof is there that TSH should be the definitive test for thyroid issues? Since we are trying to fix patient symptoms, what proof is there that TSH levels correlate with hypo symptoms? None that I can find. What proof is there that TSH even correlates well with Free T3, or Free T4. The best data that I can find show an inadequate correlation of TSH to Free T4, and even worse for Free T3.
I could go on with this, but unless you are in agreement to suspend disbelief and consider scientific data that we can provide, and for you to provide scientific study data to try and convince us of the validity of your own current beliefs, then we are both wasting our time. So it is up to you from here.
I would be very interested in learning about the algorithm you mentioned. Also, I totally agree that there are some doctors that do not take enough time to listen to patients and understand what is going on. I would also be very interested in knowing how you decide when your patients are euthyroid.
In treating a patient, isn't the most important consideration relieving symptoms, so that the patient feels well? Since Free T3 creates biological activity at the cellular level, and largely regulates metabolism and many other body functions, wouldn't that mean that Free T3 needs to be at a level that is adequate to relieve hypothyroid symptoms?
In treating a patient, isn't the most important consideration relieving symptoms, so that the patient feels well? Since Free T3 creates biological activity at the cellular level, and largely regulates metabolism and many other body functions, wouldn't that mean that Free T3 needs to be at a level that is adequate to relieve hypothyroid symptoms?
There is established algorithm for assesing thyroid function, not only TSH measurement, of course.
But I think that some other problem is there-some doctors do not pay enough attention to his patients.Every patients is uniqe person and has to be managed at this way.That means if patients hormons are at euthyroid level and she/he has further disturbing simptoms it would be nedeed furter investigatios to find out what is wrong and what can be done.Just those simptoms are not caled "hypo" anymore.Simptoms of hyper or hypotthyroidism are not uniqe for thyroid disease only, but do ocure at other states and diseases (that is why we need objective measurements).Furthermore some patiens, especially younger ones, have litle if anny symptoms, even floridely hyperthyroid. On the other hand, you can not blame thyroid for every simptom.That is the reason why we need diagnostic and therapeutic algorhytms with unified approach for every patients.
As regards "my current beliefs", those are facts that I learned in medical school,and I do not need to "aprove" or convince someone (everybody has right for own opinion).
But I find certanly dangerous to convince someone to raise substitution therapy if she/he needs for example, psychiatric examination.
But I think that some other problem is there-some doctors do not pay enough attention to his patients.Every patients is uniqe person and has to be managed at this way.That means if patients hormons are at euthyroid level and she/he has further disturbing simptoms it would be nedeed furter investigatios to find out what is wrong and what can be done.Just those simptoms are not caled "hypo" anymore.Simptoms of hyper or hypotthyroidism are not uniqe for thyroid disease only, but do ocure at other states and diseases (that is why we need objective measurements).Furthermore some patiens, especially younger ones, have litle if anny symptoms, even floridely hyperthyroid. On the other hand, you can not blame thyroid for every simptom.That is the reason why we need diagnostic and therapeutic algorhytms with unified approach for every patients.
As regards "my current beliefs", those are facts that I learned in medical school,and I do not need to "aprove" or convince someone (everybody has right for own opinion).
But I find certanly dangerous to convince someone to raise substitution therapy if she/he needs for example, psychiatric examination.
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