Aa
NEW AACE/ATA GUIDELINES
A position paper updating the AACE/ATA guidelines for endocrinologists in the treatment of hypothyroidism was released today. Seems not to have considered either the Danish or Italian studies on the benefits of T4/T3 therapy previously published in EJM, and published by NIH here in February. At least they suggest including symptoms in making a diagnosis. Interesting read, highly recommend. Here is the PDF link :
http://aace.metapress.com/content/b67v7mk73g3233n2/fulltext.pdf
http://aace.metapress.com/content/b67v7mk73g3233n2/fulltext.pdf
Apparently for hudreds of years before health insurance there was no care at all and nothing was done.
in fact most hospitals were started as a result of charity of church's. But when government got involved and insurance the hospitals and charity's etc were less and less involved and marginalized. People stopped giving money because they expected the government to take care of it.
Now religious based hospitals are required by government to offer care and procedures that are against their religion. Something that is the exact opposite of what the founders of our country and our constitution wanted.
The constitution only allowed the congress and the federal government 20 enumerated powers. When you tell me that healthcare is listed as one of those 20 powers I'll be happy to let the government have that authority.
The federal government is out of control. They are doing thousands of things that they are NOT supposed to be involved in. Health care is just one.
Fire and other governmental involvement is a state and local issue. EXACTLY the way the constitution wanted it to be. The "locals" who have more say, get to decide what they want to do about them. This is what a FEDERAL system is all about. The role of the central federal government was meant to be defined and limited. The rest left to the states and to the people.
Yes I would feel MUCH, MUCH, MUCH better if the true free market system and not the tortured anything but free market system we have now runs healthcare.
I'm now done and won't hijack or discuss this further as we are clearly not going to agree. Other than major changes need to be made. But going the government route is simply the wrong change. I have other ideas that would work I believe. But the big business's and big government people won't like them. That is why they won't get put into law because the politicians only answer to one of those two sides. Meanwhile the rest of us suffer.
in fact most hospitals were started as a result of charity of church's. But when government got involved and insurance the hospitals and charity's etc were less and less involved and marginalized. People stopped giving money because they expected the government to take care of it.
Now religious based hospitals are required by government to offer care and procedures that are against their religion. Something that is the exact opposite of what the founders of our country and our constitution wanted.
The constitution only allowed the congress and the federal government 20 enumerated powers. When you tell me that healthcare is listed as one of those 20 powers I'll be happy to let the government have that authority.
The federal government is out of control. They are doing thousands of things that they are NOT supposed to be involved in. Health care is just one.
Fire and other governmental involvement is a state and local issue. EXACTLY the way the constitution wanted it to be. The "locals" who have more say, get to decide what they want to do about them. This is what a FEDERAL system is all about. The role of the central federal government was meant to be defined and limited. The rest left to the states and to the people.
Yes I would feel MUCH, MUCH, MUCH better if the true free market system and not the tortured anything but free market system we have now runs healthcare.
I'm now done and won't hijack or discuss this further as we are clearly not going to agree. Other than major changes need to be made. But going the government route is simply the wrong change. I have other ideas that would work I believe. But the big business's and big government people won't like them. That is why they won't get put into law because the politicians only answer to one of those two sides. Meanwhile the rest of us suffer.
And back to the topic at hand...
Yes, I found it interesting that they admit that TSH fluctuates as much as 50% diurnally and that "...variations...within the normal range of up to 40%-50% do not necessarily reflect a change in thyroid status". Whoa! Yet they continue to use it as a gold standard. That's a pretty big margin of error...
Do you know who the first president was to advocate for universal health care? Stay out of this, Barb, because I know you know! Do you know the last time there was a serious effort to get it? I'll help you with this one...think Hillary. Can we afford another...what? 15-20 years of doing NOTHING?
What other essential service isn't under government control? Do you want your local fire department to be able to charge you whatever they want to save your house? Do you want your power company to raise rates at will? Do you want the SEC dismantled so bankers can have a real field day? Do you really think the government will be any worse than the insurance companies that are currently determining our care?
Competition? It works in some places. How does it work here in central Oregon? We have three hospitals, all owned by the same parent company (do you smell monopoly?), that service everyone from the Cascades to Idaho. Where's their competiotion going to come from???
Essential services are the domain of government. By their very definition, their cost is not subjet to free market pressures. When life or death issues are settled by the free market, a lot of people die. Can you live with that???
Yes, I found it interesting that they admit that TSH fluctuates as much as 50% diurnally and that "...variations...within the normal range of up to 40%-50% do not necessarily reflect a change in thyroid status". Whoa! Yet they continue to use it as a gold standard. That's a pretty big margin of error...
Do you know who the first president was to advocate for universal health care? Stay out of this, Barb, because I know you know! Do you know the last time there was a serious effort to get it? I'll help you with this one...think Hillary. Can we afford another...what? 15-20 years of doing NOTHING?
What other essential service isn't under government control? Do you want your local fire department to be able to charge you whatever they want to save your house? Do you want your power company to raise rates at will? Do you want the SEC dismantled so bankers can have a real field day? Do you really think the government will be any worse than the insurance companies that are currently determining our care?
Competition? It works in some places. How does it work here in central Oregon? We have three hospitals, all owned by the same parent company (do you smell monopoly?), that service everyone from the Cascades to Idaho. Where's their competiotion going to come from???
Essential services are the domain of government. By their very definition, their cost is not subjet to free market pressures. When life or death issues are settled by the free market, a lot of people die. Can you live with that???
COMMUNITY LEADER
"Government thru medicare reimbursement and insurance companies get to decide the prices."
I just received an EOB from my insurance company for my latest labs. They (insurance company) were billed for $800+, but they paid only $40. My labs are covered 100% by my insurance company, so the lab accepts what they get from my insurance. If Medicare and insurance were deciding the prices, we'd be able to pay for our own...... heck, I could afford to pay the $40 myself and wouldn't need insurance. But if I didn't have insurance, I'd be expected to pay the full $800+, which would make it impossible for me to have regular labs.
I have an elderly aunt on Medicare; I've actually got statements showing that Medicare paid more than they were billed for some things.
I'm not a fan of the health care act, for a couple of reasons, but I do agree with goolarra, that our system is very broken and something needs to be done to change it. Because we have the ACA, and we know (hope) that it will "evolve" as it goes along, we can only hope that it will turn out to be advantageous for most people.
Because of this AACE/ATA guideline, I do think that adequate treatment for thyroid patients will become harder to get, especially for those of us who don't fit into a box. That means, both myself and goolarra....... because she's comfortable with a TSH well above the normal limit, and I'm comfortable with a very suppressed TSH......... goes to show that TSH doesn't mean diddly squat.......
I just received an EOB from my insurance company for my latest labs. They (insurance company) were billed for $800+, but they paid only $40. My labs are covered 100% by my insurance company, so the lab accepts what they get from my insurance. If Medicare and insurance were deciding the prices, we'd be able to pay for our own...... heck, I could afford to pay the $40 myself and wouldn't need insurance. But if I didn't have insurance, I'd be expected to pay the full $800+, which would make it impossible for me to have regular labs.
I have an elderly aunt on Medicare; I've actually got statements showing that Medicare paid more than they were billed for some things.
I'm not a fan of the health care act, for a couple of reasons, but I do agree with goolarra, that our system is very broken and something needs to be done to change it. Because we have the ACA, and we know (hope) that it will "evolve" as it goes along, we can only hope that it will turn out to be advantageous for most people.
Because of this AACE/ATA guideline, I do think that adequate treatment for thyroid patients will become harder to get, especially for those of us who don't fit into a box. That means, both myself and goolarra....... because she's comfortable with a TSH well above the normal limit, and I'm comfortable with a very suppressed TSH......... goes to show that TSH doesn't mean diddly squat.......
The problem we have with the current "health care" system is that there is NO FREE market or competition in the system. We can not shop for prices the consumer has no say. It is the government or health insurance companies that primarily make all the decsions.
Insurance by and large is the problem.
A perfect example to see how the free market system and consumers and competitionworks in the medical field is in areas where the insurance companies do not cover the work.
Look at LASIK sye surgey and most plastic cosmetic surgery. Both insurance companies do no pay for. ANd with LASIK it used to cost many thousands of dollars PER EYE. But since the patient had a price to shop, the health care provideers and the makeers of the equipment etc to do the procedure DRAMATICALLY reduced the price of the procedure. Same thing in cosmetic surgery world. When patents get to price and competition between providers actually exist the price goes DOWN. Happens everywhere in every industry or marketplace.
But in healtcare we do NOT have this option. Government thru medicare reimbursement and insurance companies get to decide the prices. Many times we the consumer do not even have a clue how much a procedure costs. We just hand them our card (if we're lucky enough to have a card) and they charge to Medicare or to XYZ insurance company.
The current system is nothing more than a complex price fixing scam.
Anything the government touches they screw up. Medicare and Social security are bankrupt. Do you want these same band of bums telling us what medicine we can take and how much to reimburse Dr's?
When free market pressures are introduced prices go down. If the government gets more involved it will do the exact opposite.
Yes my wife and I have problems with the Drs and getting proper treatment. It is already bad enough with the government involvement such as it is now and the insurance companies that have fouled this up so bad. It is MORE likely that a one size all approach will result in government based anything. That is a fact based on every single bit of experience I've seen. And I work in and for government. One size fits all is all they know! We need LESS of it not more.
Insurance by and large is the problem.
A perfect example to see how the free market system and consumers and competitionworks in the medical field is in areas where the insurance companies do not cover the work.
Look at LASIK sye surgey and most plastic cosmetic surgery. Both insurance companies do no pay for. ANd with LASIK it used to cost many thousands of dollars PER EYE. But since the patient had a price to shop, the health care provideers and the makeers of the equipment etc to do the procedure DRAMATICALLY reduced the price of the procedure. Same thing in cosmetic surgery world. When patents get to price and competition between providers actually exist the price goes DOWN. Happens everywhere in every industry or marketplace.
But in healtcare we do NOT have this option. Government thru medicare reimbursement and insurance companies get to decide the prices. Many times we the consumer do not even have a clue how much a procedure costs. We just hand them our card (if we're lucky enough to have a card) and they charge to Medicare or to XYZ insurance company.
The current system is nothing more than a complex price fixing scam.
Anything the government touches they screw up. Medicare and Social security are bankrupt. Do you want these same band of bums telling us what medicine we can take and how much to reimburse Dr's?
When free market pressures are introduced prices go down. If the government gets more involved it will do the exact opposite.
Yes my wife and I have problems with the Drs and getting proper treatment. It is already bad enough with the government involvement such as it is now and the insurance companies that have fouled this up so bad. It is MORE likely that a one size all approach will result in government based anything. That is a fact based on every single bit of experience I've seen. And I work in and for government. One size fits all is all they know! We need LESS of it not more.
WOW! This mirrors my own thoughts.
After dealing with doctors that are stuck to the current system, after multiple tests that seem to be endlessly duplicated, after having my wallet drained by said testing (and I am fortunate to have good insurance), essentially..... nothing has been resolved. I really have a problem with the way our medical system works, or shouild I say doesn't work.
If I had my car serviced and had such crappy non results I would be screaming bloody murder.
Do something different!
After dealing with doctors that are stuck to the current system, after multiple tests that seem to be endlessly duplicated, after having my wallet drained by said testing (and I am fortunate to have good insurance), essentially..... nothing has been resolved. I really have a problem with the way our medical system works, or shouild I say doesn't work.
If I had my car serviced and had such crappy non results I would be screaming bloody murder.
Do something different!
I basically agree with all the above comments regarding the Guidelines. I'd love to tear it apart line by line, but I'll refrain. Can't wait to ask my endo what he thinks of it...
However, I do have to take exception to the comments about the Patient Protection and Affordable Care Act. We have a medical industry (aka health "care" system) that is on the brink of implosion, and we HAVE to START doing something about it NOW. Note I said START...it will be amended significantly (evolve). It's not the be-all and end-all, but we cannot afford to put it off any longer.
"...the USA will end up exactly like the other nations with universal healthcare." Which other nations do you refer to, flyingfool? Japan? Germany? U.K.? Switzerland? Their health plans are all very different, and they've generated very different problems for each country, but it's not like our system is problem free. You and your wife have had such a difficult time getting proper care here...how can you hang on so tenaciously to our current very broken system?
"The ONLY way you can add tens of millions of people onto the insurance roles without increasing costs with the same number of Dr's, is to cut service and ration care." Is it rationing care or rational care? Right now, we spend billions on one size fits all testing. People who need diagnostics aren't getting them, and people who don't are "just because you're 50" or whatever. A "one size fits all" approach is the rule NOW.
"One definition of insanity is doing the same thing over and over again and expecting different results. If we do the same thing as other national healthcare nations, we will certainly get similar results." I couldn't agree more, and if we keep doing what we've been doing up until now, we may indeed not get results similar to other countries', we may be the first to see our health care system crumble before our very eyes and live to envy those other countrries' results.
We already have rationing here. Many years ago, I was unable to get a replacement IUD in the States. IUDs had had their problems, and American doctors were told not to use them any more for fear of litigation. I went to Canada, and got my new IUD. The price was reasonable, the care good, excellent cooperation from the doctor's office, etc. That was probably 25 years ago...so who was suffering from "rationing"?
I think it's time to get our heads out of our American butts (hope that gets by the censors). Read about what other countries are doing. It's not all the same, it's very different. Do you we really think there aren't parts of each of those systems that works? It's time to act. What doesn't work will get fixed.
I'd recommend a couple of books, which are both informative and readable: "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," by T. R. Reid...the author takes his problem shoulder around the world and experiences the different health care systems' approaches to it (and, yes, there are night and day differences among them); and "How We Do Harm," by Otis Webb Brawley...explores the excesses and wastes of our current system (has mostly to do with cancer diagnosis and treatment, since he's an oncologist, but I think everyone will see where it applies to the medical field much more broadly).
However, I do have to take exception to the comments about the Patient Protection and Affordable Care Act. We have a medical industry (aka health "care" system) that is on the brink of implosion, and we HAVE to START doing something about it NOW. Note I said START...it will be amended significantly (evolve). It's not the be-all and end-all, but we cannot afford to put it off any longer.
"...the USA will end up exactly like the other nations with universal healthcare." Which other nations do you refer to, flyingfool? Japan? Germany? U.K.? Switzerland? Their health plans are all very different, and they've generated very different problems for each country, but it's not like our system is problem free. You and your wife have had such a difficult time getting proper care here...how can you hang on so tenaciously to our current very broken system?
"The ONLY way you can add tens of millions of people onto the insurance roles without increasing costs with the same number of Dr's, is to cut service and ration care." Is it rationing care or rational care? Right now, we spend billions on one size fits all testing. People who need diagnostics aren't getting them, and people who don't are "just because you're 50" or whatever. A "one size fits all" approach is the rule NOW.
"One definition of insanity is doing the same thing over and over again and expecting different results. If we do the same thing as other national healthcare nations, we will certainly get similar results." I couldn't agree more, and if we keep doing what we've been doing up until now, we may indeed not get results similar to other countries', we may be the first to see our health care system crumble before our very eyes and live to envy those other countrries' results.
We already have rationing here. Many years ago, I was unable to get a replacement IUD in the States. IUDs had had their problems, and American doctors were told not to use them any more for fear of litigation. I went to Canada, and got my new IUD. The price was reasonable, the care good, excellent cooperation from the doctor's office, etc. That was probably 25 years ago...so who was suffering from "rationing"?
I think it's time to get our heads out of our American butts (hope that gets by the censors). Read about what other countries are doing. It's not all the same, it's very different. Do you we really think there aren't parts of each of those systems that works? It's time to act. What doesn't work will get fixed.
I'd recommend a couple of books, which are both informative and readable: "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," by T. R. Reid...the author takes his problem shoulder around the world and experiences the different health care systems' approaches to it (and, yes, there are night and day differences among them); and "How We Do Harm," by Otis Webb Brawley...explores the excesses and wastes of our current system (has mostly to do with cancer diagnosis and treatment, since he's an oncologist, but I think everyone will see where it applies to the medical field much more broadly).
Barb you read my mind. I believe that if the health care act is not repealed or amended significantly, the USA will end up exactly like the other nations with universal healthcare.
The ONLY way you can add tens of millions of people onto the insurance roles without increasing costs with the same number of Dr's, is to cut service and ration care. Technology can make up for SOME of it. But not anything close to what would be needed. Thus rationed care is the ONLY practical way to achieve it. One sized fits all approach will be the rule, but we all know that each one of us is different and a one sized broad brush approach is the antithesis of what is needed/required in healthcare to meet patients needs.
And why would we really expect to have different results in the USA as other nations? People are people, diseases are diseases, and costs are costs. None of those things know, or are affected in any way by the language we speak or the denomination of currency we use! So of course we will experience the same results as those other nations.
One definition of insanity is doing the same thing over and over again and expecting different results. If we do the same thing as other national healthcare nations, we will certainly get similar results.
Canadians are lucky, they might be able to get some cash and come to the USA. But if we go the same health care way, where are we to go?????
The ONLY way you can add tens of millions of people onto the insurance roles without increasing costs with the same number of Dr's, is to cut service and ration care. Technology can make up for SOME of it. But not anything close to what would be needed. Thus rationed care is the ONLY practical way to achieve it. One sized fits all approach will be the rule, but we all know that each one of us is different and a one sized broad brush approach is the antithesis of what is needed/required in healthcare to meet patients needs.
And why would we really expect to have different results in the USA as other nations? People are people, diseases are diseases, and costs are costs. None of those things know, or are affected in any way by the language we speak or the denomination of currency we use! So of course we will experience the same results as those other nations.
One definition of insanity is doing the same thing over and over again and expecting different results. If we do the same thing as other national healthcare nations, we will certainly get similar results.
Canadians are lucky, they might be able to get some cash and come to the USA. But if we go the same health care way, where are we to go?????
COMMUNITY LEADER
Another thing we all have to keep in mind is that both AACE and ATA are organizations for doctors, not patients, though they do have some patient information. They set the standard of care and so long as the doctor has practiced within that standard, they've done their job.
I'm only speculating, here, but we should also keep in mind that we have a new health care act going into effect, soon and think how much much less expensive it will be if TSH is the only blood test to be run and levo is the only medication to be prescribed. I can't help wonder if we will be up against the same things our UK members are; we already see it some with patients that are on Medicaid, Medicare, military, etc. Just a thought.
I'm only speculating, here, but we should also keep in mind that we have a new health care act going into effect, soon and think how much much less expensive it will be if TSH is the only blood test to be run and levo is the only medication to be prescribed. I can't help wonder if we will be up against the same things our UK members are; we already see it some with patients that are on Medicaid, Medicare, military, etc. Just a thought.
In response or added comment to gimel's latest link I found this paragraph to be particularly interesting:
----
"The Guidelines are worded in a somewhat disingenuous way on this topic. There haven't been studies that compare levothyroxine only treatment, to treatment with natural desiccated thyroid drugs. So yes, there is no evidence to support their use. But there is no evidence that demonstrates that levothyroxine-only treatment is superior to natural desiccated thyroid. Several million prescriptions for natural desiccated thyroid are written each year, and the number of patients taking these drugs, and practitioners prescribing them, is on the rise. Many patients report anecdotally that they feel better on a natural desiccated thyroid, compared to levothyroxine, and there are a number of practitioners who have found natural desiccated thyroid effective with a subset of their patients. Unfortunately, the Guidelines, in dismissing use of T3 and natural thyroid drugs, without any research that proves the alternative to be superior, is maintaining a status quo that is not serving some patients with hypothyroidism"
-----
Along with this interesting statement note especially the last sentence in parentheses!!!!!
"Who were the authors? The task force includes some of the most well-known, but old-school, conservative endocrinologists, including Jeffrey Garber, Rhoda Cobin, Hossein Gharib, Peter Singer and others. (It is worth noting that some of the task force members have in the past had financial ties to the thyroid drug Synthroid, and seem to take turns running the various thyroid-related professional organizations in recent years.)"
Humm.
A panel of Dr's on the payroll (or were on) of a drug manufacturer all reach consensus that the "superior" treatment is with the exact same medication they are being paid by the manufacturers who make it..
Nope, no problem here, move along mindless chattel, move along! Pay no attention to the man behind the curtain!
UNBELIEVABLE!
----
"The Guidelines are worded in a somewhat disingenuous way on this topic. There haven't been studies that compare levothyroxine only treatment, to treatment with natural desiccated thyroid drugs. So yes, there is no evidence to support their use. But there is no evidence that demonstrates that levothyroxine-only treatment is superior to natural desiccated thyroid. Several million prescriptions for natural desiccated thyroid are written each year, and the number of patients taking these drugs, and practitioners prescribing them, is on the rise. Many patients report anecdotally that they feel better on a natural desiccated thyroid, compared to levothyroxine, and there are a number of practitioners who have found natural desiccated thyroid effective with a subset of their patients. Unfortunately, the Guidelines, in dismissing use of T3 and natural thyroid drugs, without any research that proves the alternative to be superior, is maintaining a status quo that is not serving some patients with hypothyroidism"
-----
Along with this interesting statement note especially the last sentence in parentheses!!!!!
"Who were the authors? The task force includes some of the most well-known, but old-school, conservative endocrinologists, including Jeffrey Garber, Rhoda Cobin, Hossein Gharib, Peter Singer and others. (It is worth noting that some of the task force members have in the past had financial ties to the thyroid drug Synthroid, and seem to take turns running the various thyroid-related professional organizations in recent years.)"
Humm.
A panel of Dr's on the payroll (or were on) of a drug manufacturer all reach consensus that the "superior" treatment is with the exact same medication they are being paid by the manufacturers who make it..
Nope, no problem here, move along mindless chattel, move along! Pay no attention to the man behind the curtain!
UNBELIEVABLE!
Hi - thanks for posting the link to it directly. I will update my post and health page for this one: http://aace.metapress.com/content/b67v7mk73g3233n2/fulltext.pdf
Ran across these comments today about the guidelines. Pretty sad state of affairs.
http://thyroid.about.com/od/gettestedanddiagnosed/a/2012-Hypothyroidism-Guidelines-Cause-Controversy.htm
One of the best of the critical comments was this one.
"Reliance on the TSH test -- and exclusion of the Free T3 test -- also ignores the fact that T3 is the active thyroid hormone at the cellular level. Adequate T3 levels require sufficient levels of circulating T4, as well as effective conversion of T4 to T3 in the thyroid gland and peripheral tissues. Integrative practitioners typically measure Free T4 and Free T3 in order to assess the levels of circulating hormone, and assess whether conversion is effective, and seek to optimize the hypothyroidism treatment, using these levels in addition to the TSH test."
http://thyroid.about.com/od/gettestedanddiagnosed/a/2012-Hypothyroidism-Guidelines-Cause-Controversy.htm
One of the best of the critical comments was this one.
"Reliance on the TSH test -- and exclusion of the Free T3 test -- also ignores the fact that T3 is the active thyroid hormone at the cellular level. Adequate T3 levels require sufficient levels of circulating T4, as well as effective conversion of T4 to T3 in the thyroid gland and peripheral tissues. Integrative practitioners typically measure Free T4 and Free T3 in order to assess the levels of circulating hormone, and assess whether conversion is effective, and seek to optimize the hypothyroidism treatment, using these levels in addition to the TSH test."
COMMUNITY LEADER
"The website to which your responder cites is NOT a credible source. It is at least tertiary information." Is this a referral to the website I used?
Michelle is basing her statement on the following sources. She has given me permission to paste them here. I am not trying to say who is right or wrong, but if she is correct and the AACE standard of .3 - 3.0 if for those who are ON medication and not for diagnosis of a problem, perhaps it explains the widely differing ranges used by various labs. Again, these are just points of information up for discussion.
(Michelle) : Again, I am standing by my research and stating that in 2003 the AACE made a press release & recommendation https://docs.google.com/file/d/10mrJI7qw0wQph3hG32krK4RwXdzzCQDk1jBq6khBG9QlXeFz38rjMMAombBL/edit
but you can see by this newletter AFTER the conference that the ranges did not hold up :https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1.1&thid=1394a5fa89bef8d0&mt=application/pdf&url=https://mail.google.com/mail/u/0/?ui%3D2%26ik%3D2b5e81f6e7%26view%3Datt%26th%3D1394a5fa89bef8d0%26attid%3D0.1.1%26disp%3Dsafe%26zw&sig=AHIEtbTva8DFIuKv2xduYuH__wgwY4GLZA
Here are the AACE recommendation that has been updated as of 2006 https://www.aace.com/files/hypo-hyper.pdf
The website to which your responder cites is NOT a credible source. It is at least tertiary information.
(I have no idea if it is or if it isn't and am not looking for an argument. I am just bringing it up, not taking a position)
(Michelle) : Again, I am standing by my research and stating that in 2003 the AACE made a press release & recommendation https://docs.google.com/file/d/10mrJI7qw0wQph3hG32krK4RwXdzzCQDk1jBq6khBG9QlXeFz38rjMMAombBL/edit
but you can see by this newletter AFTER the conference that the ranges did not hold up :https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1.1&thid=1394a5fa89bef8d0&mt=application/pdf&url=https://mail.google.com/mail/u/0/?ui%3D2%26ik%3D2b5e81f6e7%26view%3Datt%26th%3D1394a5fa89bef8d0%26attid%3D0.1.1%26disp%3Dsafe%26zw&sig=AHIEtbTva8DFIuKv2xduYuH__wgwY4GLZA
Here are the AACE recommendation that has been updated as of 2006 https://www.aace.com/files/hypo-hyper.pdf
The website to which your responder cites is NOT a credible source. It is at least tertiary information.
(I have no idea if it is or if it isn't and am not looking for an argument. I am just bringing it up, not taking a position)
Always good to bring new reading material to the table! :) Helpful eyes to keep the flow. :)
COMMUNITY LEADER
"In November 2002, AACE published revised guidelines that provided a new range for normal thyroid function. Until this time, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. AACE encouraged doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in improved accuracy of diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated."
http://www.endocrinology-online.com/Content/For%20Patients/TSH.htm
http://www.endocrinology-online.com/Content/For%20Patients/TSH.htm
Yes it is off target in my opinion, still mostly mired in T4 only therapy and the supremacy of TSH. I wrote an email to the AACE media relations contact asking why they had ignored the Danish and Italian studies asserting that T3?T4 is necessary for some patients.
I didn't mean to berate anybody, I just think that since we all seem to have so much trouble getting proper treatment from endocrinologists, it was important to know what standards they are setting for the profession so that we could continue to advocate for ourselves and all thyroid patients.
Interestingly enough, someone over on Thyroid Change's Facebook page noted that we may have been operating under a false assumption about ATA/AACE recommended TSH range. After reading their literature, Michelle Bickford stated that the .3 - 3.0 range we .....or at least I...thought was their latest updated range was actually something that was mentioned in a speech at one of their conferences as being recommended and something to discuss further, but was never actually codified by the organizations. Their official position is still .5 - 5.0 at best. Very discouraging.
Anyway, I also protested on the AACE Facebook page, as did a number of others. Last I looked, in just a few months,over 5000 people internationally have signed the Thyroid Change petition demanding better care from endocrinologists, based on patient experience that differs widely in success from what could be expected from their "standard of care."
I didn't mean to berate anybody, I just think that since we all seem to have so much trouble getting proper treatment from endocrinologists, it was important to know what standards they are setting for the profession so that we could continue to advocate for ourselves and all thyroid patients.
Interestingly enough, someone over on Thyroid Change's Facebook page noted that we may have been operating under a false assumption about ATA/AACE recommended TSH range. After reading their literature, Michelle Bickford stated that the .3 - 3.0 range we .....or at least I...thought was their latest updated range was actually something that was mentioned in a speech at one of their conferences as being recommended and something to discuss further, but was never actually codified by the organizations. Their official position is still .5 - 5.0 at best. Very discouraging.
Anyway, I also protested on the AACE Facebook page, as did a number of others. Last I looked, in just a few months,over 5000 people internationally have signed the Thyroid Change petition demanding better care from endocrinologists, based on patient experience that differs widely in success from what could be expected from their "standard of care."
I'll read through it but in truth, what I've seen it still way off target. It's still a bias judgement that TSH is the tell-all which is far from positive patient response to proper treatment.
That is one looong article. I loaded it into my WP and stripped it of all the "junk", and it's still 32 pages long to the printer. I don't read anything that long on the screen any more. So, I plan to not only read it, but pore over it, but make no time promises. Life does, indeed, intervene at times (thankfully, in some cases!). Thanks for the link.
COMMUNITY LEADER
Just because no one has commented, doesn't mean we haven't looked at it. "Life" takes over now and then and we don't all have time to stay turned to the forum. I went to the link and downloaded the pdf, but have not had time to read it, thoroughly yet, therefore, my ability to comment is limited.
"You can't play the game if you don't know the rules". From the little bit I saw, and from what you say, it doesn't sound like they changed the rules a whole lot, so I'm not sure I've missed too terribly much, especially considering that most doctors aren't going to pay any more attention to this than they did to changing the TSH reference range to 0.3-3.0, more than 10 yrs ago.
"You can't play the game if you don't know the rules". From the little bit I saw, and from what you say, it doesn't sound like they changed the rules a whole lot, so I'm not sure I've missed too terribly much, especially considering that most doctors aren't going to pay any more attention to this than they did to changing the TSH reference range to 0.3-3.0, more than 10 yrs ago.
BUMP.
I'm a little surprised that no one but Gimel has seemed to have read or commented on this. This document defines the ways you can expect to be treated by your endocrinologist here in the US...The new standards issued jointly by The American Thyroid Association and The American Association of Clinical Endocrinologists.
You can't play the game if you don't know the rules. The treatment protocol is still biased against T3 and blahblahblah about the TSH test, but does caution endos to regard patients symptoms and speaks about other types of hypothyroidism than those diagnosed by just high TSH. And regarding TSH, while they continue to refer to the high end of the range as TEN !!!, if you read further they actually say that there is evidence that the range should be narrowed, with a top range of 2.5 to perhaps be expected soon, and that labs currently are using 4.5 or lower for the range.
As we all know, our doctors are often sadly behind current research and are pig-headed if you challenge them about it. With the issuance of this document, at the very least you can take it to your doctor and insist that your symptoms are valid and need attention. I suspect that pressure from patients like us and, perhaps, from the petition from ThyroidChange.org and the like are FORCING the endocrine medical profession to acknowledge (however backhandedly) their lapse in updating their standards and the suffering it has caused patients.
I find their stance on T4/T3 therapy retarded, especially in light of the Danish and Italian studies that specifically refute the one done at UCLA and disparage its clinical protocol. They really cannot do that any longer, since both of those studies have now been published by NIH. But sweeping policy changes at the level of the accrediting organizations, like this one, are long in coming and not produced over night. It is possible that their doctors were not aware of the NIH position when this document was prepared for issuance. We need to bombard the AACE and the ATA with those studies so that their position can be updated regarding T4/T3 therapies. We patients and our subjective experiences DO finally seem to be influencing the practice of the profession, if only the ENDOCRINOLOGISTS will read the standards set for them by their accrediting organizations. The document doesn't go NEARLY far enough, but it's better than what we have been dealing with.
Stay informed. Stay vigilant. I recommend that you at least bookmark this document.
I'm a little surprised that no one but Gimel has seemed to have read or commented on this. This document defines the ways you can expect to be treated by your endocrinologist here in the US...The new standards issued jointly by The American Thyroid Association and The American Association of Clinical Endocrinologists.
You can't play the game if you don't know the rules. The treatment protocol is still biased against T3 and blahblahblah about the TSH test, but does caution endos to regard patients symptoms and speaks about other types of hypothyroidism than those diagnosed by just high TSH. And regarding TSH, while they continue to refer to the high end of the range as TEN !!!, if you read further they actually say that there is evidence that the range should be narrowed, with a top range of 2.5 to perhaps be expected soon, and that labs currently are using 4.5 or lower for the range.
As we all know, our doctors are often sadly behind current research and are pig-headed if you challenge them about it. With the issuance of this document, at the very least you can take it to your doctor and insist that your symptoms are valid and need attention. I suspect that pressure from patients like us and, perhaps, from the petition from ThyroidChange.org and the like are FORCING the endocrine medical profession to acknowledge (however backhandedly) their lapse in updating their standards and the suffering it has caused patients.
I find their stance on T4/T3 therapy retarded, especially in light of the Danish and Italian studies that specifically refute the one done at UCLA and disparage its clinical protocol. They really cannot do that any longer, since both of those studies have now been published by NIH. But sweeping policy changes at the level of the accrediting organizations, like this one, are long in coming and not produced over night. It is possible that their doctors were not aware of the NIH position when this document was prepared for issuance. We need to bombard the AACE and the ATA with those studies so that their position can be updated regarding T4/T3 therapies. We patients and our subjective experiences DO finally seem to be influencing the practice of the profession, if only the ENDOCRINOLOGISTS will read the standards set for them by their accrediting organizations. The document doesn't go NEARLY far enough, but it's better than what we have been dealing with.
Stay informed. Stay vigilant. I recommend that you at least bookmark this document.
Thanks for the link, I had been told that this was forthcoming for well over a year. First impression is that they have opened the door for more treatment based on clinical presentation of symptoms by the patient. Going to take a lonnnnng time to adequately study this. From the length, it looks like they protected themselves in every aspect of their diagnosing and treatment.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
