British endocrinologists agree with Canadian thyroid patient

thyroidpatientsca

5 years ago

British Endocrinologists agree with

PRESS RELEASE: “Society for Endocrinology & British Thyroid Association issue statement against new treatment recommendations for subclinical hypothyroidism”

On May 24th, my “rapid response letter” was published on the British Medical Journal website. I was responding to newly published recommendations: https://www.bmj.com/content/365/bmj.l2006/rr-6

On May 29th, Several points in this joint statement by the SfE & BTA echo my letter’s content.

I’m not claiming that I influenced them, but they agreed with several of my letter’s points 5 days after my letter was published. We are on the same wavelength.

1. I WROTE:

“I believe “false-negatives” will genuinely suffer without appropriate therapy if they are over 30 and not pregnant. A person is a false negative when they are denied the diagnosis and therapy for overt hypothyroidism because they are miscategorized as subclinical.”

THEN SfE & BTA WROTE:

“A particular concern about the strong conclusion and high TSH threshold for intervention in this meta-analysis is that primary care physicians may now dismiss patients with subclinical hypothyroidism rather than institute ongoing surveillance, potentially resulting in some patients with progression of hypothyroidism being deprived of treatment.”

2. I WROTE:

“The 21-item review by Feller et al, 2018 said quite explicitly in their “Limitations” section that because only 2 of the 21 studies focused on people with TSH higher than 10, the findings of their review “may not be generalizable to people with subclinical hypothyroidism and a [TSH] level higher than 10 mIU/L.” Therefore, why didn’t the guidelines keep the TSH subclinical / clinical boundary at 10 mIU/L?”

THEN SfE & BTA WROTE:

“Furthermore, with the degree of TSH elevations in the studies contained in this meta-analysis being modest, we contend that their recommendations based on a TSH cut off of >20 mIU/l go beyond the scope of the available primary data.”

3. I WROTE:

“But there are ways to improve diagnosis, starting with symptoms.”

“Clinical scoring guides may detect hypothyroidism when TSH and T4 alone would place people in an expanding gray area of uncertain diagnosis. In 2003, research confirmed the usefulness of a 1997 clinical score for hypothyroidism…”

THEN SfE & BTA WROTE:

“Such studies should … use more sensitive and specific thyroid symptom measures (e.g. THYPRO) to assess outcome.”

[NOTE: See a journal article about THYPRO https://academic.oup.com/jcem/article/99/10/3708/2836423%5D

4. I WROTE:

“My main concern with the new guidelines is for the health of patients who are truly hypothyroid despite TSH and T4 levels that place them within the now broader subclinical hypothyroidism category.”

“In 2011, a review of thyroid clinical scoring scales reaffirmed their continued relevance for diagnosis. (12) The research found that TSH did not strongly correlate with signs of “tissue hypothyroidism” throughout the body.”

“… ankle reflex response, total cholesterol, and creatine kinase significantly correlated with T4 and T3 levels. (11)”

THEN SfE & BTA WROTE:

“Since TSH and FT4 levels may not reflect thyroid status of peripheral tissues, further work is needed to develop better markers of tissue hypothyroidism and include these in future trials.”