Help me with my wifes' cycle.

[CBS]

You should have read my post. Had you, you would know that her TSH is 4.8. Hamlton, posits treatment at 4 U/I.

AACE made the decision to narrow the range because of data suggesting many people may have low-level thyroid problems that could be improved with treatment and a narrower TSH range will give doctors reason to more carefully consider those patients.

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high - particularly since it is a condition that is easy to diagnose and treat," (Gharib, 2000). "The new TSH range (.3-3 U/I) from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

The AACE urges physicians to come into the 21st century in terms of its awareness that the outdated TSH reference range needed revisiting. But this acknowledgement of what patients and some enlightened practitioners have known for years is just a first step toward a far greater awareness that is needed.(Gharib, president o the AACE).


Many family doctors, general practitioners and even endocrinologists have absolutely no idea about these new guidelines from the AACE, and are still routinely denying diagnosis and treatment to patients who have TSH levels that fall in the level between 3.0 and 5.0, or between .1 and .3. (Shoman)

PC, I wish you would learn to cite properly. It's difficult to know when you are writing and who and what you are quoting.


That said, I read your post. More importantly, I'm familiar with the arguments you are making.
Your reliance on blogs like Mary Shoman at about.com indicates someone who fails to know the literature.

Your assertion that Hamilton "posits treatment at 4 mU/l" is baseless. Hamilton makes no such recommendation. The purpose of his paper was to analyze the TSH distrubution in a population with no evidence of thyroid disease. Regardless, no responsible physician would suggest thyroid replacement therapy is indicated with a thyrotropin concentration of 4 without biochemical evidence of low serum T4.



It is clear that you not only failed to read the study, but you failed to even read the abstract. If you had, you would know Hamilton has concerns the AACE guidelines you referenced will result in inappropriate T4 therapy of euthyroid individuals.

"Our primary concern with decreasing the TSH upper limit to 2.5 μIU/mL (or even 3.0, as suggested by the American Association of Clinical Endocrinologists) is that data from NHANES III and our study show that 10–20% of individuals without apparent thyroid disease have TSH levels above 2.5 μIU/mL. Because it is unlikely that all of these individuals have occult thyroid disease, we think a higher upper limit near 4.0 is less likely to result in inappropriate T[SUB]4[/SUB] therapy of euthyroid individuals."
​

J Clin Endocrinol Metab. 2008 Apr;93(4):1224-30. Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism.
Hamilton TE[SUP]1[/SUP], Davis S, Onstad L, Kopecky KJ.

Abstract

CONTEXT: The current debate regarding whether to decrease the upper limit for the TSH reference range to 2.5 microIU/ml has considerable potential impact on the diagnosis and treatment of subclinical hypothyroidism worldwide.

OBJECTIVE: We report an analysis of TSH distribution in a population with no evidence of thyroid disease, including a normal thyroid ultrasound.

DESIGN: A subset of the Hanford Thyroid Disease Study cohort was used to examine the TSH distribution in a population having no evidence of thyroid disease, seronegative thyroid autoantibodies, no history of thyroid medications, and a normal thyroid ultrasound. The shape of the TSH distribution was compared with the Gaussian and lognormal distributions.

SETTING: This study was performed in the general community.

PARTICIPANTS: Of 1861 Hanford Thyroid Disease Study participants with TSH measured by ELISA who also had thyroid peroxidase antibody measurements, 766 comprised the normal reference group 3 (NRG-3) with no evidence of thyroid disease, including no positive antibodies and normal thyroid ultrasound.

MAIN OUTCOME MEASURE: TSH was measured.

RESULTS: The TSH distribution in the NRG (NRG-3) was right skewed and followed an approximate lognormal distribution. The best estimates of the 97.5th percentile, the percentage above 2.5 microIU/ml, and the percentage above 3.0 microIU/ml for TSH by 3rd generation immunochemiluminometric assay are 4.1 microIU/ml, 20% and 10.2%, respectively.

CONCLUSION: These results indicate that the TSH reference range should be narrowed and support a value of approximately 4.0 as the upper-reference limit.

 

[Dr_jitsu]

Comments in BOLD

PC, I wish you would learn to cite properly. It's difficult to know when you are writing and who and what you are quoting.

Really? When I am quoting, I use something called quotation marks. Look into them.


That said, I read your post. More importantly, I'm familiar with the arguments you are making.
Your reliance on blogs like Mary Shoman at about.com indicates someone who fails to know the literature.

So, reading a blog/internet source=a lack of comprehension? If that is you argument, we should not listen to or rely upon anything you say since it equals failure. Oh the hypocrisy.

Your assertion that Hamilton "posits treatment at 4 mU/l" is baseless. Hamilton makes no such recommendation. Read the conclusion, you are embarrasing yourself.

Hamilton: CONCLUSION: These results indicate that the TSH reference range should be narrowed and support a value of approximately 4.0 as the upper-reference limit.



It is clear that you not only failed to read the study, but you failed to even read the abstract. If you had, you would know Hamilton has concerns the AACE guidelines you referenced will result in inappropriate T4 therapy of euthyroid individuals.

"Our primary concern with decreasing the TSH upper limit to 2.5 μIU/mL (or even 3.0, as suggested by the American Association of Clinical Endocrinologists) is that data from NHANES III and our study show that 10–20% of individuals without apparent thyroid disease have TSH levels above 2.5 μIU/mL. Because it is unlikely that all of these individuals have occult thyroid disease, we think a higher upper limit near 4.0 is less likely to result in inappropriate T[SUB]4[/SUB] therapy of euthyroid individuals."

Are you trying to convince anyone that one study refutes the consensus of a large professional body of many, many endocrinologists? If so, please stop. If you added together all the members and their collective years of specialization, it carries a bit more heft than this study.
​

 

[CBS]

Comments in BOLD

Really? When I am quoting, I use something called quotation marks. Look into them.

Really? While one would expect someone "claiming" to hold a PhD would know enough to do just that, I see no quotation marks around this passage:

AACE made the decision to narrow the range because of data suggesting many people may have low-level thyroid problems that could be improved with treatment and a narrower TSH range will give doctors reason to more carefully consider those patients.

That quote was lifted directly from Shomon's about.com article. http://thyroid.about.com/cs/testsforthyroid/a/newrange.htm

The only conclusion that can be drawn from your omission is that you either "forgot" to use quotation marks OR you intentionally plagiarized it. So which is it, PC?

So, reading a blog/internet source=a lack of comprehension? If that is you argument, we should not listen to or rely upon anything you say since it equals failure. Oh the hypocrisy.

Exactly. I'm not expecting nor asking for anyone to "listen to or rely upon anything I say." That is why I've supported my argument with scientific evidence, not plagiarized blog opinion pieces.

Read the conclusion, you are embarrasing yourself.

Hamilton: CONCLUSION: These results indicate that the TSH reference range should be narrowed and support a value of approximately 4.0 as the upper-reference limit.

You plagiarized Shomon and I AM the one embarrassing myself?

Regardless, show me where Hamilton "posits treatment at 4 mU/l in that conclusion. [Hint: it's not there]

Are you trying to convince anyone that one study refutes the consensus of a large professional body of many, many endocrinologists? If so, please stop. If you added together all the members and their collective years of specialization, it carries a bit more heft than this study.
​

One study? Hardly. I can post studies all day long to refute the AACE's guidelines. I will refrain from doing so to spare the good TID members from having to wade through page after page of esoteric jargon. It's unnecessary anyway. You've provided ample evidence to show you are as full of shit at TID as you are at Meso.


Regards

CBS

 

[Dr_jitsu]

This will be my last post on this thread. You follow me around from board to board from thread to thread like a lovesick puppy dog. I got the info from the awesome ladies here, and from some men who had experience training women.

Based upon their results and my analysis, the program was set up long before you polluted the thread with you incessant nattering. Please stop. It is extremely rude, not only to me, but to other members of this board to go around calling people full of shit. The members here are mostly competitive athletes, or at least hard core athletes. The women here have been wonderful to me. We have exchanged a lot of PM's, ANd I have learned a lot from them. We PM for exactly the sort of problem you bring, and that is putting your own sad agenda ahead of anything else.

Please go back to MESO. You only come here because of me, and frankly your homoerotic obsession is more than creepy. I know you are dying to get into some open source debate (you hate my source) but that i not allowed here, and I do not discuss my sources in either the open forum or PM's.

In regards to my wife, she is now in the process of buying all new clothes since her existing wardrobe is now too large. We are both ecstatic, and I am very proud of her.

 

[CBS]

This will be my last post on this thread. You follow me around from board to board from thread to thread like a lovesick puppy dog. I got the info from the awesome ladies here, and from some men who had experience training women.

Based upon their results and my analysis, the program was set up long before you polluted the thread with you incessant nattering. Please stop. It is extremely rude, not only to me, but to other members of this board to go around calling people full of shit. The members here are mostly competitive athletes, or at least hard core athletes. The women here have been wonderful to me. We have exchanged a lot of PM's, ANd I have learned a lot from them. We PM for exactly the sort of problem you bring, and that is putting your own sad agenda ahead of anything else.

Please go back to MESO. You only come here because of me, and frankly your homoerotic obsession is more than creepy. I know you are dying to get into some open source debate (you hate my source) but that i not allowed here, and I do not discuss my sources in either the open forum or PM's.

In regards to my wife, she is now in the process of buying all new clothes since her existing wardrobe is now too large. We are both ecstatic, and I am very proud of her.

How someone who has supposedly earned a PhD would consider a substantive evidence based discussion "incessant nattering" and then resort to ad hominem attacks is beyond comprehension.

Regardless, it is my hope that my posts in this thread have helped the good members here understand there are very serious health risks associated with LONG TERM thyroid hormone abuse.

Congratulations on your wife's achievements. She should be very proud.

Regards

CBS