Editorials

Thyroid function tests and hypothyroidism

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.295 (Published 08 February 2003) Cite this as: BMJ 2003;326:295

Patient co-operation begins with clarity

Whilst beginning with a strong backlash against the 'rogue medical
professionals' and almost certainly the self-diagnosing internet browsing
patients, the article makes a strong case for TSH testing as a basis of
diagnosis. However...

Medical professionals must have guidelines in which to work, and base
their decisions upon. Patients, such as myself, understand this. Problems
quickly arise when a patient feels unwell, yet often has just a few
minutes of their GPs time in which to voice their concerns. A check of the
most recent blood works on their computer screen, and the GP
assures/dismisses (depending on which side of the desk you sit) based upon
the numbers being within the regarded range. The internet savy or just
plain unconvinced patient search the internet and finds.... widely
differing suggested ranges!

Several UK sources suggest a TSH reference range of 0.4 - 4.5 whilst
my GP insists it should be 0.3 - 5.5

This may not seem a huge difference, but it's highly significant to
me as I'm currently 4.6, feeling unwell but my GP will not increase my T4
dosage. (my current T4 being 13.6 in a stated range of 10 - 23)

Now it appears that the USA have amended their range to peak at 3.0 !

With UK GP's working to differing ranges, and most unable or
unwilling to consider supplementing T4 with T3 for patients who are still
feeling unwell, patients comments and 'gut feelings' MUST take a higher
significance than mere numbers.

Medical professionals need to look beyond the figures to the quality
of life of their patient. It is us, after all, that have to live with our
widely differing blood results long after our three-minute consultation
with you has ended.

Competing interests:  
None declared

Competing interests: No competing interests

29 April 2003
Simon M. Clarke
Hypothyroid Patient
Cornwall, PL14 4EQ