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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
FrederickRose
 
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Assessment of treatment efficacy

Postby FrederickRose on Wed Nov 08, 2017 12:55 pm

This post is going to be related to the other recent thread by xxyzx, so moderator please merge if appropriate.

As some of you may have seen in my earlier thread, I was recently self-diagnosed with OSA and have been trying to find the right PAP settings. I've learned a lot here and on other forums.

One of the things I'm not clear on is how to assess treatment efficacy. Broadly speaking, I understand that the goals are to feel better and to be healthier, but what I remain uncertain about is how to assess whether those goals have been achieved.

For one thing, I didn't feel terrible prior to PAP. I do feel better since starting PAP, but I'm not sure how much better I am supposed to feel. I've never had terrible daytime somnolence or other really severe symptoms.

I'm a physician and have been reading the medical literature, and there seems to be no real evidence based consensus about how to judge the adequacy of treatment. In particular, the type of data we review here in the forum, as reported by our machines, seems not to be of primary consideration amongst those who publish in reputable journals in the field.

UpToDate, a commonly used physician reference for evidence-based medicine states the following about assessing treatment efficacy (authors are Meir H Kryger, MD, FRCPC, Professor of Medicine, Yale University; and Atul Malhotra, MD, Professor of Medicine, University of California, San Diego):

Once any side effects of the positive airway pressure are successfully managed and the patient is adhering to the therapy, the patient should be asked whether the symptoms of OSA have resolved. In addition, objective data on compliance and effectiveness can be downloaded from the patient's device and reviewed, although studies on the accuracy of the information are mixed. An objective sleep evaluation is generally unnecessary if the symptoms of OSA have resolved, but repeat testing is indicated for patients who do not improve or who have recurrent or persistent symptoms such as daytime sleepiness [1]. Objective testing may consist of polysomnography or type 3 home sleep apnea testing (HSAT) with concurrent CPAP use. (See "Home sleep apnea testing for obstructive sleep apnea in adults" and "Adherence with continuous positive airway pressure (CPAP)", section on 'Identification'.)

The purpose of such testing is to help the clinician determine the reason for the treatment failure. Possible causes of treatment failure include nonadherence or suboptimal adherence, weight gain, an inappropriate level of prescribed positive pressure, or an additional disorder causing sleepiness (eg, narcolepsy) that may require alterations in the therapeutic regimen. A review of medications should also be undertaken since many drugs may lead to sleepiness. Inadequate sleep time may also negate the expected effects from treatment of OSA.


As you can see, there is nothing there about looking at the data from user PAP machines. Furthermore, there is no recommendation to look at any measured data to gauge treatment efficacy unless symptoms remain present.

This letter to the editor titled "The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy" offers an interesting perspective , IMO: https://link.springer.com/article/10.10 ... 016-3944-2

Excerpt:

There is a mountain of evidence showing how the AHI can vary from night to night, vary from laboratory to laboratory, from various nasal thermistor to pressure transducers, and AHI can vary based on the different definitions of hypopnea used in different laboratories and software [6, 7, 8, 9, 10, 11, 12, 13, 14]. The contemporary reliance on AHI as generally the only outcome measure assessed in research programs is not in line with many other aspects of medicine that are becoming patient centered as opposed to test centered [6, 7, 8, 9, 10, 11, 12, 13, 14].


For someone like me who feels "better" and has a user machine-reported AHI under 5, there seems to be forum consensus (in multiple forums) that using higher pressure settings to get the AHI even lower is worthwhile. From what I can find in the medical literature, I am not seeing evidence for such an approach. On the one hand, the health benefits of lowering the AHI further — even if we assume that the machine is correctly reporting AHI — seem to be uncertain. On the other hand, the long-term consequences of using higher pressures also seem to be uncertain.

To give a simple example, if we assume that my symptoms are well controlled, is it more desirable for me to use CPAP 14 with an AHI of 0 (data averaged over multiple days of therapy) or CPAP 10 with an AHI of 4? As far as I can tell, we are lacking high quality data to support one answer or the other. That is without even considering all the other measurable parameters other than AHI, which as xxyzx pointed out, may be highly relevant to gauging treatment response.

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Re: Assessment of treatment efficacy

Postby xxyzx on Wed Nov 08, 2017 1:27 pm

FrederickRose wrote:This post is going to be related to the other recent thread by xxyzx, so moderator please merge if appropriate.

As some of you may have seen in my earlier thread, I was recently self-diagnosed with OSA and have been trying to find the right PAP settings. I've learned a lot here and on other forums.

One of the things I'm not clear on is how to assess treatment efficacy. Broadly speaking, I understand that the goals are to feel better and to be healthier, but what I remain uncertain about is how to assess whether those goals have been achieved.

For one thing, I didn't feel terrible prior to PAP. I do feel better since starting PAP, but I'm not sure how much better I am supposed to feel. I've never had terrible daytime somnolence or other really severe symptoms.

I'm a physician and have been reading the medical literature, and there seems to be no real evidence based consensus about how to judge the adequacy of treatment. In particular, the type of data we review here in the forum, as reported by our machines, seems not to be of primary consideration amongst those who publish in reputable journals in the field. what einstein said. not everything you measure matters. not everything that matters can be measured. and the entire spectrum of SDB is still relatively new as complex/mixed apnea became official and RERAs are being considered etc

UpToDate, a commonly used physician reference for evidence-based medicine states the following about assessing treatment efficacy (authors are Meir H Kryger, MD, FRCPC, Professor of Medicine, Yale University; and Atul Malhotra, MD, Professor of Medicine, University of California, San Diego):

Once any side effects of the positive airway pressure are successfully managed and the patient is adhering to the therapy, the patient should be asked whether the symptoms of OSA have resolved. In addition, objective data on compliance and effectiveness can be downloaded from the patient's device and reviewed, although studies on the accuracy of the information are mixed. An objective sleep evaluation is generally unnecessary if the symptoms of OSA have resolved, but repeat testing is indicated for patients who do not improve or who have recurrent or persistent symptoms such as daytime sleepiness [1]. Objective testing may consist of polysomnography or type 3 home sleep apnea testing (HSAT) with concurrent CPAP use. (See "Home sleep apnea testing for obstructive sleep apnea in adults" and "Adherence with continuous positive airway pressure (CPAP)", section on 'Identification'.)
to much of the emphasis is restricted to mere obstructive apnea. there are many other problems that mess up our sleep and how we feel. the emphasis on AHI misleads people from looking at the TOTAL picture of problems. this is a common failing of doctors who will never look for more than one problem or cause.


The purpose of such testing is to help the clinician determine the reason for the treatment failure. Possible causes of treatment failure include nonadherence or suboptimal adherence, weight gain, an inappropriate level of prescribed positive pressure, or an additional disorder causing sleepiness (eg, narcolepsy) that may require alterations in the therapeutic regimen. A review of medications should also be undertaken since many drugs may lead to sleepiness. Inadequate sleep time may also negate the expected effects from treatment of OSA.

There are many reasons for failure. wrong treatment, discomfort, newly caused problems like rhinitis, aerophagia, ear problems, yada yada.

As you can see, there is nothing there about looking at the data from user PAP machines. Furthermore, there is no recommendation to look at any measured data to gauge treatment efficacy unless symptoms remain present.
True but we look at the data to try to improe our treatment and to understand what that data does tell us.
if we hve other problems then we may need otehr tests to determine what they are.


This letter to the editor titled "The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy" offers an interesting perspective , IMO: https://link.springer.com/article/10.10 ... 016-3944-2

Excerpt:

There is a mountain of evidence showing how the AHI can vary from night to night, vary from laboratory to laboratory, from various nasal thermistor to pressure transducers, and AHI can vary based on the different definitions of hypopnea used in different laboratories and software [6, 7, 8, 9, 10, 11, 12, 13, 14]. The contemporary reliance on AHI as generally the only outcome measure assessed in research programs is not in line with many other aspects of medicine that are becoming patient centered as opposed to test centered [6, 7, 8, 9, 10, 11, 12, 13, 14].

everythign varies from night to night, by sleep position, sleep stages, allergies, mediciene, and other factors.
a sleep lab is such an artificial environment that its results are usually atypical because it is hard to sleep in a strange bed and different pillows with odd lighting and air blowing in your face while they keep doing things to you for their tests.


For someone like me who feels "better" and has a user machine-reported AHI under 5, there seems to be forum consensus (in multiple forums) that using higher pressure settings to get the AHI even lower is worthwhile. From what I can find in the medical literature, I am not seeing evidence for such an approach. On the one hand, the health benefits of lowering the AHI further — even if we assume that the machine is correctly reporting AHI — seem to be uncertain. On the other hand, the long-term consequences of using higher pressures also seem to be uncertain.
effectiveness is iffy but a number of doctors do recommend higher pressures over that to clear OA.
i have not seen anything about high pressures (which are relative low in xpaps) causing harm. possibly rhinitis but that could also be drying out of the nose.


To give a simple example, if we assume that my symptoms are well controlled, is it more desirable for me to use CPAP 14 with an AHI of 1 (data averaged over multiple days of therapy) or CPAP 10 with an AHI of 4? As far as I can tell, we are lacking high quality data to support one answer or the other. That is without even considering all the other measurable parameters other than AHI, which as xxyzx pointed out, may be highly relevant to gauging treatment response.

the sleep industry has not really cared about patient comfort or the real results because its only focus is on AHI which does not cover many of the other problems with sleep.
========

the goal is to feel good and be good

a number of doctors recommend higher pressures to help hypops and RERA
raising pressure does not always help
leaks, other disturbances, centrals, stuff happens from it

we need to find the best compromise that works for us

as to hypops i have many of them
almost all are exactly ten seconds
ASSuming that resmed declared them correctly

if my spo2 is not showing any desats then i really dont care about the hypops as the number is relatively low
i had the machine up to max 25 cm and still had them
so why not just lower it so the machine does not disturb me and accept that that is the best that I can do

if hypops are disturbing me then i can just sleep longer and avoid any health issues
but if the spo2 has desats then i need to do something to get that number improved as lack of oxygen does have bad results

as i noted they dont do a carefully weighted metric based on both length and number and desats when they came up with AHI
and AHI ignores disturbances that can mess up sleep quality too
RDI even ignores external disturbances and other problems

the real problem of apnea is the desats
that damages cells
if the spo2 stays up then apnea is not a real issue

of course apnea can disturb sleep
but that can be fixed with more sleep

although too many people wont sleep longer so they have problems
most dont sleep long enough even without apnea , so have symptoms that are similar
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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Re: Assessment of treatment efficacy

Postby Julie on Wed Nov 08, 2017 2:29 pm

These links will tell you all about Sleepyhead, the software used by so many here and elsewhere, that gives a lot of detail about your sleep and lets you track what goes on overnight. It has many features and there's info about how to post the results. Please take time to read it all and experienced members here will help you interpret things. And please don't take anything Xxxyz says - no matter how authoritative it seems - seriously at all. He is quite disturbed but due to the owners here not believing in moderators, has been allowed to invade most threads with his ignorant and nonsensical stuff. Sorry!

https://sleep.tnet.com/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur
Last edited by Julie on Wed Nov 08, 2017 3:01 pm, edited 1 time in total.

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Re: Assessment of treatment efficacy

Postby xxyzx on Wed Nov 08, 2017 2:43 pm

[quote="Julie"]These links will tell you all about Sleepyhead, the software used by so many here and elsewhere, that gives a lot of detail about your sleep and lets you track what goes on overnight. It has many features and info about how to post the results. Please take time to read it all and experienced members here will help you interpret things. And please don't take anything Xxxyz says - no matter how authoritative it seems - seriously at all. He is quite disturbed but due to the owners here not believing in moderators, has been allowed to invade most threads with his ignorant and nonsensical stuff. Sorry!
/quote]
========

ROTFLMAO

that from the person who posts so much incorrect crap that many people have to reply and fix your errors

If i say anything wrong you would post facts
your posting personal attacks proves i am right
and that you have nothing of value to says


i am not disturbed at all
although liars and bullies are annoying

you are clearly disturbed by the truth

YOU CANT HANDLE THE TRUTH !!
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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Re: Assessment of treatment efficacy

Postby Pugsy on Wed Nov 08, 2017 3:03 pm

We as humans seem to need some sort of number validation for a lot of things when it comes to medical stuff.
We have normal ranges of just about everything out there and we like for our "numbers" to be with the norm.
When it comes to the OSA number stuff...I try to look at the big picture and not just a particular set of numbers but of course we have to start somewhere so numbers is where we start.

I look at the composition of the AHI and not just the single AHI number. If the AHI is composed primarily of central apneas more pressure isn't going to lower that number so there's no sense in going from 10 cm to 14 cm (using your example). More pressure won't reduce the number of centrals.
Now it might reduce the number of OAs or hyponeas but it also might not. I once did an experiment where I went from 10 cm minimum to 13 cm minimum in 0.5 cm increments spending a week at each setting. My overall AHI never really reduced with the increase in pressure even at 13 and I wasn't having centrals either. Since my "numbers" didn't really change and I didn't feel any different and didn't sleep any different then I went back to 10 cm minimum. It was simply more comfortable to start at 10 than at 13 and if there's no urgent need to do 13 then I sure didn't want to do it.

So I actually try to look at the big picture which includes AHI but is not limited to AHI along with subjective feelings as well.

The prettiest most perfect software report in the world doesn't mean much if we sleep like crap or feel like crap. It's a starting point only and for some people it is enough and for some it isn't and they have to dig deeper.

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Re: Assessment of treatment efficacy

Postby Jay Aitchsee on Wed Nov 08, 2017 3:08 pm

Doc, I think you've assessed the situation pretty well.
Most of us here that have been XPAP users for some time would probably want to see AHI in the sub 2.0 range. Generally, I think most of us feel better when that is the case. However, as you have surmised, the goal is to reduce apneas and hypopneas to a reasonable level (generally considered to be less than 5) and feel better. - to begin experiencing restful restorative sleep. If that happens at 4, or 3 or whatever, then fine. Generally, we would want to accomplish this at the lowest pressure possible because higher pressures tend to make the therapy less comfortable and more problematic with the possibility of leaks, swallowed air, etc. Some, usually newbies, strive for the lowest AHI possible (0), Personally, I think that is likely to be counter productive and is not apt to produce better quality sleep.
You do need to assess what type of events you are having. Centrals will not respond to an increase in pressure and, in fact, may increase with increased pressure.
So, in short, to treat the apnea and feel better is the goal. A zero AHI should not be. What many fail to realize causing them to continue to press for a lower AHI is that CPAP can only fix respiratory problems. It can not fix poor sleep due to other things, such as depression, caffeine, meds, poor sleep hygiene, etc., etc.

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Re: Assessment of treatment efficacy

Postby xxyzx on Wed Nov 08, 2017 3:45 pm

Jay Aitchsee wrote:Doc, I think you've assessed the situation pretty well.
Most of us here that have been XPAP users for some time would probably want to see AHI in the sub 2.0 range. Generally, I think most of us feel better when that is the case. However, as you have surmised, the goal is to reduce apneas and hypopneas to a reasonable level (generally considered to be less than 5) and feel better. - to begin experiencing restful restorative sleep. If that happens at 4, or 3 or whatever, then fine. Generally, we would want to accomplish this at the lowest pressure possible because higher pressures tend to make the therapy less comfortable and more problematic with the possibility of leaks, swallowed air, etc. Some, usually newbies, strive for the lowest AHI possible (0), Personally, I think that is likely to be counter productive and is not apt to produce better quality sleep.
You do need to assess what type of events you are having. Centrals will not respond to an increase in pressure and, in fact, may increase with increased pressure.
So, in short, to treat the apnea and feel better is the goal. A zero AHI should not be. What many fail to realize causing them to continue to press for a lower AHI is that CPAP can only fix respiratory problems. It can not fix poor sleep due to other things, such as depression, caffeine, meds, poor sleep hygiene, etc., etc.

============

indeed

it is a compromise and we all have our optimum set point
to balance all the factors concerning how well we sleep
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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Re: Assessment of treatment efficacy

Postby FrederickRose on Thu Nov 09, 2017 8:39 am

Jay Aitchsee wrote:Most of us here that have been XPAP users for some time would probably want to see AHI in the sub 2.0 range. Generally, I think most of us feel better when that is the case.


This is interesting and good information, and it's the type of information that studies have a hard time demonstrating. For example, most thyroid doctors would agree that a patient who has an underactive thyroid and persistent symptoms consistent with that diagnosis despite taking enough oral thyroid hormone to put their levels in the "normal range" may benefit from taking a little more hormone to put their levels into the higher normal range (correlating with a lower TSH value).

However, despite the fact that we have been doing these thyroid studies for decades, the evidence to support aiming for a "more normal part" of the normal range remains very limited, and the practice of doing so remains somewhat controversial.

Coming back to my case specifically, it seems like a pressure ~10 keeps my AHI below 5, but I need a lot more to get it under 2. I'm gonna try to get there to see if I indeed feel better!

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Re: Assessment of treatment efficacy

Postby xxyzx on Thu Nov 09, 2017 9:37 am

FrederickRose wrote:
Jay Aitchsee wrote:Most of us here that have been XPAP users for some time would probably want to see AHI in the sub 2.0 range. Generally, I think most of us feel better when that is the case.


This is interesting and good information, and it's the type of information that studies have a hard time demonstrating. For example, most thyroid doctors would agree that a patient who has an underactive thyroid and persistent symptoms consistent with that diagnosis despite taking enough oral thyroid hormone to put their levels in the "normal range" may benefit from taking a little more hormone to put their levels into the higher normal range (correlating with a lower TSH value).

However, despite the fact that we have been doing these thyroid studies for decades, the evidence to support aiming for a "more normal part" of the normal range remains very limited, and the practice of doing so remains somewhat controversial.

Coming back to my case specifically, it seems like a pressure ~10 keeps my AHI below 5, but I need a lot more to get it under 2. I'm gonna try to get there to see if I indeed feel better!

==========

everybody's normal is different

this is a metrics problem
the doctors love tsh which is meaningless
that only means the thyroid is told to produce T4
the body has to convert T4 to T3 to be useful

so T3 is the meaningful metric yet doctors go two steps back and rely on TSH

I have my doctor measure T3 and T4 to make sure they are good
he measures TSH because that is what docs do
but we know that my T3 levels are fine not just that the thyroid is being stimulated with TSH

I take T4 but some people have to take T3 because their body is not converting T4 to T3

if I had relied on TSH I would still be a zombie with no energy at all
patients need to find the facts and advocate for themselves to make sure meaningful metrics are measured

which relates to AHI
AHI can tell you if OA is bad or been treated
but it wont tell you crapola about how your sleep problems are being treated if you have anything other than OA

RDI will tell if your sleep is disturbed
spo2 will tell if low oxygen is killing brain cells

and yet you may still have other sleep problems
not all of them can be measured and given a number
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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Re: Assessment of treatment efficacy

Postby FrederickRose on Thu Nov 09, 2017 10:13 am

xxyzx wrote:the doctors love tsh which is meaningless
that only means the thyroid is told to produce T4
the body has to convert T4 to T3 to be useful

so T3 is the meaningful metric yet doctors go two steps back and rely on TSH

I have my doctor measure T3 and T4 to make sure they are good
he measures TSH because that is what docs do
but we know that my T3 levels are fine not just that the thyroid is being stimulated with TSH

I take T4 but some people have to take T3 because their body is not converting T4 to T3

if I had relied on TSH I would still be a zombie with no energy at all



I have spent my entire adult life studying the thyroid and can say with 100% certainty that the "truth" is somewhere in between what you believe and what you've depicted as the belief of your doctor.

For a relatively comprehensive, heavily referenced discussion, see this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409/

Here is very basic explanation of why T3 levels are usually far less important than TSH levels in the diagnosis and management of hypothyroidism:

1) In order for T3 to have an effect in the body, it must be free (not protein bound). The vast majority of T3 in the blood is protein bound and our ability to accurately measure the tiny free portion is limited.

2) Even if you know how much free T3 a person has in their blood, how much effect that level of T3 will have in various tissues (such as the heart or brain) depends on A) efficiency of hormone transport into a tissue; B) efficiency of deiodinases in a tissue; C) availability of thyroid hormone receptor in cells; D) availability of thyroid hormone receptor cofactors in cells; E) stability of messenger RNA of thyroid responsive genes; F) efficiency of RNA translation to protein; etc etc (much more complicated than described).

In practice what this means is that a person can have twice as much free T3 in their blood as another person and yet their body can be half as responsive to T3 in any given tissue, thus ending up with the same amount of T3 action/effect in that tissue. In contrast, TSH levels vary greatly with changes in thyroid hormone effect rather than amount, which gets around all the aforementioned inefficiencies. Yet the TSH as an indicator of thyroid function is limited, because it relies on assumptions of A) normal hypothalamus and pituitary function; and B) tissue effect of thyroid hormone in the brain and pituitary being representative of tissue effects in other tissues. This latter may be important in some people depending on their deiodinase activity in various tissues.

3) For a hypothyroid individual on treatment, T4 and T3 levels (free and total) can vary greatly depending on the time of the blood draw relative to the time of medication administration.

There is much more to it than that, but it is a start as to explaining why to suggest that the TSH is useless and T3 most important is grossly inaccurate.

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Re: Assessment of treatment efficacy

Postby xxyzx on Thu Nov 09, 2017 11:46 am

FrederickRose wrote:
xxyzx wrote:the doctors love tsh which is meaningless
that only means the thyroid is told to produce T4
the body has to convert T4 to T3 to be useful

so T3 is the meaningful metric yet doctors go two steps back and rely on TSH

I have my doctor measure T3 and T4 to make sure they are good
he measures TSH because that is what docs do
but we know that my T3 levels are fine not just that the thyroid is being stimulated with TSH

I take T4 but some people have to take T3 because their body is not converting T4 to T3

if I had relied on TSH I would still be a zombie with no energy at all


=========================

I have spent my entire adult life studying the thyroid and can say with 100% certainty that the "truth" is somewhere in between what you believe and what you've depicted as the belief of your doctor.

For a relatively comprehensive, heavily referenced discussion, see this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409/

Here is very basic explanation of why T3 levels are usually far less important than TSH levels in the diagnosis and management of hypothyroidism:

1) In order for T3 to have an effect in the body, it must be free (not protein bound). The vast majority of T3 in the blood is protein bound and our ability to accurately measure the tiny free portion is limited.

2) Even if you know how much free T3 a person has in their blood, how much effect that level of T3 will have in various tissues (such as the heart or brain) depends on A) efficiency of hormone transport into a tissue; B) efficiency of deiodinases in a tissue; C) availability of thyroid hormone receptor in cells; D) availability of thyroid hormone receptor cofactors in cells; E) stability of messenger RNA of thyroid responsive genes; F) efficiency of RNA translation to protein; etc etc (much more complicated than described).

In practice what this means is that a person can have twice as much free T3 in their blood as another person and yet their body can be half as responsive to T3 in any given tissue, thus ending up with the same amount of T3 action/effect in that tissue. In contrast, TSH levels vary greatly with changes in thyroid hormone effect rather than amount, which gets around all the aforementioned inefficiencies. Yet the TSH as an indicator of thyroid function is limited, because it relies on assumptions of A) normal hypothalamus and pituitary function; and B) tissue effect of thyroid hormone in the brain and pituitary being representative of tissue effects in other tissues. This latter may be important in some people depending on their deiodinase activity in various tissues.

3) For a hypothyroid individual on treatment, T4 and T3 levels (free and total) can vary greatly depending on the time of the blood draw relative to the time of medication administration.

There is much more to it than that, but it is a start as to explaining why to suggest that the TSH is useless and T3 most important is grossly inaccurate.

============

i would expect you to take the doctors view
but there are doctors who do not fully agree with the party line and agree with me

i take the patients perspective

and yes measuring T3T4 free and bound yada yada complicates things
so does time of day what you ate and other factors
and these tests cost more so they are not usually done

the point is that normal TSH does NOT mean that you are getting enough thyroid stuff that is usable and makes you feel good
There is a reason that many people have to take T3 directly not T4 like I get with synthroid and still have TSH measure as normal

TSH works good for most of the people just like AHI is good enough for those with just OA
but such metrics do not work for a substantial portion of the people who have problems and are trying to find out what to fix
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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Re: Assessment of treatment efficacy

Postby FrederickRose on Thu Nov 09, 2017 12:50 pm

xxyzx wrote:IF I ever say anything incorrect somebody will post true facts to prove it


Done. :)

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Re: Assessment of treatment efficacy

Postby nanwilson on Thu Nov 09, 2017 1:11 pm

FrederickRose wrote:
xxyzx wrote:IF I ever say anything incorrect somebody will post true facts to prove it


Done. :)



Doc. xxxyxz's claims have been refuted before... MANY times, yet he still refuses to accept that he is wrong or spouting wrongful information :? . He is never wrong... in his estimation only. :shock: :shock: .
Thank you for your insightful explanation , as I am one of those that has to take thyroid meds daily.
Cheers
Nan

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Started cpap in 2010.. still at it with great results.

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Bertha deBlues
 
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Re: Assessment of treatment efficacy

Postby Bertha deBlues on Thu Nov 09, 2017 1:19 pm

nanwilson wrote:
FrederickRose wrote:
xxyzx wrote:IF I ever say anything incorrect somebody will post true facts to prove it


Done. :)



Doc. xxxyxz's claims have been refuted before... MANY times, yet he still refuses to accept that he is wrong or spouting wrongful information :? . He is never wrong... in his estimation only. :shock: :shock: .
Thank you for your insightful explanation , as I am one of those that has to take thyroid meds daily.
Cheers
Nan


Thanks, Doctor, from another patient being treated for hypothyroidism. I appreciate the information you have shared. Best of luck to you in fine-tuning your own sleep apnea treatment. I'm still on the journey. :)
And in the end the love you take is equal to the love you make. - Paul McCartney

xxyzx
 
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Re: Assessment of treatment efficacy

Postby xxyzx on Thu Nov 09, 2017 1:45 pm

FrederickRose wrote:
xxyzx wrote:IF I ever say anything incorrect somebody will post true facts to prove it


Done. :)

============

Thank you

Keep in mind that a lot of facts people post are also just opinion and many times misinformation
IF I ever say anything incorrect somebody will post true facts to prove it. But when my posts are accurate they will always attack me personally. You can decide whether my post is correct or not by looking at which they did. [color=#FF00FF]

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