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Research Articles and Papers on:

Shared Decision Making


Journal of Thyroid Research Volume 2012 (2012), Article ID 438037, 9 pages

TSH Measurement and Its Implications for Personalised Clinical Decision-Making

Rudolf Hoermann1 and John E. M. Midgley2

Department of Nuclear Medicine, Klinikum Luedenscheid, Paulmannshoeherstraße 14, 58515 Luedenscheid, Germany
2Consultancy Division, North Lakes Clinical, 6 High Wheatley, Ilkley, West Yorkshire LS29 8RX, UK

Received 5 October 2012; Accepted 15 November 2012
Academic Editor: Johannes W. Dietrich


Advances in assay technology have promoted thyrotropin (TSH) measurements from participation in a multi-analyte assessment of thyroid function to a statistically defined screening parameter in its own right. While this approach has been successful in many ways, it has some grave limitations. This includes the basic question of what constitutes an agreed reference range and the fact that the population-based reference range by far exceeds the variation of the intraindividual set point. Both problems result in a potential misdiagnosis of normal and pathological thyroid function in a substantial proportion of patients. From a physiological perspective, TSH plays an integrated role in thyroid homeostasis. Few attempts have been made to adopt physiological insights into thyroid homeostasis for medical decision-making. Some emerging novel findings question the widely assumed log-linear TSH-FT4 relationship over the entire thyroid function spectrum. This data favours more complex hierarchically structured models. With a better understanding of its role in thyroid homeostasis in thyroid health and disease, TSH can be revisited in the context of thyroid regulation. This, in turn, could help overcome some of the limitations arising from its isolated statistical use and offer new prospects towards a more personalised interpretation of thyroid test results.

Copyright © 2012 Rudolf Hoermann and John E. M. Midgley. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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How should patients behave to facilitate shared decision making – the doctors’ view

Johannes Hamann MD1, Rosmarie Mendel PhD2, Markus Bühner PhD3, Werner Kissling MD4, Rudolf Cohen PhD5, Eva Knipfer Dr. rer. medic.6, Hans-Henning Eckstein MD7

Article first published online: 30 MAY 2011

The researchers of this study how wanted to find out how physicians feel about patients’ efforts to be engaged in shared decision making (SDM).

They surveyed physicians from distinctly different medical disciplines (238 psychiatrists and 169 vascular surgeons).

Participants were requested to judge which patient behaviours they found helpful and which behaviours they found were detrimental for SDM.

Psychiatrists and surgeons had rather positive attitudes about active patient behaviours although they had mixed feelings or negative attitudes to quite a few patient behaviours such as searching the Internet and being assertive towards the doctor.

The researchers concluded that physicians are generally quite open towards active patient behaviour in the consultation although they do consider it as less helpful and become more annoyed if patients insist on their preferences and doubt their doctors’ recommendations.

The researchers felt that doctors must realize that SDM means giving up decisional power and that they should try to be more flexible in their interactions with patients.