in the following task, you have to answer the questions inside the ( questions ISTA.docx). that will be based on Thyroid Project Description - Fall 2022 (1) (1).docx
In Study #2 (Individual Variation Study), one individual was removed for being hyperthyroid. How many men that remained in the study had hyperthyroid measurements within the 95% interval around their means?
All of them
All individuals are held to the 0.4 to 5.0 TSH range. This range is a biased indicator for hypothyroidism, as it best captures the normal thyroid range of:
African American Men
African American Women
The scientists in Study #2 (Individual Variation) collected data only on healthy men. If someone looked at their study and then said that all individuals have a thyroid range with about 0.28 standard deviations, this would be:
According to Study #3 (Should We Narrow the Range), which of the following people is most likely to have a thyroid disorder?
Someone with a consistent TSH of 0.002
Someone who used to have a TSH of 1.8 but now has a TSH of 1.9
Someone with a consistent TSH of 1.7
Someone who used to have a TSH of 1.2 but now has a TSH of 1.7
The maximum TSH measured in the population in Study #1 (Italian Population Study) is much higher than the typical cut off for normal thyroids. What is the most likely explanation for this?
the sample measured contained people with undiagnosed hypothyroidism
people in Italy can be healthier despite higher TSH levels
lots of measurement error in this study
people in Italy are more prone to hypothyroidism
Are the distributions reported in Study #2 (Individual Variation Study) normal distributions?
it is a normal distribution for men but not for women
no, these are not normal distributions
there is no way to tell from this data
yes, they report standard deviations and means
After Study #1 (Italian Population Study) was concluded the authors recommended an adjustment to the range considered normal. Their range was 0.36 - 5.28. These numbers represent:
2.5% & 97.5% quartiles
the difference between the mean and the median
two standard deviations away from the mean
the uppermost and lowermost limit in a healthy person
A woman in her 20s with signs of hypothyroidism and a family history of hypothyroidism gets her TSH levels tested 25 times in a year. She has a mean value of 3.5, plus or minus 1.5 standard deviations. Statistically, is this woman likely hypothyroid (using the 5.0 cutoff)? Use numbers to support your answer.
Yes, around 16-17% of her individual distribution is at or above the 5.0 marker
Yes, around 50% of her individual distribution is at or above the 5.0 marker
No, she is likely hyperthyroid
No, her average is below the 5.0 marker by quite a lot
No, less than 1% of her individual distribution is at or above the 5.0 marker
In Study #2 (Individual Variation Study) there were originally 17 participants but one was excluded because his measurements showed he was hyperthyroid. He did not have symptoms. Explain the type of bias or biases inherent in this decision.
Explain how establishing TSH levels and using them to diagnose thyroid disorders is a process that follows circular logic (please note your doctors do actually do more than this, this is a statistics class so I've carved off a section of an example but your doctors are far more knowledgeable about this than me!).
Read through the information below. Thyroid disorders are somewhat contentious in how they are identified, with bias and misunderstandings of variation and statistics permeating how these disorders are identified. Once you have read through the following, make sure to think about how there are potential biases present in the way we measure these things.
To prepare yourself for the Project 1 quiz, read through the following questions and think about sources of bias and mistakes in these studies and how doctors apply these results to their patients.
You've been given a bunch of standard deviations – be prepared to use those to reconstruct someone's normal distribution maximums (so: you'll need a calculator)
Look at the studies. Are there limitations to how you could interpret their results?
What do the two studies suggest about one another?
Consider the data presented. Is it normal? Sketch out what that might look like if it was or wasn't.
Consider what the normal range of TSH might represent.
Using the information from the two studies, consider who is most likely of the following pair to have hypothyroidism: a woman with 4.5 TSH, or a man with 4.5 TSH.
Consider how using means and standard deviations might impact your data if you have a non-normal distribution
Consider how individuals are screened for these studies
Consider how you as a statistically-informed doctor might diagnose a patient
Make sure you understand how standard deviations define a normal distribution!
If you would like a pre-made excel sheet with the numbers from below, you can download that here:
Background on Circular Logic
There is a little bit of Circular Logic in how thyroid disorders are defined. Circular logic is where the reasoner begins with the thing they are trying to end with. It ultimately is best defined when both sides of the argument are making the same point.
For example, the fact that so many companies have ads out for "entry level positions" that require "2 years of experience" is a form of circular logic – how can you get the experience if the entry level positions require the experience you don't have?
Most societal norms also have some degree of circular reasoning inherent in them. Most people get married because being married is normal; but if they didn't get married, would it still be normal? Without any external evidence as to why most people get married or why it is considered normal, you have the two ideas (getting married is normal) and (most people get married) as an interchangeable parts of a circle.
Background on Thyroid Disorders
Your thyroid is a gland that releases hormones that control your metabolism – how your body processes energy. There are different medical conditions that can affect this, but two of the most common are hypothyroidism (an underactive thyroid) and hyperthyroidism (an overactive thyroid). Both conditions are often initially diagnosed with a lab test, which looks for a chemical known as Thyroid Stimulating Hormone, or TSH.
When your body's thyroid is releasing too many hormones, your body will have low TSH because it doesn't want the thyroid to release any more. When your thyroid isn't doing as well at releasing hormones, your body will have high TSH because it is trying to get your thyroid to work harder. A graphic is below to show this process.
Doctors will measure the TSH in milli-units per liter in your blood. While it varies from clinic to clinic, most American doctors consider someone that has a lab result of between 0.4 and 5.0 TSH is in the normal range. Less than 0.4 would be considered hyperthyroid, and more than 5.0 would be considered hypothyroid.
Both hypo- and hyperthyroidism are difficult to diagnose, as they have many symptoms that are found in other disorders. Hypothyroidism is particularly subtle, as it mimics some of the aspects of a slowed metabolism as you age. Hypothyroidism is more common in women, with around 85% percent of hypothyroid patients being women.
Study #1: Italian Population Study
A recent study of TSH values measured in Italy shows a different set of ranges than the 0.4-5.0 range. They studied over 140,000 individual blood samples from patients at doctor's offices around the country. These blood samples were collected to analyze lots of different disorders, then donated to the scientists afterwards for their study. The scientists excluded samples from anybody who had already been diagnosed with thyroid problems. Below is a table of some of their data:
Study #2: Individual Variation Study
A second study looked at TSH levels in healthy men who had no signs of hyper- or hypothyroidism. They measured TSH levels in these 16 healthy subjects multiple times over the course of 24 hours. Below is some of their data, where each row is a person. The percent variation, or Coefficient of variation, is the variation divided by the mean and multiplied by 100. It is a good way of understanding how variation might change with different measurements.
There was one additional participant who was excluded after they measured his TSH and found that man was hyperthyroid. He was asymptomatic and did not know of his condition before the study.
Study #3: Should We Narrow the Range?
This study analyzed results from other studies and reported some of the following facts:
People with hypothyroidism have an increase of about 5% TSH a year without treatment
Hypothyroid individuals have high variation in their TSH levels when they are measured multiple times
Across dozens of studies, 95% of healthy individuals have a TSH between 0.4 and 2.5
Most of these studies have been conducted on white individuals
One study conformed that African-American individuals had a mean TSH of 1.18 versus Caucasian individuals in that same study that had a mean TSH of 1.4
As a result of these and other studies, this paper suggested that the range for normal TSH should be 0.5 to 2.0. Anyone above 2.0 should be evaluated for mild hypothyroidism. A graphic is provided below to show their suggested changes.
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