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En lege spør: Er referanseverdiene for thyreoideafunksjon gode nok? Fra Eyr 27.januar 2002 http://www.uib.no/isf/eyr/2002q1/009210.html Jeg har hatt så mange kvinnelige pasienter med stoffskifteforstyrrelser at jeg mener at voksne kvinner bør ha tatt en FT4, TSH og anti-TPO minst en gang som screening.. Regelmessig finner jeg eldre kvinner med T4 over øvre ref.verdi og lav TSH, men uten kliniske symptomer på hypertyreose. Enda oftere finner jeg, særlig hos unge og middelaldrende kvinner, symptomer forenlig med lett hypotyreose, men med lab verdier innenfor referanseområdet. Endel kvinner med vektproblemer som jeg kjenner godt, som både trimmer, og som jeg vet har struktur på hverdagen sin har T4-verdier på 10-13, TSH på 2-3. Ofte har de slitt i årevis uten å få uttelling. Hva er den enkeltes "normalverdi? Forespørsel til indremedisiner gir svar som bare refererer til referanseverdi. Forsiktig tilskudd av tyroxin kan gi god virkning på vekt, allmenntilstand og energi, samt psykisk. Billig og ufarlig. Det er, etter mitt syn, grunn til å spørre om vår vanlige metode (95% konfidensintervall fra gjennomsnitt) er god nok. Det virker som om ideell TSH-verdi hos de fleste ligger pluss minus 1, og at 2,5-3 kan tyde på at systemet begynner å bli stresset. HUNT (Nord-Trøndelag) har vist at 10-13% av kvinner har thyreoidea- antistoffer. En stor del av den kvinnelige befolkning driver jojo- slanking, med derpå følgende belastninger på kroppens egenregulering, og kanskje svekket TSH-respons. Jeg har sett noen anorektikere med svært lave verdier for både T4 og TSH. Vet vi nok om hvordan nedsatt fysisk aktivitet virker inn på reguleringene? Dette gjelder jo nå store deler av befolkningen, og kan bety ganske mye. Hypothyreose synes forstsatt å være underdiagnostisert, og det virker som særlig mentale symptomer er vanskelig å fange opp- konsentrasjonsvansker, psykasteni. En praktiserende psykiater ba om stoffskifteprøver, og brukte forsiktig tyroxintilskudd som tilleggsterapi med god effekt. Hyperglykemi, overvekt, hyperlipemi, depresjoner kan alle ha hypotyreose som underliggende eller medvirkende årsak. Jeg har prøvd T3-- Liotyronin- på 3 pasienter, 2 hadde ingen effekt, en av dem slående virkning på konsentrasjonsevne. Selvsagt vanskelig å evaluere, men jeg føler at det er usikkerhet her, og at det trengs bedre redskap enn de referanseverdiene vi har (Furst har 9-22 på T4). Jeg sjekker alltid stoffskifte ved hyperlipidemi, og har fått tilleggseffekt ved å behandle med tyroxin, selv om prøvene var innenfor, men i nedre del av ref. område. Dette gir bedret compliance på livsstilsendring og bedrer effekten av statinet. Erfaringer og synspunkter? Kjell Conradi Brumunddal legesenter Spes.allm.med.og samf.med Dine tanker om thyroidea stemmer med mine erfaringer. og jeg tror ikke det er noen fare med å prøve Thyroxin og denslags ved grenseverdier. Men ved skikkelig ille verdier -uansett retning- er det farlig, noe du også sier: "Forsiktig bruk". En psykiater sa engang at to lab.prøver var vesentlige i hans fag : Thyroideaprøver og tester for B12 -mangel. Har nylig sett resultat av begge sorter i nær familie. Etter behandling var begge de gamle damer istand til å "gå på stølen" igjen, - det er en tur som kan gi dagens "unge" pustevansker-, men for dem var det "naturlig". Langs kysten er det vel forholdet til Sjarken som er vesentlig, særlig for menn. Så den sorten prøver er nok sjelden bortkastet. Hilsen Berit Tveit Slutter meg til det som er skrevet. Sjølv har eg kommet borti eit anna "problem" Hyperaktive, ADHD barn har "ofte" T3 over "normalområdet", men normal TSH og T4. På spørsmål til endokrinologer om det er noe ein skal gjøre noe med får ein ??? tilbake. Er det noen på lista som har erfaring eller føler seg kallet til å uttale seg. Bør dei få prøve beta blokker, eller thyreostaticum ?? Siste "mann" var/er rusmisbruker med uttalt konsentrasjonssvikt og voldsom uro, har alltid (som faren) vore ei urokråke, og solid T3 over normalområdet, men normale andre thyreoidea prøver. Han tyr "gjerne" til hasj eller sterkere stoff for å dempe den indre uroen. Geir Flatabø Ulvik Fra fürst sine websider:Hva er referanseverdier? Referanseverdier er de analyseresultater som er funnet ved undersøkelse av en referansepopulasjon av klinisk friske personer. Mer presist bør de da hete helserelaterte referanseverdier. For hver analyse vil resultatene vise en spredning. Den kan være normalfordelt, men oftest er den det ikke. Mange analyser vil ha en fordelingskurve med en "hale" ut mot høyere verdier, såkalt høyreskjev kurve. Spredningen av verdier i referansepopulasjonen er summen av preanalytisk, biologisk og analytisk variasjon som omtalt ovenfor. Referanseområder Referanseområdene er vanligvis satt slik at nedre og øvre grense kutter ut henholdsvis de laveste og høyeste 2.5 % av verdiene. Generelt vil det si området mellom 2.5 og 97.5 percentilen. Ved normalfordelinger svarer dette omtrent til middelverdien pluss/minus to standardavvik. Det er verdt å merke seg at 5 % av referansepersonene på den måten har verdier utenfor referanseområdet. For noen analyser har laboratoriet bare en øvre grense (f.eks. ASAT, ALAT, Gamma-GT, Lp(a), Bilirubin). Det betyr at nedre grense har liten klinisk betydning og/eller at det er usikkert hvor den går. For andre analyser (f.eks. Folat) har laboratoriet bare en nedre grense med tilsvarende begrunnelser. Referanseområdet vil i disse spesialtilfellene omfatte 97.5 % av verdiene i referansepopulasjonen. Laboratoriet har i størst mulig utstrekning basert seg på egne undersøkte referansematerialer. Der dette ikke har vært mulig, er referansegrensene dels basert på sammenligning med andre laboratorier, dels på data fra litteraturen. Referanseområdene er gitt i tabellen, Referanseverdier og i den alfabetiske analyselisten. En del grenser er noe avrundet. Av praktiske årsaker er alle referanseområder oppgitt med samme antall desimaler som brukes i analysesvarene. Laboratoriets referansegrenser må av og til endres. Dette kan skyldes forandring av metode, reagenser, apparatur etc. Flere av referanseområdene som er oppført i denne boken kan derfor være ugyldige allerede ved utgivelsen. Laboratoriet sender 1 - 2 ganger i året ut en lommefolder med ajourførte referanseområder. På svarbrevene vil alltid det gjeldende, individuelt tilpassede referanseområdet være oppført etter analyseresultatet. Den første måneden etter at en forandring er foretatt, vil dette dessuten bli meddelt i en egen kommentarlinje på brevet. Alders- og kjønnsrelaterte referanseområder Verdiene i referansepopulasjoner av forskjellig kjønn og/eller alder kan avvike signifikant fra hverandre. Der forskjellene er store nok til å ha praktisk betydning, har laboratoriet splittet opp referanseområdene tilsvarende. For noen kjønnshormoner er det egne referanseområder for forskjellige faser i menstruasjonssyklus. Metodeavhengige referanseområder For en del analyser viser referanseområdene betydelige forskjeller etter hvilken metode som er brukt (f.eks. anti-TPO og Lp(a)). Dette gjør at referanseområdene kan være vesensforskjellige fra det ene laboratoriet til det andre. Et svar må derfor alltid sammenholdes med referanseområdet for det laboratorium som har utført analysen. Risiko- og beslutningsgrenser De individer som utgjør referansepopulasjonene er antatt klinisk friske, ikke gravide og uten medikamentell behandling. Ved utvelgelsen tar man vanligvis ikke hensyn til om personene tilhører en gruppe med økt risiko for fremtidig sykdom. Dette har f. eks. stor aktualitet når det gjelder vurderingen av et kolesterolsvar i relasjon til referanseområdet. Det er vist i store befolkningsundersøkelser at opp til 2/3 av klinisk friske norske referansepersoner tilhører en gruppe med økt risiko for ateromatøse hjerte/kar-sykdommer. De referanseområder for kolesterol som laboratoriet oppgir er verdier funnet ved undersøkelse av en referansepopulasjon valgt etter kriterier som beskrevet ovenfor. Det er derfor klart at såvel risikogrense som beslutningsgrense for eventuelle kolesterolsenkende tiltak befinner seg innenfor referanseområdet, til dels langt ned i dette. På den annen side er det for mange analysers vedkommende en "gråsone" på den ene side eller på begge sider av referanseområdet hvor resultatet ikke umiddelbart har kliniske konsekvenser. En senere kontroll kan ofte være fornuftig, særlig sett på bakgrunn av at en enkelt laboratorieprøve bare gir et øyeblikksbilde og ikke forteller noe om synkende eller stigende tendens. Kliniske beslutningsgrenser kan i mange tilfelle ligge i betydelig avstand fra referansegrenser for vedkommende analyse. Tolkning av svar i relasjon til referanseområde Det er med hensikt at begrepet normalområde er erstattet av det mer nøytrale referanseområde. Betydningen av ordet normal kan det være delte meninger om. Det kan for eksempel med rette hevdes at det ikke er normalt å tilhøre en gruppe med økt sykdomsrisiko. Det er likevel ikke til å unngå at man i praksis ofte omtaler verdier innenfor referanseområdet som normale og verdier utenfor som patologiske. Man bør imidlertid være spesielt forsiktig med å tolke grenseverdier som patologiske. Som nevnt ovenfor vil allerede 5 % av referansepersonene ha "patologiske" verdier. Tydeligere kommer dette poenget frem hvis man utfører en rekke analyser på et "friskt" individ. Vi forutsetter at de analyserte substanser varierer uavhengig av hverandre. Sjansen for at alle svar havner innenfor referanseområdene, avtar da med antallet analyser. Ved 10 analysesvar er det teoretisk bare 60 % sjanse for at alle verdier er innenfor. Dette viser også fordelen av å begrense antall analyser til det som er strengt medisinsk indisert. Det er vårt laboratoriums oppfatning at screeningundersøkelser med store analyseprofiler i praksis ofte skaper flere problemer enn de løser. |
| Hypothyroidism Sun Article, May 1999 Hypothyroidism (low
thyroid) Richard Gracer, MD Hypothyroidism is a common medical condition
that effects many more women more than men. Most hypothyroidism is a result
of an inflammation of the thyroid called thyroiditis. This may be a result
of a viral infection, or a type of "autoimmune" process, during which the
body actually fights itself. Another example of this type of disease is
rheumatoid arthritis. At times the symptoms are severe and obvious. Often,
however, they are vague and can be downright subtle. The classic symptoms
of a low thyroid are fatigue and sluggishness, feeling cold, cold hands
and feet, infertility, heavy menstrual periods, constipation, dry skin and
hair, weight gain without increased appetite or increased calorie intake,
swelling of the soft tissues, depression, and the early development of heart
disease. As early as 1892 animal thyroid extracts were used for treatment.
There was some concern over variable potency, and in the 1960s synthetic
thyroid hormone was developed. The synthetic thyroid hormone currently in
use is pure thyroxine (T4), brand name Synthroid or Levoxyl. The thyroid
produces both T4, which has 4 iodine atoms, as well as a much smaller amount
of T3, which only has three iodine atoms. T3 is four times as potent as
T4. The animal extracts contain both T4 and T3. At first the dosages of
the synthetic T4 were very high, often two to three times what we prescribe
now. Many physicians in the past were content to allow their patients to
have thyroxine levels on the high side, even if the TSH level was lower
than normal, indicating that the thyroxine dose was too high. They watched
for clinical signs of thyroid overdose and monitored the patient’s well
being. Because of concerns with abnormally increased and irregular heart
rate, and possible reduced bone density (osteoporosis), the doses were decreased.
In addition, more sensitive blood tests became available to measure TSH,
a hormone from the brain that stimulates the thyroid to make thyroid hormone.
TSH levels are high if there is not enough T4 in the blood in order to stimulate
the thyroid to produce more. It is now generally believed that when the
TSH level is normal, the body has enough thyroid hormone. Most physicians
are now content to have their patients "stabilized" on very precise doses
of thyroxine, which normalize the TSH and T4 blood levels. Currently the
recommended dose of thyroxine is 100 to 200 micrograms a day. Many patients,
however, do not feel well on these dosages. They feel better with considerably
higher doses than the blood tests indicate. Psychiatrists have known for
years that T3 helps treat depression in patients who seem to have normal
thyroid function. T4 does not help. This has been well documented in many
clinical studies and is commonly used to treat depressed patients. There
has been speculation as to why this helps. Research in rats as modern as
1996 in the journal Endocrinology, shows that giving T4 alone to rats with
no thyroid does not increase the amount of T3 in the cells to normal levels.
In the February 11, 1999 issue of the New England Journal of Medicine, Bunevicius
and his group studied the effects of giving T4 mixed with T3 versus T4 alone
to hypothyroid patients. He found that most indicators of well being and
mood were significantly better with T4 and T3 treatment as compared to T4
alone. T4 is converted to T3 at cellular level by a specific enzyme. T4
is not actually used by the cells. T3 is the active hormone. It seems clear
that the enzyme that changes T4 to T3 may be deficient, causing symptoms
of hypothyroidism even in people who have normal T4 levels. These patients
need to take T3. Physicians who use animal thyroid extracts, such as Armour
thyroid or natural thyroid are often considered to be on the " fringe" and
"unscientific". I just received a letter from and old friend and colleague
who is a thyroid specialist. I had changed a mutual patient from the carefully
regulated T4 that he had prescribed to a thyroid animal extract because
she still had ongoing significant symptoms of depression that were resistant
to therapy. I suspected that she needed more T3. Although it is too early
to tell if this particular women will respond, I've had innumerable patients
with various mixtures of the symptoms listed above who have gotten much
better on the animal extract type thyroid. I am delighted that carefully
performed clinical studies in major medical journals are now showing what
many nutritional physicians have known for many many years.
Well, I have spoken to a few people who were hypo and have cured themselves by eating an all raw fruit and veggie diet. ar > Hi, Went to Internist just now and he said my tsh 17 is very very mild hypo and couldnt possibly be causing my symptoms of depression,fatigue,alzheimers,hopelessness etc. He said even ppl with tsh of 100 generally feel just a little slow and not much else.. He said the Synthroid 0.1 is too high and wants me to cut it in half. He also said that endocrinologists are for complicated problems and that hypo was so straightforward I didnt need one at all. He thinks I shouldnt notice any symptoms with my tsh at 17. Ok well I feel MUCH better now! I did order Thyroid for Dummies and another book...and will try another dr maybe. But this experience was humiliating enough... Any thoughts? Thank you so much for your previous input..I think I'm losing my mind sometimes...K. This is malpractice. A TSH of 17 is solidly hypo under any standard practice and withholding treatment is criminal. Doctor: "Your leg is broken, but only a little bit. The break couldn't possibly be causing your symptoms of limping and pain. I've seen patients with their legs cut off walk around just fine. As a matter of fact, you have too many legs. Let's cut the other one in half. Orthopedic surgeons are for complicated leg problems, and your broken leg is straightforward. Just leave it alone. You look depressed, here take these antidepressants, they'll help you walk better.-- E. Hi all, I haven't posted lately and need some help. My last tsh was 0.92 on only synthroid 1 mg. Still having many hypo symptoms I am also hashi's well I asked my doc for some cytomel and then went on synthroid 0.75 mcg. plus .5 mcg. cytomel. started to feel much better mentally and physically. Now after 6 weeks I have started to back slide with a return of hypo symptoms,aches,gritty eyes,dizzy,stomache still large,headache,brain fog is back. W ell next week I will have a blood test for tsh,ft4,ft3,hope I can tell by my tests if I need more or less of one or the other. Has this happened to any of you? My normal pulse is usually 80 today it is 90 any thoughts? Thanks Jean This has happened to a lot of us. It seems that Dr. Arem's recommendations for reducing T4 is too much - at least as far as many of us are concerned. First of all, are you taking 5 mcg Cytomel once or twice a day? If only once, I'd suggest adding a second one in the afternoon. (I take my second one at 2 PM like Arem suggests and it works well for me). If you are taking it twice a day, then I'd suggest asking for an increase in the Synthroid to 88 mcg. -- E. (Fibromyalga, high doses of T3)You should lower your Eltroxin dose by 25mcg every 10 days whilst upping your Cytomel dose by 10 mcg each time I am now on 60 mcg of Cytomel plus 100mcgEltroxin I was on 250mcg of Eltroxin for 10 yrs going nowhere just fatter, more fatigued and in horrendous pain ..........in just 3 wks i have lost 16lbs and my hearing has improved .......its vital though to follow www.drlowe.com protocol on vitamins, exercise and ultrasound Pat | |
|
Adrenal Health Self-Test: ( page 439)
a common diagnostic performed by many chiropractors, massage therapists and
naturopaths.
Home blood pressure testing kits make this test as easy way to monitor your
own adrenal health.
1. Lie down and rest for 5 minutes. Take a blood pressure reading.
2. Stand up and immediately take another blood pressure reading.
If your blood pressure is lower after you stand up, your adrenals are
probably functioning poorly. The amount of drop in blood pressure is
usually in ratio to the amount of adrenal dysfunction.
Please read the book, The Thyroid Solution by Ridha Arem, MD. I am a physician in NJ who specializes in hormone replacement therapy. Many patients have a cellular resistance to thyroid hormone. Even though their test results are "normal" they still have an underactive thyroid. As I have been trained by fourth generation endocrinologists who treat symptoms and not just numbers, I look at the picture very differently. But we do not learn this in American medical schools. Roberta Morgan, MD Haddonfield, NJ rfoss19900@aol.com | |
| Internett er full av referanser og anekdotiske fortellinger om at mange er
hypothyroide allerede ved en TSH av 2.
Fra
artikkel thyroid.about.com:
Thyroid Awareness Month:
bmj artikkel 1332
Overlap between the statistically derived normal and abnormal ranges is accepted in
diagnostic tests, giving rise to false positive and false negative results. These
concepts have not been applied to measurements of thyroid stimulating hormone.
Rather than accepting that the test can be fallible, we transfer the problem to
the patient.J. O'Reillys response to the letters about his article
bmj1080
The clinical features of thyroid dysfunction are now rarely discussed in the medical
literature and as a consequence, the impression is given that they are of little
importance. 2. 1997;314:1764 (14 June) Letters Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients by Gordon R. B. Skinner, Clinical virologist, R. Thomas, General practitioner, M. Taylor, General practitioner, M. Sellarajah, General practitioner, S. Bolt, General practitioner, S. Krett, General practitioner, A. Wright, General practitioner bmj1764 We wish to question present medical practice, which considers abnormal serum concentrations of free thyroxine and thyroid stimulating hormonethose outside the 95% reference interval to indicate hypothyroidism but incorrectly considers "normal" free thyroxine and thyroid stimulating hormone concentrations to negate this diagnosis. The thyroid stimulating hormone concentrations in 80 patients considered to be hypothyroid on established criteria indicated that only four patients had thyroid stimulating hormone values above the reference interval of 0.5-5.5 mU/l the mean concentration of thyroid stimulating hormone was 2.2 (0.4) mU/l. Responses to the above BMJ letter bmj 1764David Derry, MD, PhD: The maxim of the day before the TSH arrived was you gave enough thyroid until the patient was better. Medical students are taught to treat a lab test and not the patient. This has gone a long way to alienate the patient from the doctor and seek alternative practices for relief. bmj1463 E. H. McLaren, Consultant physician, C. J. G. Kelly, Specialist registrar in endocrinology, M. A. Pollock, Principal biochemist Since they [patients] complained of a considerable reduction in their quality of life, which had not been helped by other measures, we decided that it was justifiable to try treating two of them with 100 g thyroxine daily (after we h ad explained the lack of scientific rationale and obtained their written consent). Much to our surprise, they both reported a considerable improvement in their condition, while the results of thyroid function tests remained within the reference range. Response to the above BMJ letter by Drs E. H. McLaren, C. J. G. Kelly and M. A. Pollock bmj1463 Nikki Tovell, informed patient, currently co-authoring a paper with Dr B. Durrant-Peatfield, 21 June 2000: Drs McLaren, Kelly and Pollack quite rightly state that it is arrogant of the medical profession to assume that everything is known about the thyroid. Currently, hypothyroid testing commonly only addresses T4 and TSH levels.if a patient has signs and symptoms of illness and test results are negative, you aren't performing the right tests. 3. 1997;314:1175 (19 April) "Hypothyroidism: screening and subclinical disease" by Dr. A. P. Weetman, professor of medicine bmj1175 "...a high thyroid stimulating hormone concentration (>2 mU/l) was associated with an increased risk of future hypothyroidism.The simplest explanation is that thyroid disease is so common that many people predisposed to thyroid failure are included in a laboratory's reference population, which raises the question whether thyroxine replacement is adequate in patients with thyroid stimulating hormone levels above 2 mU/l." Responses to the above BMJ article Dr. David Derry, MD, PhD, 17 Oct. 1999 there is no correlation except at extremes between the signs and symptoms of thyroid problems and the TSH. The thyroidologists by consensus have decided that this test is the most useful for following treatment when in fact it is unrelated to how the patient feels. The consequences of this have been horrendous. The TSH needs to be scrapped and medical students taught again how to clinically recognize low thyroid conditions. Raymond Peat, independent research, 16 Nov. 1999: the mistaken idea of hypothyroidism's low incidence in the population led to the acceptance of dangerously high TSH activity as "normal." C. European Journal of Endocrinology1998 Feb;138(2):141-5 High serum cholesterol levels in persons with `high-normal' TSH levels: should one extend the definition of subclinical hypothyroidism? by Georgia Michalopoulou, Maria Alevizaki, Gregory Piperingos, Demetrios Mitsibounas, Emily Mantzos, Panayotis Adamopoulos and Demetrios A Koutras of Athens University School of Medicine, Greece eje 1380141 Subjects with high-normal TSH levels [2.0-4.0 U/ml] combined with ThAabs [thyroid autoantibodies] may, in fact, have subclinical hypothyroidism presenting with elevated cholesterol levels. It is possible that these patients might benefit from thyroxine administration. D. The Journal of Clinical Psychiatry1.1997;58:266_270 Exaggerated TSH Responses to TRH in Depressed Patients With "Normal" Baseline TSH by Robert P. Kraus, F.R.C.P.(C), Elizabeth Phoenix, B.Sc.N., Merrill W. Edmonds, F.A.C.P., Ian R. Nicholson, C.Psych., Praful C. Chandarana, F.R.C.P.(C), and Sonya Tokmakejian, Ph.D., F.C.A.C.B. www.psychiatrist.com Subtle thyroid underfunction may be contributing to depression in some patients with TSH in the upper half of the range usually considered normal. If so, then the TRH-ST [stimulation test] may be more sensitive in identifying this than measurement of TSH alone. 2.A summary was published in July 1993: A Highly Successful Approach to Hypothyroidism by John V Dommisse, MD, FRCPC II. Doctors' Websites1. Suggestions for an Approach to the Management of Thyroid Deficiency" by Dr Barry J. Durrant-Peatfield That the diagnosis is all too frequently missed is commonly the result of an incomplete clinical appraisal in favour of the standard thyroid function tests. These tests are the real problem in diagnostic failure since there are inherent problems in interpreting blood levels of thyroxine and/or thyroid stimulating hormone (TSH) when blood levels may differ widely from tissue blood levels. Since the diagnosis may very properly, and easily, be made clinically, unreliable blood levels should NOT take precedence over clinical judgment. 2. Dr. John C. Lowe: drlowe.com Most Recent Q&As drlowe.com The upper half of the "normal" reference range for the TSH is contaminated with TSH values of patients with incipient thyroid disease. In practical terms, this means that when a patient's TSH is over 2.0, suspecting that she has thyroid disease is reasonable, although the disease may only be dawning. 3. Thyroid Disease Far More Widespread Than Originally Thought, 13 Million May Be At Risk by Dr. Joseph Mercola, DO 1997-20004. Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels by Dr. Joseph Mercola, DO 1997-2000 www.mercola.com Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly accurate measure of TSH but not of the height of thyroid hormone levels.The basic problem that traditional medicine has with diagnosing hypothyroidism is the so called "normal range" of TSH is far too high: Many patients with TSH's of greater than 1.5 (not 4.5) have classic symptoms and signs of hypothyroidism. III.Interviews With Doctors by Mary Shomon 1. An Interview with Don Don Michael, M.D., Dec. 2000: Getting What You Need from Your Doctor: Challenges of Thyroid Care Saying that your thyroid is healthy because your number is between the little number and the big number is easily as foolish as claiming that you are physically fit if your weight is between 75 and 260 pounds (That would probably cover 95.5% of the weights in the USA.) without knowing anything else. 2. "Rethinking the TSH Test: An Interview with David Derry, M.D., Ph.D." July 2000 artikkel thyroid.about.com Many people would develop classic signs and symptoms of hypothyroidism but the TSH was ever so slow to become abnormal, rise and confirm the clinical diagnosis. Sometimes it never did. Finally I began treat patients with thyroid in the normal manner I was taught. I could not see why I had to wait for the TSH to rise for me to be able to treat them. 3. An Interview with Joseph Mercola, DO, June 2000: Hypothyroidism and the Role of Armour Thyroid, Seaweed, Exercise, and More... artikkel thyroid.about.com Most traditionally based physicians have long abandoned their physical examination and diagnosis skills and appear unwilling to believe that patients who complain of all the classic hypothyroid symptoms are in fact truly hypothyroid if their TSH is normal. They would rather believe a lab test than the patient sitting in front of them. 4. An interview with Dr. John Dommisse, MD, FRCP, in which he discusses treating people with a TSH over 1, as well as the use of T3, Sept. 1999 artikkel thyroid.about.com I ran into too many patients who had classic hypothyroid symptoms, which cleared completely on appropriate thyroid treatment, and whose TSH was below 2.0 (but above 1.5) and with FT4 and FT3 levels in the low ends of their 'normal ranges'.Finally, I found some patients with several symptoms and signs of hypothyroidism whose TSH was between 1.0-1.5; so I lowered my range, for the last time, to 0.1-1.0; I now treat primary hypothyroidism with a TSH of >1.0 (if the FT4 and FT3 are low-normal, not above the middle of their 'normal ranges'). IV. Other Websites 1. About.com Thyroid Disease Weblinks and News: "What is Normal TSH? Probably Somewhere Around 1.0! artikkel thyroid.about.com From an About.com reader: "I work in a hospital lab and have done thousands of thyroid profiles. I've discovered that, while normal range for TSH is 0.5-5.0, the AVERAGE TSH for patients with no thyroid disease, is around 1.0!" 2. Mary Shomon, author of About.com Guide to Thyroid Disease and Living Well With Hypothyroidism 'HELP! My TSH Is 'Normal' But I Think I'm Hypothyroid' 11/10/97 artikkel thyroid.about.com "In my own experience, I feel downright awful at anything above 4, and I feel great between 1 and 2, which is where my endocrinologist keeps my TSH. But some doctors would have no problem keeping me between a TSH of 4 and 5.5, still in the "normal" range, despite the fact that I still have the full range of hypothyroid symptoms -- fatigue, weight gain, irregular menstrual periods, dry skin, hair falling out -- at those levels." 3. Thyroid Health Information Site: The Underdiagnosed Epidemic by Ward Dean, M.D. artikel Although many people exhibit symptoms of hypothyroidism, they usually dont receive treatment for this condition if they have normal blood test readings. Their physicians often tell them that their symptoms are due to other causes or that their problem is "all in their head." I have known many patients who were referred to psychiatrists to treat their so-called "psychosomatic" problems. However, when they were later given thyroid replacement therapy, they improved dramatically. Patients' descriptions Nancy N: I start to get hypo symptoms when my TSH starts moving up towards 1.0. I feel best and have no hyper symptoms when my TSH is at about 0.13 or less. Paula: I had hypothyroid symptoms at a TSH of 1.8, last spring, and for years before - my TSH tests were always "normal" - but apparently that is not normal for *me*. I had a TRH stimulation test which was resoundingly positive for hypothyroidism, when my baseline TSH was only 2.4 to 2.8. CW: If my TSH gets above 2.0, I get all kinds of bizarre infections I do NOT get otherwise. Marie: My latest TSH was 0.1 (under normal range) but my doctor still agreed to a trial increase in thyroxine as I was still very symptomatic and my Free T4 and Free T3 blood tests were low down in the normal range.I am feeling a lot better now. LuvARabbit: my old dr., he didn't want to treat me because my tsh was 3.3 and he totally ignored my symptoms and told me to see a shrink. Funny, with a new doc and armour thyroid, I'm doing so much better. V.Books1. Living Well With Hypothyroidism: What Your Doctors Don't Tell You...That You Need to Know by Mary J. Shomon, author of About.com Guide to Thyroid Disease, 2000 p. 252: "The current TSH levels used by laboratories to define the "normal" range of thyroid function and the use of the TSH test as a primary means of diagnosis need to be significantly reevaluated. The .5 to 5.5. "normal" range for thyroid function does not give enough information for diagnosis anymore. Research reported in the British Medical Journal found that TSH levels above 2 are likely not normal and instead include people at high risk to develop thyroid disease. This means that the real "normal" range is probably far narrower and more concentrated at the lower end." 2. The Thyroid Solution by Dr. Ridha Arem, 1999p. 223: "Increasingly, more and more physicians believe that you can be suffering from hypothyroidism even though your blood tests, including TSH, are normal." |