Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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 Objavljeno: 24 Avg 2007 09:13 Naslov sporočila: Normalen TSH, pa vendar tezave (ang) |
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Getting a thyroid diagnosis if your TSH lab tests come back as normal
Many people write to me, asking if they could be hypothyroid, despite having had their TSH tested, and it comes back in the "normal" range. These people often describe a list of standard hypothyroid symptoms and have shown low basal body temperature tests, but standard TSH testing has shown them to be in the "normal range."
Here are some things to pursue in getting a diagnosis.
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What is your lab's "normal" range, and how does your doctor define "normal?"
Different labs have different values for what is normal. For example, at the lab my doctor uses, the normal range is .5 to 5.5. A TSH of less than .5 is considered hyPERthyroid, and a TSH of more than 5.5 is considered hyPOthyroid. Other labs might use .35 to 5, or .6 to 5.2, etc., but it's important for you to know the values at YOUR lab.
AND, it's important to know that as of March, 2003, the endocrinology community has recognized that the normal range is actually narrower. While labs are not necessarily reflecting this in their testing, the official "normal range" is now .3 to 3.0. For more information, read: Endos Say Normal TSH Range Now .3 to 3: Millions More at Thyroid Risk.
If you're on the higher end of the normal range, you could very well be borderline hypothyroid for YOU, but still in the "normal" range. So, you need to know what TSH level your doctor is targeting for you. This is a very loaded, but VERY important question. Your doctor's answer will tell you her or his philosophy about "normal" TSH. Some doctors believe that being in, or getting you into the very top of the normal range is their sole objective, and then the job is done. So, for example, using the 5.5 outer edge of the TSH level from my lab, that sort of doctor believes that getting me to somewhere around there constitutes full treatment.
Other doctors believe that certain TSH levels within the normal range are more appropriate targets. My endocrinologist, for example, believes that women don't feel well (and can't lose weight or get rid of other hypothyroidism symptoms) unless TSH is down between 1 and 2, far below the higher end of "normal." (There are some suggestions in research that have shown that the average TSH of a women without thyroid disease is 2, so that may be why some women don't feel well at 4 or 5.) My doctor wants me to feel as well as possible within normal range, but finds that on average, women don't feel well at the higher end, so she aims to take it lower.
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 3 and 4, still in the laboratory "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.
The best doctor is one who believes that managing your thyroid is a combination of TSH AND how you feel. These are doctors who treat you like a patient, not a lab value! These doctors might say "well, let's get you into the normal range, see how you feel, and adjust the dosage from there."
Have you been tested for thyroid antibodies?
Some doctors believe that a thyroid that is in the process of autoimmune failure -- as evidenced by elevated antibody levels -- can cause hypothyroid symptoms BEFORE the hypothyroidism shows up as TSH outside the normal range, and should be treated with small doses of thyroid hormone.
One doctor who lays out this information is Elizabeth Lee Vliet, M.D., in her book Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. Dr. Vliet does not believe that TSH tests are the almighty indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote from Dr. Vliet:
The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but twoare women, who had a normalTSH and turned out to have significantly elevated thyroid antibodiesthat meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."
Have you had a TRH test?
In an article by Raphael Kellman, M.D. in Alternative Medicinemagazine, Dr. Kellman indicates that some hypothyroidism may not be picked up by the standard thyroid hormone panel, which tests primarily the TSH, (thyroid stimulating hormone).
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If hypothyroidism symptoms are present, but TSH tests are normal, Dr. Kellman often relies on the TRH -- thyrotropin releasing hormone --stimulation test to assess possible hypothyroidism. According to Dr. Kellman, "the physician measures the patient's TSH level (a simple blood test), gives an injection of TRH, then draws blood 25 minutes later and remeasures the TSH. If the first TSH level is normal and the second TSH level is high--above ten--it tells us the patient's thyroid is underactive. A TSH reading of 15 is suspicious, while 20 strongly points to hypothyroidism." Dr. Kellman states that, "of the patients I've seen with three or more typical symptoms of underactive thyroid but who have tested 'normal' in standard tests, 35-40% actually have underactive thyroids based on the TRH test."
Could You Have an Underlying Additional Problem that Requires More than Just Standard Thyroid Hormone Replacement such as Levothyroxine Sodium/Synthroid?
Synthroid, Levoxyl, Levothyroid, Euthyrox, Eltroxin are all brand names for the thyroid drug levothyroxine sodium, which is a synthetic version of the thyroid hormone T4. These are most often the drugs prescribed for thyroid hormone replacement for most patients.
But if you have hypothyroidism and are taking one of these conventional thyroid replacement drugs, your blood tests show a "normal" TSH and yet you still don't feel well, there may be an need for the addition of T3, the other major thyroid hormone.
For example, the book "Myofascial Pain and Dysfunction: Trigger Point Manual," describes the condition of "hypometabolism," where inability to adequately convert T4 to the T3 needed by the body leaves someone with a normal TSH level, but hypothyroid symptoms. Serum hormone studies typically show marginally low T3 and T4 levels, usually within the "normal" range, and TSH is rarely elevated out of the "normal range." At the same time, cholesterol is often elevated, and basal temperature is likely to be 97 degrees F or less. Patients with hypometabolism problems often respond well to T3 or T4/T3 treatments.
Fibromylagia can also be an underlying reason. Symptoms of fibromyalgia can be very similar to thyroid disease, and researchers have found higher incidence of thyroid disease among fibromylagia patients. And the researchers are also finding that these patients need the additional thyroid hormone T3 to resolve symptoms. For more information on fibromylagia and its symptoms, diagnosis, and relationship to thyroid disease, see my article "Chronic Fatigue, Fibromyalgia, and Autoimmune Thyroid Disease.
T3 is available on its own, as a brandname drug known as Cytomel, or can be included with T4 in the naturally derived thyroid drug Armour Thyroid, or the synthetic version of Armour, which is known as Thyrolar.
But My Doctor Thinks that TSH Testing is the Only Way to Diagnose Hypothyroidism, Antibody Tests are a Waste of Time, TRH Tests Are Useless, Synthroid is the Only Drug to Prescribe, and There's no Such Thing as Hypometabolism or Conversion Problems or Fibromyalgia, and Armour Thyroid is an Old-Fashioned, Dangerous Drug
Many endocrinologists are known for being "numbers" people. They manage by the numbers, and not by the symptoms, which can often create the "you're in the normal range, so you're fine" response many of us get to complaints that we still don't feel well. So keep in mind that even if you have easily diagnosed hypothyroidism, it may take some serious looking to find an endocrinologist who believes in finding an optimal TSH for you, and not just getting you into the high normal range and declaring you cured.
As for getting a diagnosis and treatment via the less conventional methods -- basal body temperature testing, TRH tests, antibody testing -- or drugs -- Armour, Thyrolar, Cytomel --you're probably going to need to look outside the standard endocrinology community and find a doctor who has a more holistic approach.
Here, I suggest you visit my article on finding a good doctor. |
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