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Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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 Objavljeno: 24 Avg 2007 09:03 Naslov sporočila: 5 Razlogov, zakaj problemi s scitnico niso odkriti (ang) |
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Five Reasons You Can't Get Your Thyroid Problem Diagnosed
Many thyroid patients write to ask why it can be so incredibly hard to get diagnosed. "It shouldn't have to be this difficult," Annette R. recently wrote to me. Annette saw four doctors before one was actually willing to test her thyroid. Why does it end up being so tough for so many patients? A few things to think about...
1. Your doctor doesn't know about the recommended TSH guidelines. Back in late 2002, a fairly dramatic change to the TSH "normal range" was recommended. This means that millions of people with TSH levels between 3.0 and 6.0 may be told that they have "normal" TSH levels -- and it's not true. Your doctor may be one of the ones who doesn't know -- or doesn't want to follow the new guidelines!
2. Your doctor failed to test your antibodies. Some practitioners routinely do not test thyroid antibodies -- which can evaluate for autoimmune thyroid disease -- in addition to TSH. They refuse to recognize that even when TSH is normal, elevated thyroid antibodies may cause symptoms and require treatment.
3. You didn't get a complete thyroid evaluation. Did your doctor do a complete clinical examination of your thyroid, including feeling for lumps and checking your reflexes? Did your doctor run the full range of thyroid blood tests -- not just TSH? If not, he or she can easily miss a thyroid diagnosis.
4. It's just time for a new doctor. Sometimes, it's time to wipe the slate clean and start over with a new doctor. You may be struggling to get an appointment or a callback, you can't get test results, the doctor's office has lost your files, or you're dealing with other frustrations. These are just a few signs that you need a new doctor.
5. You didn't get your thyroid tests done at the right time of day. The time of day you have your thyroid tests done can affect the results -- enough that you may be told your thyroid is normal -- when it's not. Unfortunately, this is not something most doctors know, much less tell their patients. What are the guidelines? |
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Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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| Objavljeno: 24 Avg 2007 09:09 Naslov sporočila: |
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Clinical Evaluation for Thyroid Disease
From Mary Shomon,
Your Guide to Thyroid Disease.
Stay up to date!
About.com Health's Disease and Condition content is reviewed by our Medical Review Board
Diagnosing thyroid disease is a process that can incorporate numerous factors, including clinical evaluation, blood tests, imaging tests, biopsies, and other tests. Here, the thyroid-specific aspects of a clinical examination for thyroid disease are explored.
THE CLINICAL EVALUATION
A critical part of detecting and diagnosing thyroid disease is a clinical evaluation conducted by a trained practitioner. As part of a thorough clinical evaluation, your practitioner typically should do the following:
Feel (also known as “palpating”) your neck.
Your practitioner is looking for thyroid enlargement (goiter), lumps, nodules and masses in the area around your thyroid. Some trained practitioners are also looking for something known as "thrill" on palpation, this is when the practitioner can "feel" increased blood flow in the thyroid.
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Listen to your thyroid using a stethoscope.
The practitioner is listening for what’s known as "bruit," which means that when she or he is listening with a stethoscope, the practitioner can hear the sound of increased blood flow in the thyroid.
Test your reflexes.
This is usually done with a small mallet on the knees and Achilles area. Hyper-responsive reflexes can be a sign of hyperthyroidism, and slow reflexes may point to hypothyroidism.
Check your heart rate, rhythm and blood pressure.
A slow heart rate (bradycardia) may point to hypothyroidism, and a high heart rate (tachycardia) may point to hyperthyroidism. Some patients with hyperthyroidism also have elevated blood pressure, or rhythm irregularities like palpitations or atrial fibrillation.
Measure your weight.
Rapid weight gain without a change to diet or exercise can be a sign of hypothyroidism, and rapid weight loss may point to hyperthyroidism.
Measure body temperature.
Low body temperature is considered by some practitioners as a possible sign of an underactive thyroid.
Examine your face.
The practitioner is looking for loss of hair in the outer edge of the eyebrows -- a symptom of hypothyroidism -- as well as puffiness or swelling in the eyelids or face, another common hypothyroidism symptom.
Examine your eyes.
The eyes are often affected in thyroid patients, and common clinical symptoms include: bulging or protrusion of the eyes; a stare in the eyes; retraction of upper eyelids; a wide-eyed look; infrequent blinking; and “lid lag" -- when the upper eyelid doesn't smoothly follow downward movements of the eyes when you look down.
Observe the general quantity and quality of your hair.
Hair loss is seen in both overactive and underactive thyroid. Coarse, brittle or strawlike hair can point to hypothyroidism. Thinning, finer hair may point to hyperthyroidism.
Examine your skin.
Thyroid disease, especially hyperthyroidism, can show up in a variety of skin-related symptoms that can be clinically observed. These include a yellowish, jaundiced cast to the skin; unusually smooth, young-looking skin; hives; lesions or patches of rough skin on the shins (known as pretibial myxedema or Graves’ dermopathy); or blister-like bumps of the forehead and face (known as milaria bumps).
Examine your nails and hands.
Your practitioner should look for hyperthyroidism-related clinical signs in your nails and hands, including:
Onycholysis -- separation of the nail from the underlying nail bed, also called Plummer's nails
Swollen fingertips, also called acropachy
Review Other Clinical Signs
Your practitioner should assess other clinical signs of hyperthyroidism, including:
Tremors
Shaky hands
Hyperkinetic movements -- table drumming, tapping feet, jerky movements
Low bone density, seen via DEXA scan or x-ray
Your practitioner should evaluate other clinical signs of hypothyroidism, including:
A dull facial expression
Slow movement
Slow speech
Hoarseness of voice
Edema (swelling) of the hands and/or feet |
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Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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| Objavljeno: 24 Avg 2007 09:10 Naslov sporočila: |
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Does Your Doctor Know About the New TSH Lab Standards?
From Mary Shomon,
Your Guide to Thyroid Disease.
Stay up to date!
About.com Health's Disease and Condition content is reviewed by our Medical Review Board
Even though recommended changes to clinical laboratory standards were announced last year, the American Association of Clinical Endocrinologists (AACE) identified changes early this year, and journals are publishing information about the findings, your doctor probably is still unaware that a major revamping has been done to the so-called "normal range" for Thyroid Stimulating Hormone (TSH) tests -- the primary blood test used by conventional doctors to diagnose thyroid disorders.
Until recently, the standard was that the normal range for TSH at most laboratories has fallen in the 0.5 to 5.0 range, with hyperthyroidism being below .5, and hypothyroidism above 5.0.
The new guidelines, however, the range for acceptable thyroid function, and thyroid treatment should be considered for patients who test between the target TSH levels of 0.3 to 3.0, a far narrower range.
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The AACE estimates that the new guidelines actually double the number of people who have abnormal thyroid function, bringing the total to as many as 27 million, up from 13 million thought to have the condition under the old guidelines.
What to Send to Your Doctor
Since your doctor is likely to say "I haven't heard anything about these new changes," or "the lab is still showing .5 to 5 as the normal range, and I'm not changing anything until the lab does," you will want to send some materials to your doctor ahead of your next appointment. These include the following:
1. January 2003 Press Release from the American Association of Clinical Endocrinologists
Get a copy now
Highlight the third paragraph for your doctor. this paragraph reads: "Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range5 . Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now."
2. The National Academy of Clinical Biochemistry, part of the Academy of the American Association for Clinical Chemistry (AACC), Laboratory Medicine Practice Guidelines: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease
Get a copy now
You may want to highlight the sections that read:
"It is likely that the current upper limit of the population reference range is skewed by the inclusion of persons with occult thyroid dysfunction."
"In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L."
"A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism."
"Thyroxine requirements increase during pregnancy. Thyroid status should be checked with TSH + FT4 during each trimester of pregnancy. The L-T4 dose should be increased (usually by 50 micrograms/day) to maintain a serum TSH between 0.5 and 2.0 mIU/L and a serum FT4 in the upper third of the normal reference interval." |
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