thyroidpatientsca

TSH “can be very misleading” during thyroid therapy, say researchers

July 6th, 2019thyroidpatientsca6 Comments

How many treated hypothyroid patients’ TSH has fallen below range even when both their thyroid hormones are in normal range and when they have no symptoms or signs of hyperactivity or hypermetabolism? In my observation on thyroid patient forums, the answer is “too many.” It’s common among thyroid patients to resort to such forums for peer support when their doctors lower their thyroid hormones based on the lower TSH alone. This is an important blind spot in TSH-centered therapy guidelines that must be addressed in a series of posts that examine the topic of a low TSH’s uncertain relationship to the …

Thyrotoxicosis can occur with high or normal TSH?

July 4th, 2019thyroidpatientsca2 Comments

Table 17.1 in Braverman & Cooper’s 2013 chapter in Werner & Ingbar’s The Thyroid textbook, 10th edition, lists many causes of thyrotoxicosis. The only time the TSH _hormone_ is listed as a cause of thyrotoxicosis is in the case of “Inappropriate TSH hypersecretion.” If thyrotoxicosis can occur when TSH is inappropriately _high_ or non-suppressed in relation to elevated circulating thyroid hormone levels, then you can’t define thyrotoxicosis by a low TSH level alone. A low TSH can’t even be part of the definition of thyrotoxicosis. A TSH test in general, however, is an essential part of the diagnosis of inappropriate …

Thyrotoxicosis vs. Low TSH

July 3rd, 2019thyroidpatientsca5 Comments

Our medical system has invested so much in the TSH test that we’ve given it authority to override medical discernment about thyrotoxicosis. The oft-repeated mantras that “TSH is the most sensitive and specific test” and “the only necessary test” have blinded many doctors to the diverse influences that can suppress or inflate TSH secretion. Many doctors are reducing hypothyroid patients’ thyroid medication doses on the basis of a TSH number alone. However, this TSH-centric view of thyrotoxicosis is inconsistent with the definition found in the most respected textbook in endocrinology. This leading authority defines thyrotoxicosis based on high Free T3 …

Thyrotoxicosis? Many factors can lower TSH

July 2nd, 2019thyroidpatientsca5 Comments

Many substances and health factors can, independently of thyroid hormones, lower TSH secretion significantly. These factors are not listed in Braverman & Cooper’s chapter on thyrotoxicosis in Werner & Ingbar’s The Thyroid textbook, 10th edition 2013, because their chapter avoids defining the syndrome by a low TSH. Nevertheless, these TSH-lowering factors should always be mentioned along with “thyrotoxicosis” in the context of today’s TSH-worship. Whenever doctors see low TSH lab results with normal thyroid hormones, they may presume it’s subclinical thyrotoxicosis and that they must do something about it. Essentially, these are temporary and variable factors that induce “acquired central …

Thyrotoxicosis: Symptoms and signs

July 2nd, 2019thyroidpatientsca4 Comments

Much confusion exists about the value of symptoms and signs in the diagnosis of thyrotoxicosis. The most common view is to dismiss symptoms entirely because each, considered separately, is “nonspecific” to thyrotoxicosis. However, there is no such thing as a “thyroid-specific” symptom because thyroid hormones have their effects in every organ and system of the body. What’s do the experts recommend? Look for several symptoms manifesting at once. Braverman & Cooper’s 2013 chapter in Werner & Ingbar’s The Thyroid, 10th edition, says “it is usually the combination of several that suggests the possibility of the disorder.” Their chapter divides a list into …