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Harvard Health Blog
Need to check your thyroid? Maybe not
- By: Marcelo Campos, MD,
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement tablets called levothyroxine. Levothyroxine replaces the thyroxine hormone, which your thyroid doesn’t make enough of. You’ll initially have regular blood tests until the correct dose of levothyroxine is reached…(mygenericpharmacy)
Wrong!!!! I went undiagnosed for years because doctors only run the TSH! I had several doctors think that my symptoms were hypothyroid but then they would run the TSH and tell me I was fine. I was NOT fine!!!! I finally had a doctor who ran additional tests and I was diagnosed and started taking meds and it was like a whole new life! Unfortunately my new dr wants to decrease my dose based solely on the TSH, and like the author of this article, feels the other tests don’t matter. Well they matter to the person who wants to be able to get out of bed in the morning and be able to function!!! Stop spreading this nonsense!
Agree Joan, it would be different if the Dr was unable to get out of bed and function normally. To compare quality of life with $ is a failure to listen and understand your patient.
True. My doctor told me I was fine for years. TSH perfect. I have hypo and Hashimotos with adrenal fatique Low cortisol, low natural hormones. Low B12, Low D. Began seeing a functional medicine endocrinologist.
Finally I am feeling better.
This is a nice article by Dr. Campos, and I think he draws reasonable, conventional, conclusions. I proffer no criticism in my comments. Certainly, this is an important question which deserves continuing research. We don’t know everything about thyroid function yet, and much of it takes place in tissues where we know even less – which is not of itself an argument for supplementation. I do not imply that argument. However, as studies have been published showing increases in reverse T-3 (rT-3) in patients who are very ill, there is some basis for viewing elevated rT-3 levels as an indication of a “dysregulated” thyroid metabolism. (I use the word “metabolism” and not “function” quite purposefully.) What it means in regard to an indication to treat, or who to treat, is clearly something else. I hope we encourage more clinical studies in which we evaluate, in the normal double-blinded manner, fatigue levels, mortality and morbidity, behavioral and mood changes, and other QOL considerations. The TSH level isn’t the only endpoint to be considered. T-3 is being given by many physicians now with the belief, based on their clinical experiences, that it is helpful. . We need to have an open expression of views so we can have access to the data available from those treating their patients. Such situations can drive physicians who follow practices that might lie outside of, or straddle, clinical orthodoxy underground. It isolates and may be unfair to them. It certainly impedes resolution of such issues in the normal scientific manner
I wholly disagree. My TSH was under 10 but I was very symptomatic. My doctor was skeptical, but my numbers got worse and I was put on a thyroxine trial after months and months of suffering. In no time he’d changed his mind and said ‘I can give you more. You’re not on enough.’ The lesson: he didn’t understand that I wasn’t going to improve without a diagnosis and thyroid supplementation. I could have been spared what I went through. I have been on 75mcg for about 11 years and have never tested hyperthyroid. So no over- medication there, doc. Your arguments are totally wrong and out of the arc. Remember ‘first do no harm.’ Inaction when women are unwell with hypothyroid symptoms and lab readings does harm. It doesn’t save money either. They develop other conditions, requiring statins, diabetes meds, blood-pressure meds or vasodilators, water tablets, anti-inflammatories for joint and muscle pain, migraine meds, IBS meds and anti- depressants.
Regarding only testing TSH. Dangerous! This won’t diagnose or monitor central hypothyroidism.
Is hypothyroidism just another predominantly women’s complaint that doesn’t get respect?
Question: if you extrapolate how many people have thyroid disease in the world and calculate the number of people not captured by the TSH test, I wonder how many people would remain sick in your claimed .04%. What do you do for those individuals? That being said, there is plenty of research to demonstrate that TSH is not a perfect test as it tests a pituitary hormone, is not a direct measure and relies on the idea of a perfect HPT axis.
Also, the TSH lab result value of 10 is usually a patient who is quite sick, usually with an autoimmune disease that has been slowly destroying their thyroid for years, but you’ll never know, because you wont test for anything until their thyroid is destroyed because there isnt a pharmaceutical treatment for autoimmune disease.
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