Confusing subclinical and central hypothyroidism

[diogenes]

This downloadable paper discusses a case report where subclinical and central hypothyroidism can be confused.

Central hypothyroidism or subclinical hyperthyroidism: can they be confused with each other?

in Endocrinology, Diabetes & Metabolism Case Reports

Author: Mauro Boronat 1 , 2

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Correspondence should be addressed to M Boronat; Email: [e-mail]

DOI: doi.org/10.1530/EDM-20-0059

Volume/Issue: Volume 2020: Issue 1

Article Type: Research Article

Online Publication Date: 05 Jul

[shaws]

Thanks diogenes for posting. It just goes to show how much endocrinology should know when it seems, on this forum, that their knowledge is very, very low indeed.

[humanbean]

Central hypothyroidism or subclinical hyperthyroidism: can they be confused with each other?

I actually don't believe that central hypothyroidism can even be diagnosed by doctors in the UK any more. If someone has central hypothyroidism and a TSH of, say, 1.0 their Free T4 won't even be tested. And it goes without saying that Free T3 won't be tested either. So someone with central hypothyroidism could be practically in myxoedema crisis and they would be told their thyroid was fine.

It doesn't help either, that doctors don't know the symptoms of hypothyroidism, and blame most or all of the main symptoms on women being mentally ill, anxious, depressed, attention-seeking, hypochondriacs who eat too much and are exercise-averse.

This is why I won't involve a doctor in anything to do with my thyroid or maintaining my nutrients.

[Musicmonkey in reply to humanbean]

I agree! I have argued that I have Central Hypothyroidism with my Endocrinologist as, on diagnosis, my TSH was 2.97 and my T4 was below range at 10.3 (12-22). He doesn't agree, despite me sending him many of the references provided in this article. I am being treated now, but I worry about other patients who will be told that they are fine.

The Endocrinologist lead for the NICE guidance on Thyroid disorders tried to allay my concerns by telling me that all will be well as patients who continue to feel unwell can return to their doctor to report this and have further investigations. Was I reassured? No!

[Tythrop in reply to humanbean]

Gaslighing "experts".

[Angel_of_the_North]

Central hypo is only rare because it's not tested for or diagnosed. I suspect far more people have it than endos admit to. They are quite happy to look at TSH only and condemn patients to a life of illness.

[Tythrop]

Can an earlier Thyroid Storm or sub a cute thyroiditis predispose us to "stuck" tsh at low level, so hypothyroidism never revealed to NHS flat earth society?

[humanbean in reply to Tythrop]

TSH can get "stuck" if it is low for a long period of time. This can happen to people with hyperthyroidism, for example.

To find out if this applies to you then you would need to get tested for TSH, Free T4 and Free T3 all in one test. Since the NHS is very unlikely to do this you would probably have to pay for the testing yourself.

[diogenes Remembering in reply to Tythrop]

Our bodies, in whatever state, try to optimise the situation as best they can. A sudden change in say thyroid dysfunction, spotted and treated early, can be more easily given appropriate therapy than someone who has been dysfunctional over a long period before treatment. Though we all have our unique set of genes, over a stressful time they get partly coated (the process is called methylation) and this alters the readout from the gene and therefore alters how the body works. The longer the period of untreated dysfunction, the harder it is to reverse it and indeed it can become impossible over a person's lifetime. This applies to TSH suppression which can be very difficult to reverse. And in this situation suppressed TSH will not be dangerous, because it no longer plays its part in controlling thyroid function. An example of longterm genetic change (called epigenetics) is when parent rats are trained to avoid a repeated electric shock. This naturally gives them considerable stress. When the offspring are looked at, they have the same stresses as the parents, even though they themselves have never been subject to the reason for the parent's stress. This is all down to epigenetic gene changes caused by the stress and cemented in, which then pass through to the offspring. Similar processes probably are true for upset thyroid function longterm.

[Musicmonkey in reply to diogenes]

Thanks, that's interesting!

[Jenny583 in reply to Tythrop]

Yes! Cue destruction or hiding of medical records!

[Jenny583]

So many tragedies. It's heartbreaking.💔