The following is the synopsis of a compliation of articles relating to diagnosis of hypothyroidism by TSH. It is by Antonio Bianco & Jacqueline Jonklaas, two leaders in US thyroidology. It questions diagnosis by TSH. Again the US is way ahead of the UK in bringing such questions out into the open.
I quote:
This collection seeks to compile research that (re)defines success in the treatment of patients with hypothyroidism beyond normalization of TSH levels. We welcome (mini)review, perspective, or original research articles contributing to this effort.
BackgroundHypothyroidism was first described in the 19th century, with effective treatment introduced approximately two decades later. Despite large experience accumulated over a century, some modern-day patients continue to experience persistent symptoms despite appropriate treatment.While a stated goal of the treatment of hypothyroidism is to resolve symptoms, most physicians focus on normalization of serum TSH values, which is the marker used to diagnose hypothyroidism and adjust the replacement dose of levothyroxine. However, the complete physiological replacement has not been possible in other hormones deficiency syndromes, and it may be presumptuous to assume that it can easily be achieved in hypothyroidism. Given the residual symptoms and metabolic abnormalities experienced by some patients, there is, therefore, a need to question and redefine therapeutic success in hypothyroidism. Potential issues to consider are whether there are other biomarkers of thyroid status, in addition to TSH, that may be important, and whether different biomarkers are important for different tissues. In addition, the relevance of the origin of the hypothyroidism and how to balance benefit in long-term versus immediate clinical outcomes.
Written by
diogenes
Remembering
To view profiles and participate in discussions please or .
Potential issues to consider are whether there are other biomarkers of thyroid status,
I wish someone would/ could devise a test to measure cellular T3 level!
Wishful thinking I guess!!
Knowing what is sloshing around in the serum is one thing, but unless that T3 reaches the nuclei of the cells and becomes active patients like me continue to suffer!
Without this forum I would not have known where to start looking for answers to what turned out to be this cellular deficiency. My health would have continued to deteriorate. Medics were clueless and the endo I saw said I should just take levo....which after 20+ years had left me barely able to function!
Despite large experience accumulated over a century, some modern-day patients continue to experience persistent symptoms despite appropriate treatment.
This is a strange comment to make. It implies that treatment hasn't changed for more than a century, but of course it has changed dramatically.
Levothyroxine was introduced with no comparisons being made with NDT which was the standard treatment before Levo.
And the introduction of TSH testing was done without any checks that the dosages given to patients based on TSH results led to good health for patients.
Thanks for posting this paper, I hope we follow suit, the discussion is heartening. Personally, I have found NDT has been easy to dose and I feel much better on it than I did for decades before any diagnosis of thyroid disorder and it’s a massive improvement on the two years of living hell I experienced on Levothyroxine. It may not be as difficult as they intone to help a lot of people have a decent quality of life and the choice to take it should be freely available. I’d be interested to see what happened if we were able to choose our therapy. I presume it’s feasible in the US but we don’t even make NDT any more - how very short sighted that was.
Notwithstanding the reply above by humanbean about thyroid treatment having changed over the last century not stayed the same as the authors state, my thought was 'in what profession would action (treatment) that doesn't resolve the problem (symptoms) be acceptable?
For example, think of a faulty car and a mechanic. If a customer took the car to a mechanic and asked him to fix 'a lack of acceleration, poor performance, and a knocking noise from the engine' and the mechanic gave them a litre of oil and said 'put this in the engine'. The customer (patient) would be dissatisfied that the poor performance, lack of acceleration and knocking noise (signs and symptoms of the original problem) continued and the solution (oil) didn't fix the problem. The customer would keep going back to the mechanic (doctor), until they finally gave up and took the car to another mechanic. So it's not surprising that patients change doctors in an effort to get the problem fixed. The ability of medics/researchers to state the obvious never ceases to amaze me.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Optimum TSH, T4 and T3 levels on levothyroxine
Low T4, Normal TSH but symptoms
TSH high - everything else normal
Very High ATG and Anti TPO but normal TSH?
Pituitary gland not producing TSH
