More evidence that ‘normal’ thyroid function tests do not necessarily mean that all is well with the thyroid and health
Earlier this month, one of my blogs focused on thyroid function testing. The main point I wanted to make was that ‘normal’ thyroid function tests do not necessarily mean all is well with the thyroid and health. The blog focused on research that shows that even with the ‘normal’ range, higher levels of the hormone known as thyroid stimulating hormone (raised levels of which generally mean low thyroid function) are associated with increased body weight.
This week saw the publication of a study in a similar vein [1]. In this case, the researchers involved in this study were looking at the relationship between TSH (also known as thyrotropin) levels and risk of death due to a heart-related condition (heart attack being the main cause here).
Again, this study focused on TSH levels in the ‘normal’ range, which the researchers cite as 0.5-3.5 mlU/L. This is interesting in itself, as the lab I usually use for these tests quotes and upper limit of TSH of 4.20, and I saw a patient yesterday who came with some blood test results where the upper limit of TSH was quoted as 5.50! it seems there is a lack of consensus about what the normal range of TSH should be…
Anyway, focusing back on the study, the research looked at the risk of cardiac death in a group of about 17,000 women and 8000 men over a period of something more than 8 years.
They found no significant relationship between TSH levels and cardiac death risk in men. However, in women, it was a different story. Compared to women with a TSH level of 0.5-1.4 (relatively low levels which should mean relatively high thyroid function):
Women with a TSH level of between 1.5-2.4 were found to be at a 41 per cent increased risk of cardiac death.
Women with a TSH level of between 2.5-3.5 were found to be at a 69 per cent increased risk of cardiac death.
Here again, it seems a study has found that ‘normal’ but perhaps somewhat impaired thyroid function is associated with negative consequences for health.
Managing thyroid issues can be tricky, but I do think there is a case for treating some people with ‘normal’ biochemistry if their clinical picture suggests low thyroid function. Biochemical testing can be important, but at least as important, in my humble opinion, is to make treatment decisions on what a doctor sees and hears in front of him or her.
Quite a few doctors I know express concern at the thought of someone with ‘normal’ test results taking thyroid hormone. They often cite the risk of treatment, including risks to the heart. Obviously, I think it’s a good thing that as doctors we should be aware of the risks associated with thyroid hormone treatment. I just wish more doctors would see the other side: that there can be considerable risks associated with not treating too.
References:
1. Asvold BO, et al. Thyrotropin Levels and Risk of Fatal Coronary Heart Disease: The HUNT Study. Arch Intern Med. 2008;168(8):855-860
Published April 30, 2008 . Filed under: Food and Medical Politics, Women's Health
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Thank you so much for your posts on thyroid Dr. Briffa. I believe I’m one of those who have been misdiagnosed. A few years ago I was struggling with keeping my weight stabilized and extreme fatigue. I suspected a thyroid problem and went to my doctor. She tested me and found my TSH to be 3.5. She saw no need for concern, although I had recently read that what was considered “normal” had changed and anything over 3 should be considered suspect. I asked to be referred to a endo, which she did. The endo tested me and found my TSH to be 3.3. She also saw no need for concern despite many of my symptoms lining up with thyroid issues. She waved me off with a prescription for antidepressants and exercise. I was so upset because I felt she wasn’t taking me seriously.
I’ve since just dealt with it the best I could… and gained back almost 70 lbs. Some of the gain was certainly my fault because I eventually quit following a healthy diet. But now that I’m following said diet again, I am struggling to get the excess weight off and keep it off. I am still exhausted most of the time and my hair seems to be coming out more than I think is normal. My dad was diagnosed with thyroid problems recently and I’m considering going to his doctor to have mine checked. You have helped me make up my mind to try once again to get help.
May 1, 2008 @ 8:27 pm
Amy - I totally understand your frustration and went through two years of hell, hair falling out by the handful, weight piling on, I kept yawning all the time and realised later that it was my body trying to get air into my lungs as they weren’t working efficiently! I was SO tired I could not even walk my dogs let alone ‘exercise’ as advised by my doctor! My TSH was 3 at this point and so I was ‘normal’ as far as my GP was concerned - he even said it was ‘just my age’ this was several years ago and I was only 36! Have you taken your temperature? A low temp is a very good indicator of a failing thyroid. A low GL diet helps me enormously and I am now size 10 and feeling great so don’t despair. There are a few private doctors who are experts in this field and will treat even if you are within the ‘normal’ TSH level. A ‘normal’ TSH is a very individual thing in my opinion and each case should be evaluated on presenting symtoms as Dr Briffa says. You can email me privately via our website http://www.dietfreedom.co.uk if you wish. Due to my own condition I did masses of research into this subject (thank goodness!) as if not I dread to think what would have happened as I was sinking into a deep depression and getting no help from the NHS. GP’s need to wake up to the fact that a high TSH causes symptoms that can lead to depression and start treating the actual cause! I wonder how many women taking anti-depressants, piling on weight, being told they have a normal thyroid are out there suffering? We have many members who have symptoms but normal test results. No-one knows precisely what causes the thyroid to start to fail but my theory is that we can’t cope with all the chemicals and levels of pollution that we are subjected to these days. I also think it can be triggered after an emotional trauma.
May 2, 2008 @ 10:07 am
Amy, There are other doctors that you can see for a second opinion. Dr Briffa being one of them. There are also lots of books you can read regarding helping the thyroid naturally. A naturopath or nutritionist can give supplements which can support the thyroid.
However I agree with you as I am in the same position myself. My TSH is even higher than yours but I do inderstand why my GP wont give me thyroxine. It is for life and your own gland can stop producing it if is taken. So I am in a quandry as to what to do. However the study above is worrying.
May 2, 2008 @ 12:05 pm
Tina, Could you please give me your email address. I couldn’t find it on the website. Regards Hilda
May 3, 2008 @ 3:14 pm
The worst part of this is it just too often very difficult to get not only a proper diagnosis for low thyroid function, but even with a diagnosis, it is very difficult to get proper treatment that not only gets the lab results back in line, but also helps the patient to feel better. Too many doctors simply leave the patient “high and dry” because they simply prescribe synthetic T4, get the lab result to a range they like, but still leave the patient not feeling well enough. If the patient still feels unwell, out comes the antidepressant samples or Rx pad.
Conventional medical wisdom since the 70s says that hypothyroidism is no longer common (due to iodized salt, but now many avoid salt), and that it is easy to detect and treat using the 3rd generation TSH test (considered to be the Gold Standard). Not enough doctors also test for free T4 and T3 levels (free hormone, not protein-bound), as well as thyroid anti-bodies). Additionally, many thyroid glands make enough T4 (the inactive hormone) but there is inefficient conversion to the active T3 hormone at the tissue (cellular) level).
In reality, many, if not most doctors simply treat the lab test results and not the patient, resulting in many missed diagnoses, improper and/or under treatment, and continued patient suffering. There is a reason endocrinologists are called ” the accountants of medicine”. Often, you aren’t a patient, you are lab numbers. I’ve been to an endocrinologist who rarely looked at me, but spent most of the appt looking at the lab reports.
Additionally, there is a lot of misinformation that has been taught to doctors, especially primary care doctors, that makes them reluctant to prescribe enough thyroid hormone replacement to get the patient feeling better (they believe it will cause osteoporosis). Additionally, the conventional treatment of hypothyroidism often requires customized treatment for each patient, but the doses in conventional thyroid preparations are too often not optimal (especially with T3). Very few doctors have experience with compounded Rx anymore, but that sort of individual treatment is invaluable for thyroid patients. Most of the time they just prescribe the best selling synthetic T4 drug, because that is the one pushed by a drug rep.
I know this firsthand, as I am hypothyroid. I had classic and increasing symptoms for more than a decade, multiple TSH tests (but my lab used the controversial conventional “normal” reference range of .5-5.5mIU/L). My labs were gradually increasing over the years and always had been in the “suspicious end”). My primary care doctor considered herself somewhat of an expert on the thyroid, yet she insisted my thyroid function was fine (yet even her nurse always joked about how abnormally low my temp always was). But she was happy to Rx any number of other medications for the symptoms. No thanks. When I finally learned about thyroid function on my own, I realized that I hadn’t been getting good care at all for a decade.
I saw two more primary care doctors, one DO family practitioner in my network and one internist out of my network, who would prescribe thyroid hormone for me, but in too small a dose to be effective (they were terrified of prescribing too much), so when my TSH got to a number they liked, but many of the symptoms still remained (especially fatigue, that instead of all the time, hit like a brick in the afternoon) they wanted to prescribe anti-depressants. No thanks.
Finally I just went outside my network (out of state even) to a recommended doctor with a practice only in thyroid disorders and found appropriate treatment (T4 with compounded natural thyroid extract for a treatment ratio of 98% T4 to 2% T3 - adjusted seasonally for winter and summer). It was worth every bit of out-of-pocket costs and travel inconvenience because two years later, life is nearly normal now, without taking additional Rx to suppress hypothyroid symptoms.
I really hope this latest study opens the eyes of many doctors, because there is a lot at stake with low thyroid function beyond fatal heart disease. Undiagnosed hypothyroidism has a profound effect on fertility; enthusiasm and energy to pursue work, leisure, and personal interests; mood and mental well-being, as well as ability to concentrate and think critically; physiological body functions; and of course, overall health and well-being for the long term. It’s important to keep in mind the thyroid gland makes “the master hormone”, like a conductor, which in turn orchestrates many of the other hormone levels as well as sets the pace for the entire body. When thyroid function is even a little bit off, every single cell in the body has trouble functioning “in harmony”.
May 3, 2008 @ 6:07 pm
Ladies
lovely to hear all your comments. Life with hypothyroidism is certainly tough, especially when brain fog seems almost permanent and the ability to ‘insist’ on being taken seriously fades more each day. I thought I was lucky when I was given thyroxine, BUT symptoms persist and now I am concerned about my heart - oh heck, any advice on next step would be most useful.
May 4, 2008 @ 9:32 pm
Carol, you might consider getting your vit D level checked, too.
May 4, 2008 @ 10:59 pm
Hi Hilda
tina@dietfreedom.co.uk. I take liquid Vitamin D by Biocare and feel much better for it. I just drop a few drops into a glass of water (it’s in olive oil.) There is growing evidence that we don’t get enough unless we are fortunate enough to get regular exposure to sunlight.
May 10, 2008 @ 4:11 pm
Carol and all
I thought my life would change when I was finally prescribed Thyroxine, but, like you, found that after the initial 3 week happy honeymoon my symptoms returned with a vengence. My doctor told me it might mean there was something else wrong with me and wanted to do more tests. I didnt give her the chance and took things into my own hands. I read “The Great Thyroid Scandal and How to Survive it” by Dr Barry Durrant-Peatfield. It was brilliant. I now have a very good understanding of the issues and science associated with impaired thyroid function and, armed with this knowledge took myself to a private doctor who would prescribe “Armour Thyroid” which is the natural version of thyroxine and the forerunner in this country up until the 1960s. I also identified that I had “low Adrenal Function” which impairs the body’s processing of thyroid hormones. I started taking “Adrenal glandular suppliment which made the Armour start to work. I have felt much better. I lost 2 1/2 stone following a very low carb diet and feel like my old self again. I am deeply frustrated to hear about how the NHS continues to let this huge section of the population down. They are simply ignoring a growing health problem which can lead to misery and early death for a massive section of the population.
May 14, 2008 @ 4:29 pm
Hello all
I’m again one of many other people with the “your TSH is normal (2.8) so shut up and go home” situation and the doctor doesn’t want to refer me to an endocrinologist as I’m not interresting anough for the NHS to take me serious. I’ve been suffering with the mentioned symptoms for over 10 years now and been diagnosed with Fibromyalgia/ME and all kinds of simular illnesses. I’m just so fed up with hearing ” you just have to live with it and rest a lot” more then 10 hours a day(I think by myself)?
I have done a lot of research on this and really believe that I have an underactive thyroid and would benefit from treatment. I’ve been to numerous doctors with this and keep hearing the same thing. Could anyone (Julie, Tina and others who finally fo )please tell me which private doctors will treat you because I havn’t found anyone yet (Kent).
Can anyone give me some tips please?
May 16, 2008 @ 4:23 pm
Hi Claire
Dr Andrew Wright in Bolton is very good - not near to you sadly!
Tina
July 12, 2008 @ 12:15 am
Hi
I too have suffered from birth with thyroid problems but little did I know at that young age what was to come. I was born with a lingual thyroid (the gland was embedded in the tongue)and all through my life I suffered with hypothyroidism. I too had test after test but they all came back “within normal range”. Many doctors, (most not their fault) have become technocrats and do not look at the patient anymore they seem to have been taught not to do this. I was showing extreme signs of hypothyroidism with dreadful fatigue and a very low immune system. I had infection after infection. I have had most organs removed now through being undiagnosed and mistreated and eventually underwent a horrendous operation in London to remove the lingual thyroid from my tongue. After this I was again guided by these blood tests. T4 was given and I eventually fell into a myxodema coma. I lay in bed for 18 months with fibromyalgia, ME and CFS. Brain fog and everything else you can think of until I found out about Dr Peatfield. It’s a long story so I will cut it short. I recovered, now ski, run and go to work but it took a long time to come back from near death. I run a helpline now as I feel my experience has given me so much to give others. The adrenal glands are also ignored and due to the fact that cortisol has to be present to convert T4 to T3 (the active hormone) to enter the cells in the body it is no wonder most people do not get well. It is a very fine balance to get these two hormones balanced and the longer patients are left the more likely they are to be suffering with adrenal problems as well as thyroid problems. My story is in Dr Peatfields book “The Great Thyroid Scandal and How to Survive it”. I will continue to help others and continue to try to get this system changed. Blood tests do not work and are the main cause of our hospitals spilling over with sick patients. It is no good throwing drugs at a patient, you have to get to the cause of the problem, ie a low metabolism. The great Broda Barnes was right when he said, the pulse before rising is a better indication of a slow metabolism that any blood test. Linda Thipthorp, Metabolic Advisor
September 20, 2008 @ 6:41 pm
Very interested to read posts about private treatment from Julie and the additional supplement. I was diagnosed with underactive thyroid only after I had gained 3-4 stone. Ihave been taing Thyroxine ever since and only lose weight when I am pregnant (?!). Interested to hear of any private doctors in Bucks/Berks or London I suppose as I would really like to get on with my life….
Any thoughts and ideas welcome.
September 20, 2008 @ 6:55 pm
How familiar. I am a staff nurse and have suffered with both high cholesterol and hypothyroid for 8 years. Finally my doctor gave my thyroxin when my TSH was 10.02 which kept my T4 at 11.2.She would only give me 50mcg however. When I saw a surgeon for something unrelated the first thing he said was “why are you on such a small amount of thyroxin”? For me its familiar as all the women in my family on my mothers side have hypothyroid problems and are on thyroxin. I never felt well on 50 mcg. My resting pulse at night was sometimes as low as 40 and my blood pressure was never about 100/50. Finally this year I confronted my GP as my husband and I were going to Rome for 5 days and I knew I had to walk all day for 4-6 hours at least. She doubled it to 100mcg. At least my pulse has come up and my cholesterol down. It is so obvious that if the body is slow the arteries will clog up and then IHD starts. My T4 is 17 today and my TSH O.O3 which is low. I access my own results at work so my GP doesn’t know them yet. Watch this space.
November 7, 2008 @ 8:59 pm