Are conventional thyroid function tests as reliable as we’re led to believe?
Posted on 28 March 2009
This morning, I saw this piece of news on the BBC website which reports on the accusation some doctors (endocrinologists) have leveled that some doctors are misdiagnosing and mistreating thyroid disease. The main gripe appears to be the fact that some doctors are willing to entertain the diagnosis of low thyroid function (hypothyroidism), even when blood tests are normal. Moreover, thyroid hormone can be initiated in these patients, which may be harmful.
Key to understanding why some doctors do not put their full and utter faith in conventional blood tests when assessing thyroid function is a knowledge of the normal physiology of the thyroid. The thyroid is responsible for producing thyroid hormones which stimulate the metabolism and facilitate energy production in the body
Published March 28, 2009 . Filed under: Food and Medical Politics, Specific conditions
Dr Briffa- Any idea why I have high TSH, low T4 but when T3 was tested it was three times the normal amount?
March 28, 2009 @ 12:28 am
As author of the book Stop the Thyroid Madness: a Patient Revolution Against Decades of Inferior Treatment, and owner of the website http://www.stopthethyroidmadness.com……I am proud of you!
I have a 45 year old niece who had a “normal” TSH for 15 years, yet we now see she had clear hypothyroidism with a variety of symptoms to match the entire 15 years! She was put on an anti-depressant, told to exercise more and eat less, and told that her fatigue is “simply” from being a mother of ONE child.
Baloney.
As a result of being held hostage to the TSH “normal” range, and being forced to live with undiagnosed hypothyroidism, my niece also now has adrenal fatigue—another complicated condition to treat, and important to treat so she can tolerate T3 in Armour.
And the above scenario has happened to MANY patients, even if they didn’t have to go so long. It has also happened to those on the inferior levothyroxine, which leaves most everyone with their own variety of lingering hypothyroid symptoms.
Thank you for being open-minded, Dr. Briffa!
p.s. Here’s my latest blog post about the idiocy of what’s going on in the UK: http://www.stopthethyroidmadness.com/blog
March 28, 2009 @ 12:28 am
Dr. Briffa,
I have a family member whose hands can feel like icicles at some times and then be extremely warm at others, regardless of ambient temperature, and there seems to be little rhyme or reason to this.
With hypothyroidism, would the hands almost invariably be cold or would there be wild unpredictable fluctuations like this? Or does this sound more likely to be auto-immune related? I realize you can’t determine much based upon so little info, but any input at all would be much appreciated.
March 28, 2009 @ 8:20 am
Joe
Anything’s possible, but it doesn’t sound much like hypothyroidism to me, especially if there are little or no other signs and symptoms of this condition. A more likely diagnosis, I think, is Raynaud’s phenomenon.
March 28, 2009 @ 10:20 am
Hilda
I’ve not seen results like these before. One thing to consider is the possibility that much of your T3 is in the form of the inactive ‘reverse’ T3.
March 28, 2009 @ 10:24 am
Interesting. But how can you be sure that the diagnosis of hyperthyroidism without a positive test result is correct and that a response to THT is not a placebo response (it doesn’t have to be ‘glorified’)? After all, the symptoms could be symptomatic of something else.
March 28, 2009 @ 12:28 pm
?
March 28, 2009 @ 12:30 pm
But why would this article be more useful for GPs than the guidance from the Royal College of Physicians (which says the only accurate way to diagnose a thyroid disorder is via a blood test) or the British Thyroid Association (which says urine tests, saliva tests and measuring body temperature are not reliable ways of diagnosing the condition)?
Diagnosis by the presentation of symptoms is also fraught with difficulties, as the BBC article says:
The BTA is concerned about doctors outside the NHS and misnformation on the web, not GPs.
March 28, 2009 @ 3:17 pm
Couldn’t agree more, over time I’ve met not a few people whose symptoms, including diabetes (both types) and “depression” especially treatment-resistant depressions, have resolved or improved from a geographical move from an area where TSH of 5 or even 10 was considered “not to be treated” to somewhere they are more aggressive. One person lost nearly half her body weight and improved her IQ back by 50 points
Some people actually need TSH around unity to become “normal”. Others may have “normal” TSH but T3 or T4 is way out – hard to tell as many labs don’t do these tests, even one friend was unable to get hers tested privately as the lab didn’t have the kit. Sometimes a simple prescription like a brazil nut a day (for selenium) or iodised salt may help with the conversion.
Our GP here are very proactive and find low thyroid not uncommonly, principally but not exclusively in post-menopausal women, with incidence increasing with age. Whether this is a local or general phenomenon is impossible to tell since so many other regions simply don’t look, or don’t treat.
IMO this is a typical NICE/meeja scare story, it’s not implausible that some people are unneccessarily treated but the number of untreated cases which should be addressed is probably several orders of magnitude greater
March 28, 2009 @ 3:38 pm
Is this really an issue with the reliability of the ‘conventional thyroid function tests?’ as the blog titles states or is about how the results of the test are interpreted?
I believe the estimate was in increase in the US was from 13m to 27m, not a quadrupling but in any event, what is the issue with this? The AACE changed their guidelines because data suggested that low-level thyroid problems were being missed and that a narrower TSH range would allow doctors to consider these cases more carefully. Here’s the press release:
http://thyroid.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=thyroid&cdn=health&tm=9&f=00&su=p284.9.336.ip_p726.5.336.ip_&tt=2&bt=1&bts=1&zu=http%3A//www.aace.com/newsroom/press/2003/index.php%3Fr%3D20030118
This does not cast doubt on the reliability of the test itself. Is this any reason to disregard it?
Also isn’t it relatively simple to discount secondary hyperthyroidism during diagnosis since signs are very different?
March 28, 2009 @ 3:59 pm
Once again it takes John Briffa to get to the heart of a problem that affects so many people. To anyone who has an interest in this subject I would strongly recommend Broda Barnes’ book “Hypothyroidism, the Unsuspected Illness” as bedtime reading. Barnes main philosophy was “Health begins and ends with the proper balance of the endocrine system” and he also gave us these two key discoveries:
1. The development and use of thyroid function blood tests left many patients with clinical symptoms of hypothyroidism undiagnosed and untreated.
2. Patients taking thyroid replacement therapy have much better improvement of symptoms with natural desiccated thyroid hormone rather than synthetic thyroid hormones.
Barnes also investigated the link between hypothyroidism and hypoglycaemia which links in with a whole range of issues that John Briffa discusses, and, I would suggest, is essential reading for diabetics.
A final bit of info – just because you take thyroxine don’t think that that’s the problem solved. If you feel tired get your levels checked again. My sister has jus had her dose quadrupled and my mother’s dose has just been increased by 30% so it does need continuous monitoring and rechecking if symptoms reappear. Also if you’re tired still get your iron levels checked…..
March 28, 2009 @ 4:30 pm
Oh yes, I also forgot to mention the Zone diet and it’s followers amongst those with inflammatory conditions, which is also, with a bit of tweaking, the diet recommended by Broda Barnes…..also don’t get put off by Barnes being a little out of date – the chap spent 50+ years studying this stuff – he knew what he was talking about!
March 28, 2009 @ 5:11 pm
Carol. I would get T3 tested, plus revers T3 ans antibodies, also candida and go to a naturopath or nutritional doctor to look at adrenal fatigue and diet especially essential fats as hormones have to lock on to cells which is affected by haning the right fats in the membrane. Hilda Glickman, nutritionist
March 28, 2009 @ 6:12 pm
Very clearly written John. Perhaps this should be circulated round GP practices or published in their journal. As you say, sadly there are many people suffering with low thyroid who don’t get treatment because the blood tests are “normal”. Do you think any other tests are more useful such as looking at antibodies or the Broda Barnes test?
March 28, 2009 @ 9:19 pm
One of your readers from the USA. Found this interesting as I was treated with anti-depressants for a period of time — and then taken off them when physical symptoms got worse. Eventually, my doctor attended a lecture on thyroid developments, tested my free T4 and free T3 and began treatment with supplements of both. She determined that I should never have been on the anti-depressants. Since then I have begun to recognize when I need to be retested and the meds adjusted. As it turns out, a mid-range free T3 for me means I have symptoms; two days of increased T3 supplementation and I’m back to feeling like a normal person. I have been driving friends crazy suggesting that they get proper thyroid testing, since throughout the last three years, my TSH has remained “normal.” So anytime I see doctors considering that it is not the perfect test so many believe it to be, I want to applaud.
Regards,
S
March 28, 2009 @ 9:48 pm
This re-enforces a feeling I have had for some time.
I am a herbal practitioner of 22 years in practice and many a time I have had people (mainly women of a certain age), with glaringly obvious low thyroid symptoms, but a negative blood test.
I have, in most cases, gone ahead and treated them as if they had low thyroid function, with a degree of success.
Overall treatment invariably includes treatment for the pituitary gland, especially if distressing menopausal symptoms are part of the picture.
One saving grace in this approach is that herbal medicine does not ‘replace’ thyroxine, but encourages the natural production of any needed hormones.
Jenny Jones
March 28, 2009 @ 10:20 pm
Thank you for this excellent article.
I am interested to see that you don’t mention another increasingly common cause of hypothyroid symptoms alongside normal TFT results – the conversion from T4 to T3 within the body’s cells, for reasons such as low enzymatic function or hormone resistance in general.
In my case, this was the problem, and my low thyroid function turned out to be secondary to Chronic Fatigue, and once I was treated with nutritional medicine over several months, my body started to function better, which had a knock-on effect on my conversion levels revealed in subsequent thyroid function blood tests. After over three years of taking natural thyroid hormone to support my low thyroid function, I’ve now been able to stop the supplementation. My eyebrows have returned and my body temperature is 98.4F for the first time in my adult life (I’m 49). Hopefully one of the steps towards full recovery!
March 28, 2009 @ 10:38 pm
Katy
You’re very right about this: It’s not that uncommon to find someone with ‘normal’ TSH and T4 levels to have low or low-normal T3 levels. I find that getting T3 levels up (treatment with T4 won’t always do this, as you suggest) is often key to resolving hypothyroid symptoms.
March 28, 2009 @ 10:50 pm
Thank you for this article – it is very timely.
I was diagnosed as hypothyroid 5 years ago and have been very frustrated with the “treat-the-labs” approach, as a result of which I sought the guidance of a naturopath who immediately diagnosed adrenal fatigue, low iodine, low B12, and low iron to mention just a few items. As I have found out, these are all part of a classic constellation of symptoms/deficiencies that present with hypothyroidism and may actually cause hypothyroid symptoms OR be the result poor thyroid function, so I am particularly disappointed that my ‘tradtional’ PCP and endocrinologist didn’t test for these very basic items. Iodine especially seems to be key to optimum thyroid function, and to test for it is relatively simple and inexpensive (a 24-hour urine test), especially compared to some of the more ‘high tech’ tests such as radioactive iodine uptake studies which seem to be more popular among specialists.
If we are going to use lab results, they should at least be scientifically standardized and should be regarded as PART of the diagnostic process. They should also include testing for the above mentioned minerals/vitamins in addition to relatively obscure but essential items such as reverse T3.
Again, thanks for your articles on this. The more patients are aware, the more they can advocate for themselves and find doctors who are willing to work with them holistically instead of as lab data.
March 29, 2009 @ 12:48 am
Hi
I have been taking thyroxine for at least 8 years now and despite jogging and walking for 30 mins three times a day, eating a low carb diet I am so pooped at the end of the day I sometimes sleep for two hours before supper. I also am bi-polar (JUST CONFIRMED) and don’t seem to have the mental energy to keep fighting with my body. My weight has gone up from a consistent 9.5 stone to 12.5 and yes I am 53 but PLEASE don’t anyone tell me its my age or I’ll scream.
Any suggestions – PLEASE
March 29, 2009 @ 2:18 am
Tony
March 29, 2009 @ 10:53 pm
One of the best ways to test for hypothyroidism is still the basal temperature. Upon awakening 96.5 and below – good chance the person is hypothyroid. Follow-up tests (FT4, FT3, TSH), looking for a goiter and thyroid antibody tests, possibly a fine needle biopsy, etc. should then be done.
Some doctors will say this is an old method (temperature taking) – but I believe it is tried and true and is a very good indicator of what is happening to the metabolism as well.
Hashimoto’s Thyroiditis in 70% of cases is as the result of a mycoplasma infection – treated with doxycycline in small amounts, a remission of the disease could occur in some cases.
March 30, 2009 @ 10:45 pm
Thank you, Dr Briffa, for speaking out once again on this issue. As a hypothyroid patient who has seen much better clinical results with combined T4/T3 treatment (specifically natural thyroid extract) than with T4 only, and with a treated TSH suppressed below the normal range, this reiteration of dogma by the Royal College of Physicians is both alarming and frustrating. One can only hope that dissenting voices like yours can help to balance the medical climate somewhat.
April 1, 2009 @ 11:18 am
Dr Broda Barnes years ago put forward the theory of basal temperatures showing suspect thyroid action. The only time I got my temp up to 38c was when I had terrible fever. When I first started taking it, it was normally 34c but was told that ‘no one took temperatures now to check thyroid problems. How many people are still using fluoride toothpaste, that is one aggravation – there are lots of toothpastes without it. The Australian Thyroid Association (?) had information questionaires to check symptoms and there are pages of symptoms. To tick more than about eight symptoms is asking to be called a hypocondriac by your GP. Good article about taking either natural or synthetic hormones. I have taken only natural, but my adrenal function is suspect too.
I have done a ‘family tree’ of all my cousins and their children, as I’ve read its hereditary. Of the 16 of us, 12 have below normal temperature, weight problems, depression,constantly tired etc. Not being a doctor they dont take my advice and get their thyroid checked, even my sister who had goiter many years ago. Most of them have have been checked and told its not thryroid. The difference it makes to your life when you get the medication correct is just too good to be true.
April 1, 2009 @ 11:36 am
Tony
?
April 3, 2009 @ 8:42 pm
“Tony”
??
April 15, 2009 @ 9:31 am
I have a referral letter from an osteopath to have tests for T3, T4 and Thyroid antibodies. My TSH level is “normal” at 2.9. My doctor says the lab wouldn’t do the other tests with a “normal” TSH. Where can I obtain private blood tests without a referral from my doctor for these in the North West of England?
April 15, 2009 @ 5:17 pm
When will the ‘authorities’ realise that there is a lot of ‘self-treatment’ going on, and will continue to go on, in the area of hypothyroidism, whether they declare that treatment ‘wrong’ or ‘dangerous’ or not?
Now that we underdiagnosed/undertreated hypothyroids can access information for ourselves via the internet, and more sources of information are becoming available (such as hypothyroid patient websites and books such as Dr Peatfield’s ‘Your Thyroid and How to Keep it Healthy’ and Janie Bowthorpe’s ‘Stop the Thyroid Madness’), we are no longer content to suffer with our symptoms just because the blood tests are so-called ‘normal’. We go to brave doctors like Dr Peatfield or we take our information from internet forums populated by other people who have consulted him or other like-minded medical professionals, and we order our natural desiccated thyroid, T3, adrenal supplements etc direct from online suppliers. So we’re ‘hidden’ from the official statistics.
If the ‘authorities’ were bothered to find out how many hypothyroids are self treating, they would probably be aghast.
But they should ask themselves why do so many people feel the need to do this, particularly in the UK where medical treatment is theoretically free.
The ‘authorities’ simply have their heads in the sand over the diagnosis and treatment of hypothyroidism. In my blog at http://gooddietgoodhealth.blogspot.com/search?q=hypothyroid there’s a link to an excellent paper on the treatment of hypothyroidism by thyroid expert Dr John C Lowe. I hope one day the ‘authorities’ will recognise its value. Until then, those of us who need help will simply ignore GPs and endocrinologists who either believe or are forced to toe the official line, and continue to self treat.
Jackie
June 16, 2009 @ 4:09 am
please can you help me?my endocronologest will not give me thyroxine because he says my thyroid levels are IN MID RANGE! even though he knows im presenting ALL the symptoms of slow thyroid. my gp says im deprressed(surprise surprise!) i challenged him to put me on thyroxine for 4 months and if it didnt work id take all the anti depressents he could throw at me! for those 4 months i felt better than i have for 9 years. my hair started to grow as did my nails,eyebrows.cuticals ect i lost weight my bmi came down to normal my collesterall came down the list goes on and on.my gp sent me to a so called specialist i have had no thyroxine for nearly 5 months now he says my throid levels are mid range even though he accepts the theory that MY thyroid might run at a much higher rate than mid range he refuses to give me thyroxine. i begged him in tears he has sighned me out of hospital care and told me hes just had the exact same conversation with the last 3 women patients hes had. they left crying too. please can you help me i can not live any longer like this. this is not liveing i just exist.iv tryed to keep it short as the list goes on and on. im so desperate im thinking of buying levothyroxine off the internet from the usa but im scared incase the place shuts leaveing me high and dry or i give myself to big a dose.i can not live much longer in this state nor do i want to.
June 24, 2009 @ 9:20 am
Nikki, you need to go private and see a Doctor such as Dr Briffa or Dr Skinner (Birmingham) who will be able to help you even though your blood test results are ‘normal’.
You don’t have to live with depression and all the other symptoms but i would probably give your usual Dr and endocronologist a wide bearth…some people have their minds shut and it’s a waste of time trying to convince these people. Instead see someone who understands the problems with the blood tests results….get better and have the last laugh.
Best of luck with everything,
Claire
August 1, 2009 @ 1:58 pm
Dear Dr Briffa,
I became depressed, sluggish, tired all the time and gained a lot of weight 17 years ago at the age of 13.
My lab results for TSH and T4/T3 are normal according to my doctor, but I took my temperature on waking this morning and it was 34.6 degrees celsius.
Could this be a case of hypothyroidism? And is it essential to use a mercury thermometer? I have been using a digital one as I find them less fiddly.
August 10, 2009 @ 11:19 pm
Kit
“Could this be a case of hypothyroidism?”
In a word, “yes”.
“And is it essential to use a mercury thermometer? ”
Don’t know. Unless your digital thermometer is wildly inaccurate, your body temp appears to be low.
August 11, 2009 @ 6:02 am
Many thanks for replying so soon. I much appreciate it.
According to its manufacturer the digital thermometer I used had an accuracy range of +/- 0.2 degrees celsius, so I think the results are outside the margin of error.
I also read somewhere that temperature readings below 97.6 degrees fahrenheit should be followed through with tests for the presence of both thyroid peroxidase and thyroglobulin antibodies. Do you think that this would be necessary or useful?
Cheers.
August 11, 2009 @ 9:29 pm
Hi Dr Biffa – I find the whole hypothyroidism very interesting and you explain it so well. I too have a problem with my thyroid although my GP tells me I am perfectly normal and has done for the past 10 years. Last month my TSH measured 1.99 (GP blood test) but a private urine test revealed that I had very low T4 and T3. My GP has poo-pooed my results despite the test being from a reliable and professional laboratory. I have used thyroid supplements, nutritional glandulars and converters in the past plus iodine and selenium but am still not improving. Can you give me any guidance please?
October 30, 2009 @ 3:25 pm
Dr Briffa,
Are there any pointers to suggest that thyroid issues, hypothyroidism, arise from factors of the modern human habitat, perhaps including features of the modern diet?
December 9, 2009 @ 1:26 pm