3 ms·
I'd hope that was the case everywhere, but there's still a big grey area. The British Thyroid Association says: "There is no evidence to support the benefit of
by mendelsd 9y ago
I'd hope that was the case everywhere, but there's still a big grey area. The British Thyroid Association says:
"There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L. Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis" [1]
So what might happen to you if your TSH is, say 3.5, for at least a decade (hey hey, I know the answer to this one...)? Well, you're at risk of elevated cortisol with resulting mental illness, to which my previously posted links will attest. Doctors, if they're not especially attentive, will just prescribe the usual anti-depressants (perhaps a low dosage as an anxiolytic) which are band-aids and don't get to the root of the problem.
Note that I never mentioned non-standard tests - "keep testing" means "keep getting the standard tests". The problem is that interpretation of the standard tests varies - some test results may or may not indicate disease, and this is not always carefully followed up on. There are of course many more people in this grey area than there are people with overt disease. I'd say if you're in the grey area and you have chronic mental health symptoms the risk/reward ratio is overwhelmingly in favour of treatment with thyroid hormone (carefully monitored of course).
[1] http://www.british-thyroid-association.org/info-for-patients/Docs/TFT_guideline_final_version_July_2006.pdf http://www.british-thyroid-association.org/info-for-patients...
- epmaybe 9y agoBut then why not just look at the t4 and t3 levels?
- mendelsd 9y ago"Currently, measurement of the serum TSH concentration is the most reliable indicator of thyroid status at the tissue level. Studies of mild (subclinical) thyroid hormone excess or deficiency (abnormal TSH/normal range FT4 and FT3) find abnormalities in markers of thyroid hormone action in a variety of tissues (heart, brain, bone, liver and kidney). These abnormalities typically reverse when treatment to normalize serum TSH is initiated" [1] The reference has loads more detail... [1] https://www.aacc.org/-/media/Practice-Guidelines/Thyroid-Disease/ThyroidArchived2010.pdf https://www.aacc.org/-/media/Practice-Guidelines/Thyroid-Dis...
- epmaybe 9y agoI wasn't arguing that, I was suggesting that if it wasn't clear why the tsh level is high or low, to add on a t4 level check. Which is what is currently done, at least in the US.
- mendelsd 9y agoWell, there's a common condition called subclinical hypothyroidism which may be asymptomatic and harmless, or it may indicate thyroid disease and be accompanied by various non-specific symptoms. It's defined by slightly elevated TSH but normal T4 test results. Anybody with that condition would not be helped by what you are proposing. In general, it seems to me that you will get some false negatives when using a less sensitive test result to qualify a more sensitive test result.
- pas 9y agoThe link seems to be 404, was this the document you intended to link? http://www.acb.org.uk/docs/default-source/guidelines/TFTguidelinefinal.pdf http://www.acb.org.uk/docs/default-source/guidelines/TFTguid...
- mendelsd 9y agoYes indeed, thank you.