How Can I Get Treatment For Hypothyroidism With Normal Tsh
If you have symptoms of hypothyroidism but your doctor says your TSH is fine, have hope! You could still have hypothyroidism with a normal TSH.
First, I would ask my doctor to run a wider range of thyroid tests including:
Next I would ask my doctor to treat me based on hypothyroid symptoms and body temperature. Its important to note, if a doctor will not run these tests or wont acknowledge symptoms, I would find another doctor immediately. I would not waste any emotions trying to educate a doctor who has a different viewpoint.
Consider Other Levothyroxine Brands
Levothyroxine is the generic name of the drug marketed under many different brand names. The majority of people first starting treatment will be prescribed the Synthroid brand. Other available brands include Levoxyl, Levothroid, and Unithroid.
While the U.S. Food and Drug Administration tightly regulates the type, purity, and amount of key active and inactive ingredients in a drug, different manufacturers may use different fillers and binding ingredients, some of which may affect drug absorption or trigger adverse symptoms. Changing brands may potentially alleviate unintended side effects. Talk to your doctor about whether this might be right for you.
What Is Thyroid Medication
Thyroid Hormone Treatment Levothyroxine is thestandard of care in thyroid hormone replacement therapy and treatment of hypothyroidism. Levothyroxine is equivalent to the T4 form of naturally occurring thyroid hormone and is available in generic and brand name forms.
How do I take levothyroxine? To optimize absorption of your thyroid medication, it should be taken with water at a regular time each day. Multiple medications and supplements decrease absorption of thyroid hormone and should be taken 3-4 hours apart, including calcium and iron supplements, proton pump inhibitors, soy, and multivitamins with minerals. Because of the way levothyroxine is metabolized by the body, your doctor may ask you to take an extra pill or skip a pill on some days of the week. This helps us to fine tune your medication dose for your body and should be guided by an endocrinologist.
For patients with celiac disease or gluten sensitivity, a gluten free formulation of levothyroxine is available.
Some individuals may have genetic variant that affects how the body converts T4 to T3 and these individuals may benefit from the addition of a small dose of triiodothyronine.
Liothyronine is replacement T3 thyroid hormone. This medication has a short half-life and is taken twice per day or in combination with levothyroxine. Liothyronine alone is not used for treatment of hypothyroidism long term.
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So If My Labs Are Normal But I Still Feel Bad Then What
It can feel frustrating to get your lab results back only to learn that everything is “normal,” despite not feeling that way. It’s certainly possible to still have low thyroid symptoms with normal labs.
Ahead, other factors that may be contributing to your symptoms. Of course, none of these is a medical diagnosis. We recommend that you work with a doctor who takes a proactive approach to uncover the root cause of your troubles.
Subclinical hypothyroidism is a mildly elevated TSH level in the presence of normal free T4. You may or may not experience mild symptoms of hypothyroidism. It is challenging to determine which symptoms, if any, are related to subclinical hypothyroidism as the symptoms are often nonspecific and could be related to any number of other things.
Clinical symptoms of hypothyroidism usually present when the disease is fully developed. Still, there may be a correlation between higher TSH levels and the severity of symptoms.
Symptoms of hypothyroidism may include: â
- Weakness, lethargy, fatigue
Vitamin or mineral deficiencies
Micronutrients, which include vitamins and minerals, are essential to our body’s function. Our bodies need adequate micronutrients for a healthy metabolism, immune function, growth and development, bone health, and many more processes.
Hypothalamic and/or pituitary disease
Common symptoms of adrenal stress are:
- Dizziness when standing
- Gastric ulcers
Poor thyroid hormone conversion
Inquire About A T3 Drug
There are many doctors who consider the addition of a T3 hormone, in the form of Cytomel , wholly unnecessary and problematic. They will point to the fact that it is prone to rapid uptake in the intestines and may quickly turn a hypothyroid problem into a hyperthyroid problem. T3 hormones can also interfere with T4 blood test results and complicate the monitoring of your disease. All of these things are true, but to a degree.
If you are able to maintain control of your TSH and T4 but are feeling unwell, the addition of Cytomel may improve your symptoms, according to research from Spain and the National Institute of Diabetes and Digestive and Kidney Diseases.
The same research suggests that the combination of Cytomel and levothyroxine may improve symptoms without any additional side effects compared to levothyroxine alone.
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Can I Take The Test At Home
At-home thyroid test kits are commercially available without a prescription and measure the same hormones as the traditional thyroid panel.
For at-home testing, you prick your finger to get the necessary blood sample. That sample is then mailed to a laboratory that conducts the thyroid panel and makes the results available to you directly.
While at-home testing can measure thyroid levels, it is generally not a substitute for a test ordered by your doctor. If an at-home test detects abnormal thyroid levels, your doctor will likely recommend a new blood sample and thyroid panel to confirm the results. At-home tests for thyroid labs may not be as accurate as tests done in a laboratory.
Thyroid Treatment Depends On The Right Diagnosis
The five patterns above are only a partial list. Several others also cause hypothyroid symptoms and dont show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, its likely you have one of them.
Not only do these patterns fail to show up on standard lab work, they dont respond well to conventional thyroid hormone replacement. If your body cant convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesnt matter how much T4 you take you wont be able to use it.
Unfortunately, if you have one of these patterns and tell your doctor your medication isnt working, all too often the doctors response is to simply increase the dose. When that doesnt work, the doctor increases it yet again.
As I said at the beginning of this article, the key to a successful treatment is an accurate diagnosis. Without understanding precisely whats causing the problem, you may end up with a treatment that isnt well-suited to your specific situation.
The good news is that, once the correct diagnosis is made, patients respond very well to treatment.
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What Is The Consequences Of Inaccurate Tsh
People are misdiagnosed for hypothyroidism based on what doctors believe to be normal TSH result. Consequently these patients go untreated, continuing to experience a myriad of life hindering hypothyroid symptoms. Patients like myself feel emotionally hopeless because we know something is wrong, yet we cannot get proper treatment. Some patients are told by doctors its all in your head and you just need therapy when in fact hypothyroidism with a normal TSH is real and treatable. Your health matters, you dont have to suffer with symptoms of hypothyroidism.
Why Not Check Thyroid Hormones Directly
Why not check the thyroid hormones themselves, to see if the gland is not functioning properly?
The thyroid only makes small amounts of T3. Even in cases of severe hypothyroidism, T3 levels dont go down that much. T4 is produced in large quantities by the thyroid. However, TSH is a far superior screening test because small changes in T4 cause large TSH spikes. Usually when a person has hypothyroidism, TSH levels become very high way before T4 levels fall below normal. So, in our analogy, the thermostat is very sensitive to small variations in temperature.
Thats why a normal TSH almost always means the thyroid gland is healthy and producing enough thyroid hormones. Research finds that a simple TSH test is enough to identify hypothyroidism in 99.6% of the tests performed.
You may have heard of expanded or full thyroid panels, which often include tests for TSH, total T3, total T4, free T3, free T4, anti-TPO antibodies, thyroglobulin, and reverse T3. There is no evidence these extra tests help to diagnose and manage thyroid disease, although they definitely add to health care costs. Proponents of expanded thyroid analysis believe more data may support a personalized intervention plan. However, what happens in a lab test often fails to mirror the elaborate dance of hormones in the body. Additionally, findings are highly variable. What happens in your body today may change in a matter of days or weeks, even without significant interventions.
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The Problems With The Standard Thyroid Panel
If a patient comes to her doctor with a laundry list of hypothyroid symptoms, her doctor will most likely order a standard thyroid panel. However, the standard thyroid panel is problematic for several reasons:
Think twice before prescribing thyroid hormone. These five patterns of thyroid dysfunction not only fail to show up on lab work but also tend to respond poorly to conventional thyroid hormone replacement.
The Myth Of Blood Tests As The Only Reliable Way Of Diagnosing Thyroid Conditions
If your TSH test result is abnormal the lab will run an FT4 check as well. Whilst this is an improvement on a TSH only check, it is still fallible and can produce false negatives.
Doctors have been looking for a diagnostic test for thyroid problems ever since the importance of thyroid hormones was recognised late in the eighteenth century. There have been numerous proposals for different tests for thyroid illness prior to the advent of the blood test used today but not one was found to be reliable. Unfortunately, the currently used thyroid function test, based on a blood sample, has its own limitations.
What should really be measured are the thyroid hormone levels in every cell in the body. As it is not practical to do this, they are in effect inferred from those in the bloodstream. However, the transfer of thyroid hormones from the bloodstream and into the cells is quite a complicated matter and there are several points in the process where problems may arise.
If your clinician dismisses your symptoms as being too general and non-specific Non-specific “have more than one possible cause” to allow a definitive diagnosis to be made from them, your hypothyroidism may well remain undiagnosed. Ideally non-thyroidal blood markers indicating thyroid hormone insufficiency should be identified and these would be more informative.
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Misconceptions About The Thyroid Gland
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Is There Anything Else I Should Know
In the past, panels of tests were more common. More recently, however, the practice has been to order, where possible, one initial or screening test and then follow up with additional testing, if needed, to reduce the number of unnecessary tests. With thyroid testing, one strategy is to screen with a TSH test and then order additional tests if the results are abnormal or if clinical suspicions warrant.
Your thyroid hormone test results can be affected by:
- Increases, decreases, and changes in the proteins that bind T4 and T3
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What Should I Do If I Have A Nodule In My Thyroid
But, in order to be on the safe side, its ideal that every patient who has a thyroid nodule undergoes certain tests to ensure that this is the case. Tests such as a comprehensive history and physical, palpation of the thyroid gland, tests of your thyroid function through blood work, and even an ultrasound may all be warranted.
Hypothyroidism With Normal Blood Tests
Some patients are convinced that their symptoms of tiredness, weight gain and feeling low are the result of an underactive thyroid gland, even though levels of the hormones thyroxine and thyroid-stimulating hormone are normal.
This mistaken belief has not been helped by numerous articles in newspapers and magazines and inaccurate information on the internet. Unfortunately, a few doctors are prepared to diagnose hypothyroidism and treat patients with thyroid hormones, even though blood tests are normal or with no blood testing at all. These doctors do not usually have any training in thyroid disease.
The following answers to questions frequently asked by patients who feel that they would benefit from thyroid hormone treatment may help to convince you that it is not possible to have an underactive thyroid gland if the blood levels of T4 and TSH are normal.
But I have the symptoms of an underactive thyroid
How do you know what level of thyroxine is normal for me?
In the authors hospital the normal or reference range for free thyroxine in the blood is 1025 picomoles per litre , although this will vary slightly from laboratory to laboratory. If your free T4 is measured at 14 pmol/l, you might reasonably ask whether it should not be 20 pmol/l and, if so, whether T4 should be given to relieve your symptoms.
Why do some patients with normal blood tests feel much better when taking thyroid hormones?
What is the harm in taking thyroid hormones if they make me feel better?
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Is It Possible To Reduce Thyroid Peroxidase Antibodies If They Are Elevated
And this might just be the most important part of this article.
After all, if you know that TPO antibodies are causing problems in your body, doesn’t it make sense to try and do something about them?
But here’s the problem:
From the perspective of your doctor, there’s nothing that can be done about elevated thyroid peroxidase antibodies.
Doctors take what is called the “sit and wait” approach to managing people who have elevated thyroid antibodies.
They sit and wait until your own body damages the thyroid gland to the point that you need prescription medication.
Just because your doctor doesn’t have any medical treatment options for you doesn’t mean you can’t do anything, though!
Seeing a doctor is important, for sure, but when it comes to managing your thyroid antibodies you are probably going to be on your own.
It may sound difficult but it actually isn’t.
Making some changes to your lifestyle can have an impact on your immune system and thyroid health and this may directly help your antibodies.
Doing things like changing the food that you eat can have a huge impact on your antibody levels.
Avoiding foods that are known to be inflammatory is a great place to start.
Eating foods that are known to possess natural anti-oxidants and plant-based nutrients is also a wise decision.
You can also focus on improving your lifestyle.
And guess what?
You don’t really need a doctor to tell you that eating fruits and vegetables is a good thing, right?
How Is Hypothyroidism Diagnosed
Most major medical associations recommended diagnosing hypothyroidism through a blood test using a simple two-step approach.
- First, we check the level of thyroid stimulating hormone , which the pituitary gland in the brain releases to stimulate thyroid hormone production.
- If TSH is high, we confirm low thyroid function with a test called free or unbound T4 .
It may help to think of the pituitary gland as a thermostat and the thyroid gland as a heater. The thermostat senses low temperatures outside of the body and turns on the internal heater. When body temperature reaches a set threshold, the thermostat signals the heater to stop working. In the body, it is the TSH produced by the pituitary gland that signals the thyroid to make more T4. When there is less free T4 in the blood, the pituitary senses the low levels and starts making more TSH.
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