Clinical Implications Of Within
TSH levels fluctuate over time within a person, both in euthyroid individuals and in most patients with thyroid disorders. If clinicians are not aware of fluctuations in TSH levels within an individual patient, this could lead to under- or overdiagnosis, and to inadequate prescription of thyroid medication to patients with thyroid disease. Since the mean TSH levels and the prevalence of subclinical hypothyroidism is increasing with age, this is especially important for the diagnosis and follow-up of older patients. Also, for clinical scientific research is it important to consider within-person variations in TSH levels over time, since this could cause more heterogeneity in research outcomes.
Other Medications And Herbs
Some herbal supplements and medications can have an impact on thyroid hormone levels, either by competing with the body’s thyroid hormone activity, amplifying the effects of thyroid hormones, or altering medication absorption and activity.
- Medications: Starting or stopping prescription drugs that you are taking for another condition besides your thyroid disease can affect your thyroid levels and your symptoms in a number of different ways. Some medications that may affect thyroid levels include certain cholesterol-lowering drugs, corticosteroids, growth hormone, lithium, and amiodarone.
- Herbs: The Ayurvedic herb guggul, supplements such as tyrosine, products like kelp that contain iodine, and bladderwrack supplements are some of the naturopathic remedies that are known to increase or decrease thyroid function, alter test results, and produce a variety of thyroid related symptoms.
It is best to ask your pharmacist and doctor about potential interactions.
Does Stress Cause Thyroid Disease
Chronic stress is known to play a role in the development of many diseases, including autoimmune diseases. Autoimmune thyroid diseases, such as Gravesâ disease and Hashimotoâs thyroiditis, are by far the most common type of thyroid disease.
If you have Gravesâ disease or Hashimotoâs thyroiditis, you may be wondering what triggered your illness. Could it have been a stressful time in your life?
There is not a lot of high quality evidence for the link between stress and the development of thyroid disease specifically, due to a lack of research.
A 2005 article published in the journal Thyroid argues that stress may precede the onset of Gravesâ and Hashimotoâs diseases. The authors argue that stress may modulate the immune system, which could cause autoimmune disease in those who are genetically predisposed.
A 2013 article also argued that stress plays a role in the pathophysiology of Gravesâ disease. The authors suggest that stress management should be part of a patientâs treatment plan.
Dr. Guandalini is in agreement that there may be a link between stress and the development of autoimmune diseases like Gravesâ disease and Hashimotoâs thyroiditis.
A large retrospective study conducted in Sweden in 2018 showed clearly that subjects that experienced stress-related disorders were about 30% more likely to develop an autoimmune condition,he explained.
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What Are Thyroid Hormones
Thyroid hormones are secreted by the thyroid gland using iodine, a mineral that is present in many foods and is abundant in seafood. The thyroid gland is a butterfly-shaped endocrine gland located at the base of the front of the neck. Endocrine glands are a network of organs that produce and release various hormones necessary for the normal functioning of the body.
Thyroid hormones regulate the metabolic rate of the body and thus play a major role in the proper functioning of every organ in the body. Thyroid hormones are essential for normal brain and physical development in infants. Thyroid hormones regulate body temperature and help maintain the normal function of all organs including the brain, heart, and muscles.
Thyroid hormones are found in two forms in the body:
- Thyroxine : Thyroxine constitutes approximately 95% of thyroid hormone circulating in the blood.
- Triiodothyronine : T3 accounts for the balance of 5% of thyroid hormone and is formed by the removal of one atom of iodine from T4, which is mostly done in the liver or kidney.
Only a minuscule percentage of thyroid hormones are in a free form that can enter cells and activate metabolism. More than 99.95% of T4 and 99.5% of T3 are bound to proteins in the blood. The binding proteins act as a storage system for the thyroid hormones, regulating the availability of free T4 and T3 for metabolic function.
Why Thyroid Hormone Levels Fluctuate
The thyroid is the butterfly-shaped gland at the base of your neck. It produces hormones that regulate your body’s energy use, along with many other critical functions.
As part of the endocrine system, the thyroid gland makes and stores hormones that help regulate the body’s metabolism in the form of blood pressure, blood temperature and heart rate.
When your thyroid hormone production drops, your body processes slow down and change. Hypothyroidism can affect many different systems in your body.
Undiagnosed thyroid disease puts patients at risk for other ailments, such as cardiovascular diseases, osteoporosis, and infertility.
Thyroid hormone levels may fluctuate over time. These fluctuations may occur as your thyroid condition progresses. Still, other factors like age, hormonal changes, and medication variations may also alter your thyroid hormone levels, producing a variety of symptoms.
Common symptoms of hypothyroidism include:
- Weight gain or increased difficulty losing weight
- Coarse, dry hair or hair loss
- Dry, rough pale skin
- Muscle cramps and frequent muscle aches
- Memory loss or brain fog
- Irregular menstrual cycles
Each patient may have any number of these symptoms, varying in severity.
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Conditions That Make The Tsh Less Reliable
In addition to the conditions listed above, there are a few other states that make the TSH less reliable.
I am talking specifically about insulin and leptin resistance:
Both of these conditions reduce T4 to T4 conversion , studies showing this link for leptin resistance here ).
In the most basic sense as leptin levels and insulin levels increase, the body preferentially converts T4 to the inactive thyroid metabolite reverse T3.
This leads to an “adaptive” state which reduces metabolic energy expenditure.
In lay terms, it reduces your metabolism or the number of calories that you burn on a daily basis.
The exact mechanism by which leptin and thyroid hormone are connected is not completely understood ), but one thing is certain:
Leptin levels and thyroid function are connected.
Leptin resistance and hypothyroidism both appear to be caused and sustained by calorie-restricted diets which cause high reverse T3 and low free T3 levels leading to clinical hypothyroidism.
The big problem is that this condition is relatively new and our understanding is limited.
But, as a result, it’s not well recognized by many providers or physicians who aren’t trained to identify or look for it despite the fact that it is highlighted in the medical literature.
Why Thyroid Levels Keep Changing
Had my blood work this wk and my thyroid level was down again. I do not have a thyroid. My level stayed the same for 7 yrs. After I had my breakdown it drops everytime I get my blood work, I started at 100mcg and it has changed 4x, now I’m on 50mcg. I ask the doc why, he said it was hard to say, it could be because I have lost so much wt, or any number of things. Told me not to worry, how can I not worry? Its driving me crazy!!! Von-1
I found the following extensive list of possibilities:
There are various causes for thyroid levels to change or fluctuate:
Thyroid hormones can very throughout the day – example if TSHPituitary and tshTshis 1.5 it can fluctuate 1.0 – 4.0. Are you having your thyroid tested at approx the same trime of day. Best for hypers in the AM because that is when the thyroid hormones are the highest and hypos in the PM because that is when thyroid hormones are the lowest.
Changes in potency from batch to batch of your thyroid pills. Synthroid brand has been notorious for this, other brands have tended to have more stringent quality controls in place.
Possibly your blood samples have been tested at different labs, or some other lab mix up
Have you changed the timing of when you take your thyroid pill? This can affect the way it’s absorbed, whether with or without food. Thyroid is best taken first thing in the morning, on an empty stomach.
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How Long Does It Take To Recover From Thyroid Surgery
It will take your body a few weeks to recover after your thyroid is surgically removed . During this time you should avoid a few things, including:
- Submerging your incision under water.
- Lifting an object thats heavier than 15 pounds.
- Doing more than light exercise.
This generally lasts for about two weeks. After that, you can return to your normal activities.
Hashimotos Is Not As Scary As It Sounds
Read patient blogs about Hashimotos thyroiditis, and youll find it portrayed as a frightening disease.
In reality, Hashimotos is a benign, highly treatable condition, stresses Dr. Kellis. Taking thyroid supplements will improve most of your symptoms, and most people do quite well on them.
The bow-tie-shaped thyroid gland, at the base of your throat, secretes a hormone called T4 . Your body must convert T4 to T3 to maintain your metabolism, and regulate your body temperature, heart and other vital organs.
Sometimes, when youre first diagnosed with Hashimotos, you can still produce some thyroid hormone, she notes. As the years go by, you may produce less hormone, so your doctor will gradually increase your dose of medication, she says.
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Thyroid Surgeons And Doctors At The Surgical Clinic
If you and your doctor decide that surgery is the treatment you need. Come visit The Surgical Clinic. We have many providers in Tennessee who can give you the care you need. All of our board-certified surgeons are highly trained individuals and have many years of experience.
356 24th Ave. North | Suite 400 | Nashville, TN 37203TEL 615.329.7887 FAX 615.340.4537
FOOT & ANKLE SPECIALISTS OF NASHVILLE4230 Harding Pike | Suite 202 | Nashville, TN 37205TEL 615.662.6676 FAX 615.662.8371
300 20th Ave. North | Suite 301 | Nashville, TN 37203TEL 615.284.2400 FAX 615.284.4644
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397 Wallace Rd. | Suite 301 | Nashville, TN 37211TEL 615.425.0550 FAX 615.833.8287
4535 Harding Pike | Suite 304 | Nashville, TN 37205TEL 615.269.9007 FAX 615.269.3448
356 24th Ave. North | Suite 300 | Nashville, TN 37203TEL 615.301.5264 FAX 615.340.4537
85 White Bridge Rd | 2nd Floor | Nashville, TN 37205TEL 615.938.7545 FAX 615.938.7546
The Complete Thyroid Panel: How To Diagnose Hypothyroidism
So let’s say you are convinced that your thyroid is suboptimal and you’d like to prove it.
What tests do you need and how do you interpret the results?
We are going to go over them below, but I need to say something first:
Thyroid lab tests shouldn’t be used as THE definitive test for diagnosing and managing hypothyroidism by themselves.
They can be very helpful for the initial diagnosis and sometimes for management, but once you introduce thyroid hormone into the system exogenously you have changed the dynamics of the system.
I’m not going to go into detail on this now, but just realize the lab tests aren’t the end all be all for diagnosis.
Having said that they can be quite helpful, especially if you are thyroid hormone naive .
If this is the case, then these ranges may be helpful for you:
- Free T3: Should be in the top 50% of the reference range
- Reverse T3: Should be < 15 , if your Free T3 is high and your reverse T3 is high then your ratio of T3 hormone in your medication is off
- TSH: Should be < 2.0 *anything higher indicates tissue level hypothyroidism in other tissues in the body
- Total T3: Generally should be in the top 50% of the reference range
- Free T4: Generally in the mid-range
- Sex hormone binding globulin: In women, it should be in the 70-80 range and can be helpful for determining tissue levels of thyroid hormone
- Thyroid antibodies: Should be < 30
- CRP and ESR: Both of these markers should be as low as possible
As an example:
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Are There Any Other Tests For The Diagnosis Of Hyperthyroidism
The vast majority of cases of hyperthyroidism are diagnosed by the combination of clinical history, initial laboratory screening tests, and the determination of T4 or fT4 blood concentrations.
On rare occasions, additional tests such as the T3 suppression test or advanced imaging studies of the thyroid gland may need to be performed. Imaging studies are usually done at a referral center.
Should I Exercise If I Have A Thyroid Disease
Regular exercise is an important part of a healthy lifestyle. You do not need to change your exercise routine if you have a thyroid disease. Exercise does not drain your bodys thyroid hormones and it shouldnt hurt you to exercise. It is important to talk to your healthcare provider before you start a new exercise routine to make sure that its a good fit for you.
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What Is Free Thyroxine Concentration
Free thyroxine concentration is the portion of the thyroxine hormone that is not bound to any blood proteins. Determination of fT4 involves a single blood sample that is sent to a referral laboratory for a special test called free T4 by equilibrium dialysis .
“The concentration of fT4 is less affected by factors such as coexisting illness or medications.”
The concentration of fT4 is less affected by factors such as coexisting illness or medications. However, a small proportion of normal cats are known to have fT4 concentrations above the reference range. Therefore, determination of fT4 is usually reserved for those cats with strong clinical signs of hyperthyroidism, whose initial screening tests supported hyperthyroidism, but whose total thyroxine concentrations were not high enough to be diagnostic.
What Causes Hypothyroidism
The most common cause of hypothyroidism is an autoimmune disorder. This means your immune system starts to attack itself. It makes antibodies against the thyroid gland. Another cause may be treatment for an overactive thyroid gland. That may include radioactive iodine therapy or surgery.
A condition called secondary hypothyroidism can also sometimes happen. Its when your pituitary gland stops working. The pituitary gland then no longer tells the thyroid gland to make thyroid hormones.
Newborns are tested at birth for hypothyroidism. This condition must be treated immediately. It can affect a babys brain and nervous system.
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When Is The Tsh Helpful
We just spent all this time discussing why the TSH doesn’t provide very much value, but it turns out that it does have some limited value.
TSH can actually be very helpful in initially diagnosing hypothyroidism and in helping to determine the ideal dose of thyroid hormone medication.
If your TSH is outside of this range then you should be evaluated further and you should consider a trial of thyroid medication.
The rate at which your TSH drops can be helpful in determining your total dose of thyroid hormone needed.
Let’s say you start with a TSH of 3.5.
You start titration with Natural desiccated thyroid and after 2 months your TSH drops to 1.0 on 2 grains of NDT.
This indicates your total dose will likely need to be much higher than someone who drops their TSH down to 0.05 with the same dose.
This highlights that each patient has a unique demand for thyroid hormone in their body and standard dosing should not apply to everyone.
It’s also important to remember that both T3 and T4 will cause your TSH to decrease.
In fact, T3 thyroid hormone is 3x more potent at decreasing your TSH than T4 thyroid hormone , so put that into perspective when using medications like cytomel, liothyronine or NDT.
So if you are started on any medication containing T3 and your TSH does not drop very quickly then that is an indication you might need higher doses of thyroid hormone.
Changes In Menstrual Periods
Because hyperthyroidism tells your body to move faster, the menstrual cycle can become lighter and faster. You may also notice longer periods of time in between your periods.
On their own, these symptoms may indicate other medical problems. However, when you or your doctor identify more than one of these symptoms at a time, there is a good chance its due to thyroid problems.
Thankfully, most thyroid disorders are treatable and are not life-threatening. However, if you notice a rapid heart rate and experience either a fever or deliriousness, you should call your doctor immediately. These are signs of a hyperthyroid complication called thyrotoxic crisis.
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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.