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What Does Borderline Thyroid Results Mean

Other Tests That May Prove Helpful Diagnostically

Why Your Doctor Is Wrong About Thyroid Testing

In addition to the symptoms and signs mentioned above, subclinical hyperthyroidism can have specific effects on the cardiovascular system and on bone metabolism. Therefore, other testing that may be helpful in deciding how to manage a particular patient with SH would include a cardiovascular and a bone mineral density evaluation.

Several studies have identified an association between SH and atrial fibrillation. Patients with SH have a 2.8-5-fold increased risk of developing atrial fibrillation this risk is higher in patients over the age of 60 and in patients with completely suppressed TSH levels. Treatment of SH has been found to improve this risk. The relationship is not as clear between SH and other types of cardiovascular disease. In patients with a history of atrial arrhythmias or underlying heart disease and in patients over the age of 60, it would be reasonable to consider performing a cardiac evaluation.

This evaluation could include any or all of the following: electrocardiogram, ambulatory Holter monitor, and echocardiogram. The findings of this evaluation would help to distinguish which patients are more likely to benefit from treatment.

Types Of Low Tsh Levels

Low TSH levels can generally manifest as four types of thyroid conditions:

  • Primary hyperthyroidism, which occurs when you have high thyroid hormone levels and low TSH levels.
  • Mild hyperthyroidism is a thyroid condition that results in a low TSH level and normal thyroid hormone levels.
  • Thyroiditis is an inflammation of the thyroid because of other conditions.
  • Pituitary disease, which causes the pituitary gland to not produce enough TSH to properly stimulate the thyroid gland.

How Is Hyperthyroidism Diagnosed

A blood test can diagnose having an overactive thyroid gland . A normal blood test will also rule it out if symptoms suggest that it may be a possible diagnosis. One or both of the following may be measured in a blood sample:

  • Thyroid-stimulating hormone . This chemical is made in the pituitary gland in the brain. It is released into the bloodstream. It stimulates the thyroid gland to make thyroxine. If the level of thyroxine in the blood is high then the pituitary gland releases less TSH. Therefore, a low level of TSH means that your thyroid gland is overactive and is making too much thyroxine.
  • Thyroxine . A high level of T4 confirms hyperthyroidism.

Sometimes the results of the tests are borderline. For example, a normal T4 but with a low TSH. Other tests are sometimes done to clarify the situation and the cause. For example, another blood test that measures T3 is sometimes helpful and an ultrasound scan of the thyroid gland or a thyroid scan may be done if you have a nodular goitre.

Also, if tests are borderline, one option is to repeat the tests a few weeks later, as sometimes borderline tests are due to another illness. Other tests may be done if a rare cause of hyperthyroidism is suspected.

In people with Graves’ disease a blood test may detect specific autoantibodies which are commonly raised. However, these can also be raised in some people without Graves’ disease so this is not a specific test for Graves’ disease.

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Does Thyroxine Treatment Have Side Effects

No good-quality research is available on the side effects of treating subclinical hypothyroidism with thyroxine, but it’s generally considered to be a well-tolerated drug. Because the body usually produces this hormone on its own, there are no problems if the dose is correct. If it’s too high though, side effects can’t be ruled out. Possible side effects include heart problems like or a racing heartbeat.

Guidelines On Early Detection And Treatment

What Does Borderline/Subclinical Hypothyroid Mean?

A review of the history of guidelines for subclinical thyroid dysfunction provides insight into the reason for practice variation . In 1990 and again in 1998, the American College of Physicians found it is reasonable to screen women older than 50 years of age for unsuspected but symptomatic thyroid disease. The guideline specified that the goal of routine testing was to find overt, but overlooked, thyroid dysfunction, not subclinical hypothyroidism. Because the clinical significance of mildly elevated TSH test results was uncertain, the guideline recommended obtaining a free T4 test only when the TSH level was undetectable or 10 mIU/L or more. The ACP guideline panel used a systematic review of the literature to arrive at its recommendations.These guidelines expired in 2003.

In 1999, the American Association of Clinical Endocrinologists recommended screening asymptomatic women over the age of 60.In 2000, the American Thyroid Association recommended screening all patients over 35 years of age every 5 years . These organizations used a consensus process to develop guidelines and did not use systematic reviews in arriving at their recommendations.

Evidence for the association of subclinical hypothyroidism and adverse health outcomes and quality of evidence for risks and benefits of treatment: Findings of the American Association of Clinical Endocrinologists, the American Thyroid

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Treatment For Eye Problems

You may need to see an eye specialist if you develop the eye problems of Graves’ disease. Relatively minor symptoms affect the eyes in about half of people with Graves’ disease. Measures such as artificial tears, sunglasses and eye protectors whilst you sleep may be sufficient to help.

However, about 1 in 20 people with Graves’ disease have severe eye changes. Treatment can then be more difficult and may include surgery, radiation treatment or steroid tablets.

If you smoke then it is important that you try to stop. Smoking can actually make your eye problems worse.

Rationale For Screening And Treatment

Subclinical Hypothyroidism

Although there is wide agreement that the long-term benefits of early treatment of subclinical thyroid dysfunction have not been proven, there is disagreement about what to do until better evidence is available. This disagreement reflects differing views of the clinical relevance of research about the complications of subclinical thyroid dysfunction.

Proponents argue that thyroid dysfunction is common and associated with significant morbidity. Additionally, a serum TSH test is relatively inexpensive, accurate, readily available, and generally a very acceptable test for patients to undergo.,Symptoms of overt thyroid dysfunction also can be vague and at times difficult to diagnose, and therefore, thyroid screening may allow the diagnosis of overt disease earlier in the clinical course, thus reducing morbidity.,, For subclinical hypothyroidism, treatment with levothyroxine is noninvasive and inexpensive. Finally, proponents argue that the potential harms of screening are small in relation to the potential benefits: Because the potential harm of early detection and treatment appear to be so minor and preventable, it seems prudent to err on the side of early detection and treatment until there is sufficient data to address these issues definitively.

Subclinical Hyperthyroidism

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Treatment Failure And Adverse Effects

Treatment failure is uncommon. Possible reasons for failure to achieve the targeted T4 concentration include owner noncompliance in administering medication or patient refusal to swallow the pills. Variable gastrointestinal absorption of levothyroxine is also considered to be a possible cause.28 If a target post-pill T4 concentration has been achieved and clinical signs are not controlled, the dosing frequency should be increased to twice daily. Additionally, the diagnosis of hypothyroidism should be reconsidered. If the diagnosis of hypothyroidism is definitive and the dogs T4 concentration is well controlled, consider whether a concurrent disorder could be causing clinical signs.

Dogs are generally resistant to the effects of excessive levothyroxine supplementation. However, clinical signs such as polyuria/polydipsia and hyperactivity may develop.26

When Tests Are Abnormal: Some Common Scenarios

What Does Borderline Blood Sugar Levels Mean?

The following six cases discuss what to do in some common situations when thyroid test results are abnormal.

Case 1.You are evaluating a child for short stature , and find that the free T4 is mid-normal, but the TSH is 0.3 . What should you do?

  • Discussion. A TSH which is low but greater than 0.1 with a normal total or free T4 has no clinical significance. This result does not account for any of the symptoms that may have prompted the thyroid testing, and should be viewed as a variation of normal. If the TSH is less than 0.1 and the free T4 is elevated, you probably have a hyperthyroid child, but even in early/mild hyperthyroidism, the TSH is invariably less than 0.1 and often less than 0.01. A low TSH is also not indicative of pituitary TSH deficiency. In such cases, the free T4 will be low and the TSH generally normal. Tell the child’s parents that the thyroid tests are fine, and do not repeat them unless clinical symptoms of hyperthyroidism appear. I have never seen a case like this evolve into clinical hyperthyroidism.

Case 2. What if, on screening, the free T4 is normal but the TSH is 0.05 and the child has no clinical signs of hyperthyroidism?

Case 3.A patient who is being screened for thyroid disease due to obesity has a normal free T4 of 1.2, but the TSH is slightly increased to 7.0. There is no goiter. How aggressive should one be in further testing and treatment?

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Free T4 By Equilibrium Dialysis

Free T4 is the non-protein bound thyroxine present in the blood. Measuring FT4 can help determine if cats with high-normal or borderline total T4 levels are normal or hyperthyroid. The equilibrium dialysis method is the only assay used for testing feline samples in this lab. FT4 ED levels can be falsely elevated by mishandling specimens/samples . FT4 concentrations may also be affected by low protein states caused by kidney or liver disease, neoplasia, etc. We have determined the Free T4 Two Step method used for dog samples is not valid for cats.

Prevalence And Course Of Mild Thyroid Dysfunction

Using the upper limit of the reference range as a cut off, approximately 5 percent of women and 3 percent of men have subclinical thyroid dysfunction . Approximately one in four of these individuals has a markedly elevated TSH concentration . Such patients are likely to progress to overt hypothyroidism over 20 years.

The other 75 percent of individuals with subclinical hypothyroidism have mildly elevated TSH levels . In this group, age, sex, geographic region, and the presence of thyroid auto-antibodies are strong predictors of the rate of progression to overt hypothyroidism. From one-third to two-thirds of these individuals have antithyroid antibodies. Depending on age, sex, and TSH level, 50 percent to 70 percent of these individuals will progress to overt disease over 20 years. In those who do not have antithyroid antibodies, the risk of progression is lower.

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If You Have A Borderline Underactive Thyroid Do You Need To Treat It

What to know before getting treatment for a borderline underactive thyroid, according to Health’s resident medical editor.

Short answer: It depends. Your thyroid gland governs much of the metabolic activity in your body, and when its underactive , that can cause all sorts of symptoms, including weight gain, feeling cold, and fatigue. However, sometimes hypothyroidism is so minor that there are only very mild, nonspecific symptoms, or none at all, and its detectable only through blood tests.

To treat hypothyroidism, a patient needs to take a hormone medication to replace the amount that the thyroid cant make. Borderline cases can progress to overt hypothyroidism, so some say its useful to take medication, especially if you also have a risk of heart disease even mild hypothyroidism can lead to elevated cholesterol levels.

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That said, other research suggests that taking medication for subclinical hypothyroidism may have no benefit. If youre not experiencing any symptoms, you should think about whether the potential side effects are worth it.

Your primary care physician or an endocrinologist can help you weigh the costs and benefits of treatment in your case. Your MD may have you hold off on taking medication and get regular tests to monitor your levels. Or, if you have symptoms, she may advise taking the medication temporarily to see whether you start to feel better.

    Why Was This Study Needed

    What a High TSH Really Means for your Thyroid + What ...

    The thyroid gland produces hormones that help to regulate the bodys metabolism. Around 15 in every 1,000 women in the UK have an underactive thyroid though fewer women in pregnancy have the condition, about four in every 1,000 women. People with definite low thyroid hormones can feel tired or depressed, gain weight and experience muscle aches, it can also lead to high cholesterol. In pregnancy there can also be harms to the unborn child including failure to develop normally and reduced intelligence. Therefore, clinical hypothyroidism during pregnancy is usually treated with levothyroxine, a drug that replaces thyroid hormone.

    However, the exact risks associated with borderline blood levels, and the cut-off thyroid levels for treatment are not clear. There could even be harms from unnecessarily treating women with sub-clinical hypothyroidism. About 5% of women screened in pregnancy would be labelled as having sub-clinical hypothyroidism, depending on definitions.

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    What Do Borderline Positive Tpo Antibodies Mean

    You get your thyroid test results back, and your thyroid peroxidase antibodies are borderline positive. Now you wondering, what does this mean?

    Approximately 20 million people in the United States have some form of thyroid diseaseâincluding hypothyroidism . Often, people with thyroid disease are undiagnosed or misdiagnosed because symptoms can be unspecific and develop gradually.

    How To Lower Tpo Antibodies

    As mentioned, the presence of TPO antibodies may indicate a possible risk of developing thyroid dysfunction. Most people with borderline positive TPO levels, who have normal TSH levels, do not require medical treatment. However, it may help to lower antibodies to protect your thyroid gland from future disorders.

    Here, a few strategies to help reduce TPO antibodies:

    Try an anti-inflammatory diet

    Foods that can trigger inflammation include gluten, dairy, soy, grains, eggs, nuts, seeds, and nightshades. The autoimmune protocol diet may help you identify which of these foods is triggering for you. A 2019 study shows that identifying your dietary triggers on the AIP diet may and modulate the immune system.

    Supplement with vitamin D

    Supplementing with vitamin D may reduce TPO antibody levels. A study in the Indian Journal of Endocrinology and Metabolism shows a significant reduction in TPO antibodies in patients with newly diagnosed autoimmune thyroid disease after three months of vitamin D supplementation.

    Supplement with selenium

    Research suggests that supplementing with selenium may be useful in managing TPO antibodies by defending against oxidative stress.

    Remove or avoid environmental toxins

    The development of autoimmune thyroid disease is mainly due to family background. However, environmental toxins like radiation, iodine excess, pesticides, or chemical exposure can also elevate TPO antibodies.

    Manage your stress

    Get enough sleep

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    What Do Tpo Antibodies Mean

    Many labs look only at Thyroid Stimulating Hormone to assess thyroid health. Still, we believe it is critical to measure the thyroid hormonesâFree Triiodothyronine and Free Thyroxine , and TPO antibodies. Finding the early appearance of TPO antibodies before the onset of thyroid hormone disruption may reduce longer-term health concerns.

    Borderline positive TPO antibodies may suggest a possible evolving issue with Hashimoto’s thyroiditis. Hashimoto’s, an autoimmune condition, is the most common cause of hypothyroidism in the United States. An autoimmune disease occurs when immune cells mistakenly attack healthy tissue instead of protecting it. In Hashimoto’s thyroiditis, immune cells mistakenly attack the healthy thyroid tissue, causing inflammation of the thyroid.

    If your thyroid experiences damage to the point that the gland no longer produces enough thyroid hormones for your body to function correctly. When your body does not make enough thyroid hormones, this condition is hypothyroidism.

    Should People With Thyroid Problems Avoid These Foods

    Thyroid 101: What do your Thyroid tests results really mean?

    Soy: If you have hypothyroidism, yes. Eating too much soy causes problems only for those with hypothyroidism, which occurs when your thyroid gland does not make enough thyroid hormones, Dr. Nasr says.

    The main problem is that soy may hinder absorption of the hormones that such patients take.

    Some studies show that if you eat a lot of soy, or drink a big glass of soy milk, within one hour of taking a thyroid hormone, it might affect absorption, Dr. Nasr says. Many individuals depend on a consistent absorption of those hormones to achieve a steady state.

    Generally, expertsrecommend that people who have a borderline thyroid one thats a littleunderactive but youre still trying to preserve thyroid function do not toconsume large amounts of soy every day, he adds.

    Turnips and rootvegetables: No. These vegetables aresometimes thought to cause thyroid problems, but thats not the case, Dr. Nasrsays. They are good for your diet, regardless of any thyroid issues.

    One root vegetable that is the exception is cassava, a common staple in certain parts of Africa. This plant is known to produce toxins that can slow an already underactive thyroid, especially in the presence of an iodine deficiency, Dr. Nasr says. But thats not relevant here in the United States, unless you cook cassava and you eat it every day.

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    Problems With The Assessment Of Thyroid Function And Levothyroxine Replacement Levels In Pituitary Disease

    News Date | Medically Fact Checked

    Dr Trevor A Howlett, MD FRCP

    Consultant Endocrinologist, Leicester Royal Infirmary

    Doctors who are not specialists in endocrinology often have difficulty interpreting thyroid blood tests in patients with pituitary disease which can lead to failure to diagnose a mild deficiency and inappropriate changes in levothyroxine dosage in patients taking replacement.

    This article attempts to explain the problems with interpretation of thyroid blood tests in pituitary disease to help you to become an expert in your own pituitary-thyroid function.

    In normal health, the thyroid gland makes thyroid hormones which broadly keep all the cells and organs of the body ticking over at the correct rate. With too little thyroid hormone in the body, everything slows down and symptoms may include tiredness, slowness in thinking, weight gain, constipation and dry skin. Conversely with too much thyroid hormone everything speeds up and people may notice a fast heartbeat and increased risk of heart rhythm problems, weight loss, sweating and shakiness.

    Because of the usefulness of TSH, many labs will now only measure TSH when a non-specialist orders thyroid function tests or TFTs .

    This means that TSH levels alone are useless for deciding whether someone with pituitary disease has developed a pituitary-thyroid deficiency or whether they are on the correct amount of levothyroxine replacement .


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