New Parameters for Hypothyroidism

[jvt121]

Dr,
Thank you for hosting this forum. You recently posted on the forum that the current standard for treatment of Hypothyroidism is a TSH of above 2.0.
Can you please direct me to some studies that I can bring to my dr to  show her? I have had my TSH taken every 3-6 months for 2 years now and it is showing a steady increase from 2.051 to the current 2.238 and my symptoms are worsening, including hair loss, unexplained weight gain, (I have a fastidious diet and I exercise) memory issues, foggy thinking etc. Perhaps the worst of it is that I have had extreme menstrual pain that causes me to lose work and is very disruptive every month.  I also have a sister who has hypothryoidism, a mother and father who did, and a grandmother who had a goiter.  I have all the symptoms and a positive family history.

I find this process very frustrating because since my TSH tests are under 5 no dr I have found is willing to consider a trial of medication regardless of the family history and positive symptoms. In my line of work, sluggish thinking, and I hate to say it, but excessive weight, all but assure failure.  

Also, I get frustrated because I have had a low body temperature EVERY time I have gone to the drs office for my entire life. Recently  it was so low that the nurse said "Oh this can't be right, you must be cold from being outside", and she disregarded the reading! I had been in the waiting room for over 45 mins so being "cold from outside" was not possible. Also, my blood pressure has always been low. Drs have said "oh you must be an athlete". When I tell them I jog they blame the low BP on athleticism. If I tell them I don't jog or exercise, they blame the weight gain on lack of enough activity. You just can't win.  

Plus, with the low incidence of side effects of the medication, especially at low or gradually increasing doses, shouldn't  it be the patients choice of whether to try it or not?

Thanks for listening and again, any studies you could point me to regarding the parameters would be greatly appreciated.

[jvt121]

Yes, I see.
Thank you. I am continuing to research and will post anything I find that could be helpful. This is a rediculous issue. I mean, they sell things like GABA over the counter which could have a severe neurological effect (according to my husband the neuroscientist) and people are allowed to choose for themselves. I don't see why we can't choose to try the medication if we want to. If the Dr's are worried about being sued, then have us sign a waiver. Plus, given the current health care climate here in the US, wouldn't the makers of these drugs be pushing to lower the limits so more people would go on and consume their products? It  doesn't make sense to me.
Finally, when a drug - makers greed could do us some GOOD they aren't doing anything.

[gimel]

Thanks for the link.  I have gone through it a couple of times.  Dr. Weetman's reference was that TSH over 2.0 was an indication of possible future hypothyroidism.  From what I've read about him, he was not advocating treatment at that level.  
In fact, he seems to have been a very firm advocate of not  providing treatment to any patient that is deemed to be Euthyroid, meaning within the "normal" TSH range.  I think you can get a good perspective about Dr. Weetman's opinions by reading this link.

http://thyroid.about.com/od/newscontroversies/a/weetman.htm

Also, please not the following quote.    

Weetman calls for doctors'

    ..".avoidance of thyroid hormone treatment of euthyroid individuals, a robust defence of the biochemical basis for the diagnosis of hypothyroidism and institution of replacement with synthetic thyroxine as the standard, rather than Armour thyroid extract".

He is a big part of the huge controversy going in the UK because of the lack of treatment of patients with thyroid symptoms, but TSH within the "normal" range.  It got to be such an issue that patients have been pressuring their local politicians to force the Nationalized Health System to give direction to doctors to change their protocol for diagnosing and treating thyroid patients.

[jvt121]

I found it in this article int he British Medical Journal:

http://www.bmj.com/cgi/content/full/314/7088/1175#Treatment_of_subclinical_hypothyroidism

Certainly something the print out and bring to the Dr.

Best-

[gimel]

Just curious as to where you saw mention of a range for TSH that was 2.0 for the high limit.  I haven't seen anything like this and would like to confirm the source.  The only revision I am aware of was the one by the AACE about 6 years ago, changing the old .5-5.0 range down to .3-3.0.
In my opinion hypo or hyper thyroidism should be defined mostly by symptoms, not strictly by results from blood tests.  This is especially true for TSH, which correlates very poorly to symptoms.  Unfortunately the medical community still clings to TSH as the predominant factor in deciding a patient's treatment.  
After symptoms, the most important factor is free T3, which is the most biologically active component of thyroid hormones. It is four times as potent as free T4. Free T3 has, by far, the best correlation with hypo symptoms, while TSH correlates very poorly.  I believe that the best overall result can be obtained by having a doctor that will listen to your symptoms and test and adjust your free T3 and free T4 levels as required to alleviate your symptoms and get you to the Euthyroid state, which means neither hypo nor hyper.  

[jvt121]

Thank you.

:)

[stella5349]

you can google up the AACE recommendations for hypothyroidism. They can't fight those guidelines.

I am not the doctor here and your post may not be answered by Dr. Lupo.

He concentrates his posts over on the expert side.

Take care