Which Tests for Hashis

[Peternz]

Hi

I am currently overseas and think i may have developed hashis.  I understand there are three tests but people have been telling me that you only need one to determine if you have the disease and the amount of medication required.  Can someone tell me the name of this test and some providing a link to some supporting documentation.

Cheers

Peter

[borninquisitive]

I'd say there is something definitely wrong with not treating a patient until their TSH is at 10.00
I have my own experience and have listened to many who are undiagnosed, who sound very suspicious for thyroid dysfunction and have shared suspicious looking labs. As have I listened to many women and men (however, fewer) who have described their experience (both physical complaints and doctor experiences) prior to diagnosis.
I think many of us in thyroid forums are aware of this. When you take in the whole picture, it's obvious something is very wrong.

I too do not understand why the target for those medicated, would not apply to those who are outside that target, who are not on medication. Referring to those who have many symptoms and other possibilities have been ruled out.

~Kate

[borninquisitive]

Yes, I did read this article. It's good to try to pick up the "nuances" of literature or to say, perhaps the spirit in which it was written. I think approaching it strictly in a "text book" like manner can be a disservice. It is after all, Science. Can you imagine if the scientific community was filled with nothing but narrow minded scientists? Oh boy! Better for us that they have an educated, open mind, that: looks, listens and thoroughly investigates.

Anyway. I don't think "authorities" who publish medical literature/guidelines go in with the intent to stifle discretion but I think doctor's who are not well educated on the subject and/or fearful in dealing with it, will fall back on rough guidelines-no matter that in doing so, would be a disservice to a patient.
Sadly.

As for the TSH reference range. Well, from the looks of it, their "controls" (which would lead to our reference range) were polluted, so-to-speak. Even if they were not, the range is broad. As an individual, if someone has been carting through life with say a 1.20 feeling fine and then here they are at 2.50 and moving up but still in range...that will not have an affect on how they feel? They don't know what's wrong with them but go to the doctor finally. Everything they complain of sounds very suspicious for thyroid and thus, a TSH test ensues. "Normal" i.e. in range. Eventually, antibodies are checked: there are elevations but their TSH is "in range" (we'll just say at 3.20) No treatment. In my opinion, this doctor has either ignored symptoms, uneducated or is fearful.

That said, I believe in thorough investigation. After that is done: if it looks like a duck, quacks like a duck- then it deserves to be handled as such.

I've probably said far more than you care to hear. lol

~Kate

[Adami]

I agree with you borninquisistive, something seems very wrong with this 10+ number, and a disservice to quote it to people.  I had a lot of negative symptoms from subclinical hypo at around TSH 7, and Levothyrozine has made amazing improvements in me.  How can the same article say no treatment until 10+ then go on to say the target level is below 3.0.  Why is it doctors don't want to factor more of the known symptoms in determining treatment?

[AR-10]

Page two sets the tone.

Most of pages seven and eight are worth reading, too.

But the information is not current to the point of cutting edge, either.

[AR-10]

http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf

You have to have acrobat reader, and you have to start down at page eight (bottom right) and continue onto page nine.

It is very informative.
If the link works. ;)

[borninquisitive]

"...off my soapox. ;-D "

Well, not just yet. lol On that note, when you have Doctors who truly believe the reference range needs changing and/or that hashi/hypo patients should be treated with a TSH above 2.5 with elevations in antibodies...I can't help but wonder for those who continually site-if your TSH is 10+ that *then* it's probably reasonable to treat with medication? What, do they think such doctors as mentioned above are part of some conspiracy?

[borninquisitive]

"The AACE guidelines also state if the TSH is between 5.0 and 10.0 in conjunction with goiter or anti-thyroid peroxidase antibodies treatment is recommended."

I don't understand why somebody would clip a piece of the AACE guideline and fail to mention what you just did.
Understandable if somebody mentioned it previously (no need for redundancy) or maybe if they are running short on time... but consistently post the same guideline, without mentioning what you have?

If a person thinks that somebody with a low TSH should be treated if they have Graves and/or nodules-why wouldn't they think/express the same for Hashi?

On that note, what gripes me and speaking just of the reference range: that treatment can be had with a borderline low TSH etc. and yet, hear...eh but you, we'll  let you become out of range (hypo side) before treatment? I don't disagree with treatment on the hyper side but I disagree with making hypos suffer more than they already do. It's inhumane.

...off my soapox. ;-D

[Letterer]

For your question above, TSH + FT4 + FT3 will help determine your thyroid function, along with symptoms. The two antibodies tests (TPO Ab and Tg Ab) will determine if the hypo is caused by an autoimmune attack. Treatment for hypo is the same whether or not it's autoimmune.

My TSH has not gotten above 2.5, but because my FT4 and T3 were in the 20% range (low), plus high (Tg Ab) antithyrogloblin antibodies (2000+), having numerous hypo symptoms and my mother having had hypo, my doc decided to start me on low dose of meds. There are a number of factors involved in deciding on treatment, not just TSH alone.

[AR-10]

That is based on the assumption that your T3 and T4 are normal. If your hormones are out of balance, all that stuff goes out the window.

If your TSH comes back H
and your T3 comes back L
and your T4 comes back L

you will be treated.

The AACE guidelines also state if the TSH is between 5.0 and 10.0 in conjunction with goiter or anti-thyroid peroxidase antibodies treatment is recommended.

Google AACE guidelines and there it is.


And Perfect4444, I'm sorry, but if you had hashimoto's you still have it. You just have it under control. I'm glad to hear that.

[perfect4444]

i was diagnosed with hypo. then later on i was diagnosed with hashi which led to not being able to eat or drink the doctor tried prednisone and augmentin. i later had my thyroid removed and feel great. no more chocking and rapid heart. when i told my thyroid specialist i felt better. he replied you should no more thyroid no more hashi. talk to a endocryologist. hope you feel better soon

[GravesLady]

AACE - American Association of Clinical Endocrinologists  2006 amended guidelines.
US Government 2004 Guidelines
UK 2006 Guidelines,  
American Thyroid Association
The Endocrine Society -  Albert Einstein College of Medicine, New York. September 23, 2004 .  

quote - TSH 2.5 - 4.5: May be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations in this range would be misidentified as having hypothyroidism

TSH of 4.5 to 10:  No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.........

TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable.

Data do not confirm clear-cut benefits for early therapy....... - unquote

Would you like the diagnose guidelines for hyperthyroidismor cancer or nodules, etc.

[AR-10]

A TSH of 10.0 is not "fine unless you are diagnosed with thyroid problems".

Diagnosed levels are not different. Test results are test results, period.

If my TSH is 7.0 and my free T3 is low, I am going to be treated. Doctors don't look at test results and then determine a course of treatment based on whether or not you have already been diagnosed with a disease.

[GravesLady]

TSH  Thyroid stimulating hormone          - above 10 (diagnose)
Free T4 (FT4) Free Thyroxin                   - low
Free T3  (FT3) Free Triiodothyronine or    - low
Total T3 (T3) Triiodothyronine                  - low

Its a matter of interpretation of all three, as far as HashiI.

0.3 to 3.0 (as of 2003) This out dated to a amended 2006 and it referes to a patient that is already diagnosed and on treatment. Then levels will differe from Lab to Lab, county to county, state to state and country to country.

Diagnosed levels are different.

You neede test done instead of second guessing.  A lot of other health conditions share thyroid symptoms and antibodies.  So you need thyroid test, the only way to be sure.

[AR-10]

No single test of the ones listed will tell you what you need to know.

You need all of the tests to determine if you have thyroid problems and if you need medication, as well as what dosage would be indicated if you need meds.

[AR-10]

You would want to ask for thyroid antibody tests. There are at least two.

You would also want to ask for tests on your TSH, free T3, and free T4.

Make sure you get the word "free" in there, as there are also tests for T3 and T4, but they do not give as clear a picture of what is going on as the free T3 and free T4.

[Peternz]

there is more dosgae information but its not showing it hhmmm i think theres enough

[Peternz]

Adults:

Hypothyroidism: 1.7 mcg/kg/day in otherwise healthy adults 50 years or patients with cardiac disease, refer to Elderly dosing.

[Peternz]

I have has no tests as yet i understand there are 3 test TSG, T3, T4 from looking around the internet it appears that a TSH is the only one required to determine if you have hashis and the dosage can be determined from this.

Test / Name Normal Range Interpretation
"TSH" Test -- Thyroid Stimulating Hormone / Serum thyrotropin  0.4 to 6

0.3 to 3.0 (as of 2003) Under .4 can indicate possible hyperthyroidism. Over 6 is considered indicative of hypothyroidism. Note: the American Association of Clinical Endocrinologists has revised these guidelines as of early 2003, narrowing the range to .3 to 3.0. Many labs and practitioners are not, however, aware of these revised guidelines. (See Endos Say Normal TSH Range Now .3 to 3: Millions More at Thyroid Risk)  
Total T4 / Serum thyroxine  4.5 to 12.5 Less than 4.5 can be indicative of an underfunctioning thyroid when TSH is also elevated. Over 12.5 can indicate hyperthyroidism. Low T4 with low TSH can sometimes indicate a pituitary problem.  
Free T4 / Free Thyroxine - FT4  0.7 to 2.0 Less than 0.7 is considered indicative of possible hypothyroidism.  
T3 / Serum triiodothyronine  80 to 220 Less than 80 can indicate hypothyroidism.


Levothyroxine


Adults:

Hypothyroidism: 1.7 mcg/kg/day in otherwise healthy adults 50 years or patients with cardiac disease, refer to Elderly dosing.

I just dont understand what a titrate dose is.

[GravesLady]

People might be referring to antibodies.  However Antibodies do not diagnose, they only confirm the diagnose from thyroid levels.

Hashi Antibodies are not curable nor treatable, there is nothing that can be done about them.

Hashi treatment is the same as for being hypothyroid.

We can be hypothyroid and not be Hashi. But we can't be Hashi without being hypothyroid, and, that shows in thyroid levels.

You can be non-active Hashi with normal thyroid levels, but that is not treatable, only active Hashi, which will show in your thyroid levels.  Have you had them done.