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Thyroid Disorders Community
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125112 tn?1217277462

Things that make you go Hmm

I have heard that x amount of people with thyroid antibodies do not go on to develop thyroid dysfunction.
My question is, unless a person has been followed since discovery of antibodies and by the same doctor (or whomever) -how is this known? Is there any literature showing the research (not just the statement) behind this?

Another thing I have wondered: when somebody has been having many symptoms, but their TSH is within reference range (say 3.25) but with antibodies, some doctors may treat and other's will not.  Would it be justifiable for the doctor, who will not treat to state: "You don't have thyroid dysfunction?"

How many have been told this and their labs would move out of range? Do their symptoms somehow only count when labs move out of range?

The reason I ask this, as I know people (don't we all?) who've dealt with symptoms, in range labs...who would one day be treated.
Before then, told, "You are fine" and the terrible one: It's in your head or perhaps you suffer hypochondrias.
If this has been said to a patient and sometime later, their labs move out of range-does the doctor, who's said the above think, "Hmm. Must be coincidence?"



18 Responses
Avatar universal
Ahh, interesting question. I know that in lower amounts thyroid antibodies can be present in other AID's besides Hashi's/Graves or in normal, healthy people - however, I've also read that the higher the antibody count the more likely you are to have thyroid disease.

You know, I didn't seek medical care because I wanted to have Hashi's. I went to the doc with a multitude of symptoms I could no longer ignore as they were affecting the quality of my everyday life. I had no preconceived idea of what was wrong - that was up to the doc to find out, right? The only "abnormal" test result was a TgAb that was 50X above the reference range. I've been tested for lupus, Lyme, celiac, parasites, adrenals, many things. The only "out of range" result was the TgAb. Since there's no other logical explanation and many of my symptoms are classic hypo, plus a family history, why is this such a difficult conclusion to reach? Because my TSH is only 2.23. Why do I have to continue to suffer when there's something that can be tried that may help?

It makes sense that when somebody is asymptomatic that a "wait and see" scenario might be in order. But when you have symptoms, + antibodies, out of whack FTs but only mildly elevated TSH it's a disservice to the patient to make them continue to suffer while you sit and wait for the TSH to reach the magic number.

Sorry to ramble, I'm so sick and tired of being sick and tired! As to your last comment, if one is indeed seeing a doc who writes you off because the TSH isn't high enough, I guarantee when it does go out of range he/she will cry coincidence. Why? Because to do otherwise would mean they have to admit they were wrong in their thinking oh so long ago when you were begging for some relief.

I'm so glad there are docs out there who will treat the whole body and not just one lab, there's hope!
314892 tn?1264627503
You bring up some good points. It does only seem in retrospect that someone w/ symptoms and a TSH in range, who then finally goes out, would then be told that they probably had the thyroid problem for a while. (Run on sentence, I think- sorry.)
My TSH was always in the upper end of normal with seemingly unrelated symptoms- dizziness, tires, twitching, weakness. My endo said after reviewing my history of alopecia, dizziness, etc, that I have probably been hypo since high school. i am now 40! My gut told me it could be that. Remenber, I work in the lab and see the results of bloodwork everyday. My numbers at the high end of the range stood out like a sore thumb from the levels of less than 1 up to about 2.

Definately some things to ponder.

Kitty
Avatar universal
I said here many times, if you feel bad, you need to  do something. It is your body, it is you have irregular heart beat, or tired all day, or gained 30 pounds in 3 months. if they don't help you, find some one else. I fired 3 doctors in 5 years to find a good one I like.  There are many reasons that different doctors act differently. you will never know what was the reason behind them, but for you, you just have to find one who is willing to spend the time and work with/treat you...
97628 tn?1204465633
The hormone treats TSH, not antibody level    http://www.medhelp.org/posts/show/380183

The rise itself doesn't matter because there are doctors somehwere who will treat people when they aren't actually hypothyroid anyway.

Perhaps a more constuctive approach would be to take action to address the complaints individually.

Exercise also does a great deal to increase energy levels, decrease anxiety/depression and control weight.
314892 tn?1264627503
This post was meant for people to share their thoughts, not to be told that we are treated for hypothyroidism we don't have. Endocrinologists have diagnosed most of us based on lab results and history. I didn't do asking for treatment. The endo TOLD ME I had Hashimoto's and recommended treatment. They ordered the ultrasound, not me.

Once again here is a reference on why these doctors DO treat mild hypothyroidism.
This is from The Journal of Clinical Endocrinology and Metabolism 2005;

Indeed, the new NACB guidelines (10) state that "greater than 95% of healthy, euthyroid subjects have a serum TSH concentration between 0.4 and 2.5 mU/liter." They go on to state that "ambulatory patients with a serum TSH >2.5 mU/liter, when confirmed by repeat TSH measurement made after 3–4 wk, may be in the early stages of thyroid failure, especially if TPOAb is detected." Logically it would seem that the exclusion of TPOAb-positive individuals from populations employed to establish a normal TSH reference range constitutes recognition that this TPOAb-positive population has Hashimoto’s disease and is vulnerable to progression to overt hypothyroidism.

Thyroid diseases are known to include many seemingly unrelated symptoms. I guess the testimony of people who are treated and feel better doesn't matter.

Dr. Lupo just replied to JatMunda'a post. ( She also posted here). Here is the exchange:

Hi...recently i went for my Health screeninig test.my thyroid test was,
  
Thyroid Studies      Result        Reference
        T3                 2.35          (0.92 - 2.79 nmol/L)
        Free T4         13.72         (11.50 - 22.70 pmol/L)
        TSH              3.520         (0.350 - 5.500 mlU/L)
        Anti-Tg          38.4           (0.0 - 34.0      lU/mL)
        Anti-TPO       499.3         (0.0 - 12.0      lU/mL)
  
Iam not taking any medicine regarding thyroid,but physically i have a lot of other symptoms.
I would like to know that According to your Experience and knowledge.is there any Thyoid problem with me?
                                                         Thanks.  

Doctor's Answer

1 day ago by Mark Lupo, M.D.


View Profile
Mark Lupo, M.D.  
37 years old
Sarasota - FL  



You have hashimoto's thyroiditis with early hypothyroidism.  Would see a thyroid specialist or primary doctor to consider a trial of treamtent given the symptoms.

Many of us here have nearly the same exact labs (or higher TSH) and similar history, yet we have just been told that we have been treated for hypoT that we don't have.

The rise in the TSH DOES matter. An individuals TSH normally remains within 0.75. Any deviation from this is likely indicitive of thyroid dysfunction.

This may fall on deaf ears, but I feel compelled to present the other side of the debate.

Thus, although there is little doubt in our minds that a TSH level between 5 and 10 is abnormal, we would go further to state that a TSH level that rises in a given individual from a set point of 1.0 to a value of 3.5 is likely to be abnormally elevated and imply early thyroid failure. The NACB guideline 8 states that "analytical variability together with between-person and within-person estimates of biological variability suggest that the magnitude of difference in ... TSH... values that would be clinically significant when monitoring a patient’s response to therapy... is 0.75 mU/liter" (10). This concept that small differences within an individual’s normal range are significant is suggested by the study by Michalopoulu et al. (33), who treated TPOAb-positive hypercholesterolemic patients with TSH levels between 2 and 4 mU/liter with low dose levothyroxine and demonstrated normalization of TSH levels and improvement in their lipid profile.

JCEM 2005

This many doctors aren't going to put their careers on the line to give people treatment they don't need. Yes, sometimes a trial of medication can help determine if the symptoms are due to thyroid in some cases.
97628 tn?1204465633
I was addressing the individual who complained that their TSH wasn't yet high enough for treatment and nothing I said was untrue. I am not going to waste time citing articles  again.
This is an open board and I was adressing that indivisual. if you wnat a pricat convetrsation you cna easily have one.
They do treat people without objective evidence of hypothyroidism all the time. Just like cardiologists who who give beta blockers for people who have 2 PVCs a day because those 2 PVCs make them so nervous, not because they are in any medical danger from them. Treating symptoms without any material evidence of underlying disease is done all the time.
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