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Getting a thyroid diagnosis if your TSH lab tests come back as normal

Have you had a TRH test?
In an article by Raphael Kellman, M.D. in Alternative Medicinemagazine, Dr. Kellman indicates that some hypothyroidism may not be picked up by the standard thyroid hormone panel, which tests primarily the TSH, (thyroid stimulating hormone). If hypothyroidism symptoms are present, but TSH tests are normal, Dr. Kellman often relies on the TRH -- thyrotropin releasing hormone --stimulation test to assess possible hypothyroidism. According to Dr. Kellman, "the physician measures the patient's TSH level (a simple blood test), gives an injection of TRH, then draws blood 25 minutes later and remeasures the TSH. If the first TSH level is normal and the second TSH level is high--above ten--it tells us the patient's thyroid is underactive. A TSH reading of 15 is suspicious, while 20 strongly points to hypothyroidism." Dr. Kellman states that, "of the patients I've seen with three or more typical symptoms of underactive thyroid but who have tested 'normal' in standard tests, 35-40% actually have underactive thyroids based on the TRH test."

Could You Have an Underlying Additional Problem that Requires More than Just Standard Thyroid Hormone Replacement such as Levothyroxine Sodium/Synthroid?

Synthroid, Levoxyl, Levothyroid, Euthyrox, Eltroxin are all brand names for the thyroid drug levothyroxine sodium, which is a synthetic version of the thyroid hormone T4. These are most often the drugs prescribed for thyroid hormone replacement for most patients.

But if you have hypothyroidism and are taking one of these conventional thyroid replacement drugs, your blood tests show a "normal" TSH and yet you still don't feel well, there may be an need for the addition of T3, the other major thyroid hormone.

For example, the book "Myofascial Pain and Dysfunction: Trigger Point Manual," describes the condition of "hypometabolism," where inability to adequately convert T4 to the T3 needed by the body leaves someone with a normal TSH level, but hypothyroid symptoms. Serum hormone studies typically show marginally low T3 and T4 levels, usually within the "normal" range, and TSH is rarely elevated out of the "normal range." At the same time, cholesterol is often elevated, and basal temperature is likely to be 97 degrees F or less. Patients with hypometabolism problems often respond well to T3 or T4/T3 treatments.

Fibromylagia can also be an underlying reason. Symptoms of fibromyalgia can be very similar to thyroid disease, and researchers have found higher incidence of thyroid disease among fibromylagia patients. And the researchers are also finding that these patients need the additional thyroid hormone T3 to resolve symptoms. For more information on fibromylagia and its symptoms, diagnosis, and relationship to thyroid disease, see my article "Chronic Fatigue, Fibromyalgia, and Autoimmune Thyroid Disease.

T3 is available on its own, as a brandname drug known as Cytomel, or can be included with T4 in the naturally derived thyroid drug Armour Thyroid, or the synthetic version of Armour, which is known as Thyrolar.

But My Doctor Thinks that TSH Testing is the Only Way to Diagnose Hypothyroidism, Antibody Tests are a Waste of Time, TRH Tests Are Useless, Synthroid is the Only Drug to Prescribe, and There's no Such Thing as Hypometabolism or Conversion Problems or Fibromyalgia, and Armour Thyroid is an Old-Fashioned, Dangerous Drug

Many endocrinologists are known for being "numbers" people. They manage by the numbers, and not by the symptoms, which can often create the "you're in the normal range, so you're fine" response many of us get to complaints that we still don't feel well. So keep in mind that even if you have easily diagnosed hypothyroidism, it may take some serious looking to find an endocrinologist who believes in finding an optimal TSH for you, and not just getting you into the high normal range and declaring you cured.

As for getting a diagnosis and treatment via the less conventional methods -- basal body temperature testing, TRH tests, antibody testing -- or drugs -- Armour, Thyrolar, Cytomel --you're probably going to need to look outside the standard endocrinology community and find a doctor who has a more holistic approach.

Here, I suggest you visit my article on finding a good doctor.