I believe patients should lobby various groups and organizations, calling for laboratory reports to flag results above a TSH of 2.5. Contact the thyroid patient groups -- such as the Thyroid Foundation of America -- and tell them your membership in the coming year depends in part on them representing your interests on this critical issue. Contact the professional organizations -- such as AACE, ATA, and the Endocrine Society. Contact your health insurers and HMOs. Talk to your endocrinologists and physicians. Write to the laboratory where you blood is sent.
3. A New Practitioner.
When faced with endocrinologists or other physicians who are reluctant to diagnose by any other means than a rigid interpretation of the TSH results, it may be time to see a more integrative or holistic practitioner. This may be a holistic MD or an osteopathic physician, or a trained and licensed naturopath, for example. In my opinion, some of the best thyroid care is provided by integrative practitioners who view TSH testing as only one component of thyroid diagnosis and treatment. These practitioners typically call on a range of approaches for diagnosis and management of thyroid disease, including:
- Additional blood tests, such as Free T4, Free T3, and antibody profiles
- Clinical evaluation of visible signs of thyroid disease, including changes in reflexes, swelling and edema of the face and extremities, hair loss in head and body, loss of outer edges of eyebrows, among others
- Clinical manual and visual examination for thyroid enlargement and nodules
- Check of blood pressure and heart rate
- Imaging tests to identify thyroid enlargement, atrophy, and nodules
Closing Thoughts
Thyroid Awareness Month is coming in January. Each year, AACE adopts a theme and conducts a public relations and awareness campaign with the media to help focus attention on thyroid issues. In past years, the issue was doing a thyroid self-check of the neck, and the menopause/thyroid connection. While these PR campaigns can be helpful, I would like to see AACE spend its time and money this year focusing on an outreach campaign to the rest of the medical community. Let's see a campaign to educate all doctors about the symptoms of thyroid disease, and the fact that, as Dr. Garber said, "[TSH] values between 2.5 and 4 are more likely to reflect early disease. Though intervention is not necessarily called for, it may be called for on an individual basis."About the Author
Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.Sources
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Fatourechi V, Klee GG, Grebe SK, et al. "Effects of reducing the upper limit of normal TSH values." Journal of the American Medical Association. 2003;290:3195-3196.
Garber, Jeffrey, MD, FACE. "Hypothyroidism--Talking Points 2006," US Endocrine Disease 2006, Online
"New Campaign Urges People to "Think Thyroid" at Critical Life Stages and Get Tested," American Association of Clinical Endocrinologists, Press Release: January 18, 2001, Online
"Over 13 Million Americans with Thyroid Disease Remain Undiagnosed," American Association of Clinical Endocrinologists, Press Release: January 2003, Online
Shomon, Mary. "The TSH Reference Range Wars: What's "Normal?", Who is Wrong, Who is Right..." About.com Thyroid Site article, Online
Shomon, Mary. "Endocrinologists Say TSH Normal Range is Now 0.3 to 3: Millions More at Risk," About.com Thyroid Site article, Online
Shomon, Mary. "Does Your Doctor Know About the New TSH Normal Range?" About.com Thyroid Site article, Online
Shomon, Mary. "AACE Changes Position re: TSH Normal Range," About.com Thyroid Site article, Online
Shomon, Mary. Telephone interview with Dr. Jeffrey Garber, MD, FACE. August 16, 2006
Surks, Martin et. al. "Subclinical Thyroid Disease," Journal of the American Medical Association. Vol. 291 No. 2, January 14, 2004, Online
Surks, Martin. "Commentary: Subclinical Thyroid Dysfunction: A Joint Statement on Management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society," Journal of Clinical Endocrinology and Metabolism,, 90(1): 586-587, 2005, Online
