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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Saturday, November 22, 2008
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Saturday, November 22, 2008
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Diabetes |
Hypothyroid10/19/2004 01:28PM |
Two years ago I was diagnosed with hypothyroid. I take my medication very carefully and have my blood work done every three months. My blood work showes that I am in "normal" range but I do not feel any better. Other changes are happening - hair growth, weight gain, carpal tunnel, and intolerence to any types of birth control. I am going to see a specialist next month. Is there anything else they can do besides the levathroid? I get concerned because it says normal range but I sure do not feel like it. Please help!!!
The thyroid is a hormone producing gland located in the neck. The word thyroid is derived, I believe, from the Greek for shield which roughly corresponds to the shape of the gland in the front part of the neck overlying the trachea (windpipe). Two of the most common thyroid conditions that people can develop are an underactive or an overactive thyroid, hypothyroidism or hyperthyroidism, respectively. Hypothyroidism can result from a number of causes, the most common today being an inflammation of the thyroid over a long period of time, chronic (or Hashimoto's - named for the person who described this condition) thyroiditis. Less commonly, people can have hypothyroidism because of iodine deficiency (the thyroid requires iodine to make the two forms of thyroid hormone, referred to as T4 and T3, for the number of iodine atoms in each molecule) or effects of various other drugs which interfere with thyroid function. Thyroid hormone is essential for survival and has a major impact on level of metabolism and sense of energy and overall sense of wellbeing. Thyroid hormone production from the thyroid gland is under the control of the pituitary gland which is located on the undersurface of the brain. The pituitary produces TSH (thyroid stimulating hormone). The process functions in a negative feedback manner like a thermostat: If the level of thyroid hormone production is too low, the pituitary responds by raising TSH above the normal range, and vice versa. We primarily rely upon the TSH level to evaluate the level of thyroid function.
One of the recent controversies in the care of people with hypothyroidism regards the definition of what is normal. Historically, we have established normal ranges for thyroid tests based on the distribution of TSH results in a population not known to have thyroid disease. However, some experts believe that the "normal" populations that have been used include people with modest abnormalities in thyroid function which have not been diagnosed yet. They believe that the "true normal range" for TSH is much narrower than what is reported in most laboratories; according to this point of view, the true normal range for TSH which is also the target range for treatment of hypothyroidism is about the lower half of the previously described normal range. Perhaps, in your situation, there is room to add a bit more thyroid hormone and still keep the TSH within the safe range. Leading endocrinologists believe that the safest way to replace thyroid hormone is with the use of the T4 (levothyroxine) form of the hormone. There is controversy about whether some people need replacement with a combination of both T4 and T3 (tri-iodo-thyronine). I have patients who swear that they cannot get by with T4 alone. At the same time, there is evidence that T4 replacement is much safer than T3 replacement. My and my colleagues' overwhelming preference is to treat with T4 to avoid the safety concerns.
The normal range controversy is a relatively recent issue so not all specialists will be familiar with this, so you might want to take this response with you when you go to see them.
Good luck - please feel free to write back with additional questions.
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Robert M. Cohen, MD Associate Professor Division of Endocrinology and Metabolism Department of Internal Medicine College of Medicine University of Cincinnati |
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