Posted 31 December 2017 - 01:24 AM
Hi everyone, wishing you all a happy, safe and healing new year!
I thought i would end 2017 by venturing into the hotly controversial area of TSH.
Many of us have been treated by practitioners who place an inordinate amount of importance on our (often suppressed) TSH levels. Some of us find out the hard way that this is definitely not good practice, so i thought i would bring together some links to information that we sometimes spend a good deal of time looking for - and often at a time when we have become quite hypOthyroid as a result of over-treatment by TSH obsessed doctors
Some recent papers discussing the TSH test:
Front Endocrinol (Lausanne). 2015 Nov 20;6:177. doi: 10.3389/fendo.2015.00177. eCollection 2015.
Homeostatic Control of the Thyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment.
Hoermann R1, Midgley JE2, Larisch R1, Dietrich JW3.
"As a consequence, the use of TSH, valuable though it is in many situations, should be scaled back to a supporting role that is more representative of its conditional interplay with peripheral thyroid hormones. This reopens the debate on the measurement of free thyroid hormones and encourages the identification of suitable biomarkers. Homeostatic principles conjoin all thyroid parameters into an adaptive context, demanding a more flexible interpretation in the accurate diagnosis and treatment of thyroid dysfunction."
Full text is availble at:
Front. Endocrinol., 22 December 2017 | https://doi.org/10.3...endo.2017.00364
Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment
Rudolf Hoermann1*, John E. M. Midgley2, Rolf Larisch1and Johannes W. Dietrich3,4,5
"If TSH serum concentrations provided a more sensitive and accurate mirror image of thyroid hormone status than thyroid hormones themselves, this would be an ideal diagnostic tool. This argument emerged in the 1980s, and was readily accepted by clinicians (12, 13). TSH measurement subsequently gained a dominant role in thyroid function testing, facilitating cost effective disease screening, introducing new definitions of subclinical hypothyroidism or hyperthyroidism, and delivering biochemical treatment targets (1417). A plethora of epidemiological studies then associated TSH concentrations with clinical outcomes (1821). This resulted in a questionable paradigm elevating an indirect controlling parameter to such prominence and dominance as expressed in current guidelines for diagnosis and treatment of thyroid diseases (1416). With the holy grail in the hand of scientists, clinically orientated approaches contradicting the TSH paradigm and noting discrepancies between a biochemically euthyroid and clinically hypothyroid status were readily dismissed (2226). However, concerns have resurfaced in the light of recent basic and clinical studies revealing fundamental issues with the interpretation of TSH measurements and documenting unsatisfactory improvement in the quality of life of patients treated for hypothyroidism according to the current TSH paradigm (1, 2729)."
"We conclude that a TSH measurement representing ambiguous and overlapping categories between thyroid health and disease is by itself unreliable as a diagnostic tool. "
"Many studies reported increased risks associated with suppressed TSH such as atrial fibrillation and osteoporosis but failed to properly classify the hormone status of patients into euthyroid versus hyperthyroid, and frequently did not even distinguish between treatment-induced TSH suppression and endogenous hyperthyroidism (94). Importantly, thyroid hormones, while suppressing pituitary TSH, have been reported to upregulate the locally produced osteoprotective TSHβv variant (95). Statistical associations with TSH cannot establish causality, as the opposing effects of low-TSH and low-FT3/TSHβv frequently occur together in LT4-treated patients."
"Simplified concepts such as the negative thyroid pituitary feedback control contributed a fundamental understanding of endocrine principles, but were subsequently not refined for dealing with more complex facets of the various thyroid disorders and the clinical requirements of the diagnostic process. The pituitary TSH response is too diverse to be viewed as a sensitive mirror image of thyroid function"
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I also recently unearthed some papers discussing antibodies and bone health that question the oft heard claim that suppressed TSH in and of itself causes osteoperosis (links to which are contained in the following thread):
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...and a couple more:
J Clin Endocrinol Metab. 2003 Sep;88(9):4135-8.
Brokken LJ, Wiersinga WM, Prummel MF.
Full study link http://jcem.endojournals.org/content/88/9/4135.full.pdf
Long-term TSH suppression in Graves- hyperthyroidism
Authors: Chung YJ, Lee BW, Kim J-Y, Jung JH, Min Y-K, Lee M-S, Lee M-K, Kim K-W, Chung JH.
Reference: Thyroid 16: 1251-1257, 2006
Continued suppression of serum TSH in patients with Graves- disease during antithyroid drug treatment is related to TBII, pre-treatment severity of hyperthyroidism, and time to normalization of serum T 3 and T 4.
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Be safe and be well
Posted 31 December 2017 - 12:51 PM
Please put this article about the TSH at the Thyroid 101. You are free to work through this section and see which links are no longer working and find the appropriate links to replace any if you'd like. Unfortunately I tend to 'zone' out when working on Thyroid 101 for too long. The simplicity of my posts is kept in this format to help me with my ongoing focusing/brain fog issue. Although I have improve a lot over the last few years and keeping my thyroid levels up as high as I possibly can, I believe that having a profound hearing loss makes for continual difficulties as well.
Posted 01 January 2018 - 06:23 PM
Thank you for the links. This is what I found the most interesting conclusion: "The pituitary TSH response is too diverse to be viewed as a sensitive mirror image of thyroid function." I had also never read about TSH-beta-v variation.
Cheers and thank you for finding all the scientific research!
Posted 03 January 2018 - 12:49 AM
Hi Mmztcass & Mudra
Hope your 2018 is off to a great start
Sorry, i can't add posts in the 101 section, i think it's adimin/moderators only... i will go through the 101 section though over the next few weeks and check for broken links etc .. just not today, i'm feeling deliciously lazy
I can't seem to resist looking this sort of stuff up i'm finding it really promising that attitudes seem to be changing and researchers are asking better questions and not basing their conclusions around TSH - which is looking rather more like a red herring than a gold standard where autoimmune thyroid disorders are concerned.
I hadn't heard of the TSHβv variant either, something to add to my list of things to investigate got a feeling it's going to be complex and i'm sorta feeling like keeping things simple at the moment (currently on holiday - hurrah!)
Posted 03 January 2018 - 01:20 PM
Hi Allies - that's the thing! The more researchers investigate, the more complex it all seems to be. Simple feedback loops seem to be way more intricate than initially hypothesized. Now, let's hope that the current 'narrative' will change quickly to reflect new findings in research. With the internet that seems like a true possibility.
Have a great, lazy holiday!