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Hey there, this is Dr. Ruscio. I just want to share a quick update regarding the thyroid TSH and why you should be really careful in terms of what you are told you should do about an elevation of your TSH. You’ve hopefully heard some of my criticisms of the field of functional, natural, and integrative medicine regarding how overzealously, we’re interpreting small perturbations and findings on thyroid labs. This certainly includes people I work with in the clinic. In fact, I just had a patient this morning and she had previously a TSH of 6.3. So the cutoff on most labs is 4.5. So she was according to the conventional lab ranges, slightly elevated. This is known as subclinical hypothyroid. When that minimum elevation of TSH is paired with normal T4, this is known as subclinical hypothyroid, meaning you’re not true hypothyroid. Why this is so crucially important is because the data here are fairly clear in showing that most of these cases will spontaneously remit or will spontaneously, all on their own with no treatment or therapeutics or support, go back to normal.
Too Quick to Medicate
Now, what was so interesting here is that while working with me, she was also doing some local testing with her NP, her nurse practitioner. I advised her not to be too quick to act on this 6.3, this elevated TSH paired with normal T4 and also normal T3. Let’s retest in a month or two, especially given the fact that she had been improving symptomatically. As the data suggests, you will likely see normality or normalization of your TSH. So what do you know, about two months later? Her TSH has now gone into the normal range of 3.6, from 6.3 and T4, and T3 are still normal. All the while she has continued to improve symptomatically. To contrast this with what I think really needs to be amended in the field, her NP wanted to put her on thyroid hormone at that initial visit with the elevated TSH. What a travesty that would have been, because once you put someone on thyroid hormone, the repeat testing doesn’t tell you if they no longer need the hormone, because all of the levels have been paved over by the hormone that the person is now taking orally.
So this is a crucially important situation where we don’t want to be too quick to act to put people on thyroid hormone without giving adequate time to see if, especially at these subclinical findings, again – high TSH, normal T4 according to the conventional ranges – normalizes all on its own at your next retest. The trajectory of these two different patient scenarios is so different. The one patient from the more, what I would argue, overzealous camp will be put on thyroid hormone in some cases for years, until a provider has enough common sense to go back and check this. Or, as in this case with a more reserved and kind of circumspect approach, no medicine was started and a retest a couple months later found she was back into the normal range. We stopped her from going on a medication ostensibly for years that she would not have needed.
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Get a Second Opinion
If you’re concerned about this, double check and get a second opinion to make sure that you’re A) not on thyroid hormone that you don’t need to be, or B) that perhaps you are given thyroid hormone too quickly, based upon this lab work, that really didn’t justify that approach.
Now, according to the philosophy of some providers, subclinical hypothyroidism does justify use of medication. Although the data here are clear that there is almost no benefit shown when those who have that pattern of high TSH and normal T4 go on thyroid hormone. Almost no benefit has been documented unless you’re very young, you are pregnant or are struggling with infertility, or your TSH is well above 10. These are important nuances to understand in navigating the conversation around thyroid, which is all too often vilified or positioned as a cause of all symptoms. It may well be, but we don’t want to force upon someone thyroid hormone when the labs really don’t justify that because that can lead someone to be on medication they don’t need. This also distracts from actually determining what underlying cause is leading to the symptoms that you’re having. So again, I would encourage you to double check. Don’t stop taking the medication until you check with your provider, but if you’re suspicious that your provider is being a bit overzealous, have a double check. It may be well worth it. Okay. That is our show. Hopefully this helps.
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