The TSH Gotcha

We have before us multiple scenarios, all of which start and end in the same place. (This is going to be a tad long, so grab a cup of coffee to see you through to the end.)

The adventure starts when you drag into the doctor’s office complaining about weight gain, extreme fatigue, thinning ...We have before us multiple scenarios, all of which start and end in the same place. (This is going to be a tad long, so grab a cup of coffee to see you through to the end.)

The adventure starts when you drag into the doctor’s office complaining about weight gain, extreme fatigue, thinning hair, mood swings, feeling a little down, and so forth–the standard hypothyroid story. Dr. Sherlock, if you’re lucky, will take these clues and decide to test for a thyroid problem.

And so you give a little blood for a few tests, and our scenarios start.

The big kahuna of thyroid blood tests is the misbegotten TSH (thyroid-stimulating hormone) test, our topic here.

Here’s the theory behind the test: The pituitary gland, which controls the thyroid and every other part of the endocrine system, creates TSH to tell the thyroid gland when to make thyroid hormone. • If the pituitary decides you have enough thyroid hormone in your system, it quits ordering more. The TSH results land in the normal range. • If you’re producing too much thyroid hormone, the pituitary backs off any TSH and puts out a factor that tells the thyroid to knock it off. The TSH comes in low. • If you don’t have enough thyroid hormone racing through your cells, the pituitary pours out more and more TSH to get the thyroid gland to do its duty. TSH results show up anywhere between high normal and the stratosphere.

Based on that theory, one quick look at the TSH results decides your thyroid fate. • If the TSH is within “normal range,” supposedly you’re fine. Problem is, nobody agrees on what the “normal range” is. Chances are you’re not at one extreme or the other–although the TSH test isn’t reliable, so who knows–but that doesn’t mean you’re home free. You don’t have to be far off the mark to in trouble. For instance, even mild hypothyroidism explodes your chances of heart disease, but you may still be in the “normal range.”

Besides, you feel bad. So the doctor solicitously offers you an antidepressant. And you probably feel wretched enough to take it. It won’t do a bit of good, but the deal is sealed. You’ll have to change doctors and try again to get proper treatment. It’s not unusual to go to six or seven doctors–or more–before somebody gets it right. • If your TSH is low, the doctor declares you hyperthyroid. Maybe not, Sherlock. If the pituitary is out of whack, it won’t produce TSH no matter the circumstances. Most concussions damage the pituitary, and it may never recover enough to tell the thyroid to do something wonderful. So the thyroid does nothing, and the TSH test says nobody’s home. This creates a problem since med schools teach doctors a low TSH can only mean hyperthyroidism.

They dismiss the disconnect between hyper complaints of losing weight, heart palpitations, extreme nervousness, etc. and the nearly catatonic patient before them. A simple tap on the ankle to check reflexes would separate the hyper from the hypo, but doctors don’t do that any more.

Given the supposedly impossible combination of a low TSH and hypothyroid symptoms, the perplexed doctor scribbles a prescription for an antidepressant. As if! It won’t do a darn bit of good. It’s like putting a cast on your leg because you have a cold.

But what if the TSH test is legitimately low? Well, you could have an infection. And, as I mentioned, the test is unreliable. Or you may really be hyperthyroid. In any case, go carefully before getting involved in irreversible hyperthyroid treatments. Research the tar out of alternative medicine’s options. Let the irreversible stuff be a last resort.

Meanwhile–and I can’t believe these words are coming out of my fingers–you might think about drinking V8 juice. It contains soy (natural flavoring on the label), which will depress your thyroid, which will help with the symptoms. Contrary to popular opinion, soy is a major menace to health–but V8 has high nutritional value, and you’ll only drink it for a short time until you sort things out. • Finally, if your TSH is high, the doctor will declare you hypothyroid and, this time, write a prescription for a thyroid medication instead of an antidepressant. But don’t celebrate too soon.

You’ll get a prescription for Synthroid, levothyroxine or some other T4 medication–none of which is worth spit. Doctors, however, see T4 as the medicine of choice, indeed the only one they’ll order. Some of them know it doesn’t work, but they still have to order it.

Explaining why T4 meds don’t work is a long, long tale, so I’ll just talk results–or lack thereof.

T4 medications help very, very, very few people. Like, maybe, none. Your symptoms persist, unchanged. Oh, you try to will things to be better because you’re so tired of feeling like garbage, but nothing happens.

So you drag yourself back to the doctor for another test. Here’s where a Catch-22 rears its ugly head. While the T4 medicine does nothing for your symptoms, it does normalize the blood test. Your TSH will be normal when you take T4 meds. The doctor may fine tune the dose a few times, but in the end, if you keep complaining about feeling terrible, you’ll get an order for an antidepressant. Which, of course, won’t help.

I can offer but a small ray of hope: Doctors are losing faith in the TSH test. Some medical schools no longer teach it. It’s about time, but it doesn’t help you today.

Before the advent of the TSH test forty-some years ago, doctors treated thyroid issues by addressing symptoms, the approach that works. Also back in the day, doctors prescribed the bio-identical Armour thyroid instead of the synthetic T4 meds (which appeared on the scene along with the TSH test). Armour worked well. Exceedingly well. It still does, if you can get a doctor to order it.

So, here’s a suggestion: When your doctor hands you a prescription for an antidepressant, try to bargain for a trial of Armour Thyroid before you try the antidepressant. What do you have to lose besides your misery?