Posted by noa on June 28, 2000, at 15:54:53
In reply to Nikki---the limits lie, posted by Abby on June 27, 2000, at 22:56:07
I'm with Abby on this one.
Subclinical hypothyroidism is often overlooked, because if the doc only looks at statistical norms, and adheres rigidly to the statistical cut-off numbers, they will not see that for many people, slightly elevated TSH with normal thyroid hormone levels is an indicator of hypothyroid that could have an essential effect on treatment for depression.
Once identified, the treatment goals are different than they would be for some other hypothyroid patients, although, again, many docs stick too rigidly to the statistical norms. So, for example, statistically, a TSH of between about .5 and 5.5 is considered normal. But for many people, a TSH over 2 is high and is associated with some distressing hypothyroid symptoms, mostly the psychiatric ones, or fatigue. ( There is one doctor from England cited on Mary Shomon's website who claims that per his review of the literature, a TSH over 2 is highly predictive of future diagnosis with hypothyroid).
I only started to feel better when my TSH was suppressed, through thyroid hormone replacement, to below 1.
Let me quote from the letter my endocrinologist wrote to my GP:"Some patients with depression and hypothyroidism occasionally require more than the usual replacement doses in order to feel considerably better. Sometimes they have to be titrated bit by bit even with a suppressed TSH until their sense of well being does not improve any further......if she was feeling well on this regimen with good energy, it does not need to be increased further. however, if there was still some degree of fatigue, she could try increasing the Synthroid slightly...even if the TSH was suppressed. She could check every 6-8 weeks; and as long as there was continued improvement in her energy and well being, the dose could be mildly increased after that. Once there was no further improvement, the dose should be no further increased. Sometimes this strategy is useful, even though it results in a suppressed TSH in patients who are refractory to typical antidepressant therapy. Usually you do not have to go much out of the normal range to reach the point where no further benefit is rendered...."
poster:noa
thread:38335
URL: http://www.dr-bob.org/babble/20000619/msgs/38582.html