PATIENTgtgtI just don’t think I should have to dress like this for my physicals, that’s all I’m saying doctor. DOCTORgtgtNot to worry. Most patients adapt quickly, even learning to enjoy it. Are there any other questions PATIENTgtgtYes. About my hypothyroidism. You said my TSH is now normal, but I still have all the symptoms. I think I need more medication. DOCTORgtgtI understand your concerns fart. However, Our Holy Miracle of the Infallible TSH Test is the gold standard for treating hypothyroidism. Your TSH is normal, therefore you are cured and don’t need more medication. I will check you again in 6 months.
PATIENTgtgtIf I’m cured, why do I still have all my symptoms DOCTORgtgtIt’s a complex subject. Many hypothyroid patients probably suffer from other diseases, such as fibromyalgia, which could explain their continuing hypothyroid symptoms. PATIENTgtgtIsn’t it more rational to assume that lingering hypothyroid symptoms simply indicate lingering hypothyroidism Why invent a new disease with conveniently similar symptoms to explain the one already squarely in front of us DOCTORgtgtBecause your TSH is normal. So we have to inventI mean, look for other causes of your symptoms. PATIENTgtgtWhen I have sneezing, a runny nose and a cough, the continuation of those symptoms.
Tells me that my cold is still there. But when I feel cold, tired and have achy muscles, you would have me believe that the continuation of those symptoms means that a mysterious new disease with identical symptoms has snuck in, kidnapped my hypothyroidism and taken its place DOCTORgtgtYou’re intentionally trying to make this sound silly and undermine my authority. I have a suit and tie, while you have no credibility in that admittedly hot and sexy costume. This consultation is over. PATIENTgtgtDoes TSH actually measure thyroid hormone DOCTORgtgtNo. It measures a pituitary hormone that stimulates the thyroid.
Our Holy Miracle of the Infallible TSH Test
PATIENTgtgtSo does TSH reliably stimulate the thyroid DOCTORgtgtNot always. Some TSH, such as that from pituitary tumors, is biologically inactive. But those cases are very rare. PATIENTgtgtDid you test my pituitary anyway, just to be sure DOCTORgtgtOf course not. It’s very rare. PATIENTgtgtSo does a normal TSH test absolutely prove that no hypothyroidism is there DOCTORgtgtNot always. It could also mean your pituitary is simply happy with a level of thyroid hormone that is insufficient for the rest of the body. In truth, the validity of the TSH test rests on so many flimsy assumptions that it could be the worst thing to ever happen.
To endocrinology. But it’s wonderfully easy to measure. PATIENTgtgtDoctor, this TSH test seems very unreliable. Is there any way to actually test the thyroid directly DOCTORgtgtYes, we can measure the actual Free T4 and Free T3 hormone levels. Knowing your lack of faith in Our Holy Miracle of the Infallible TSH Test, I took the liberty of doing those tests. Your Free T4 and Free T3 levels are also normal, therefore you are cured, and you owe your TSH an apology. Please say 60 Hail TSH Tests before your next exam, and.
Go in peace. PATIENTgtgtSo doctor, is it true then that hypothyroidism is always cured by attaining sufficient levels of thyroid hormone in the blood DOCTORgtgtTechnically, no. Hypothyroidism means a lack of thyroid hormone inside the cell. It really doesn’t matter how much is in the blood, since it only works inside the cells. But any difference between serum levels and intracellular levels is very rare. PATIENTgtgtHow do you know that crickets chirping DOCTORgtgtWow, would you look at the time. Please accept my apologies for keeping you so long. Good bye. PATIENTgtgtSo do blood hormone levels accurately reflect cellular hormone levels.
DOCTORgtgtpause No. Not really. Even with normal serum hormone levels, thyroid hormone cannot enter the cell without adequately functioning cellular receptors. Reverse T3, sluggish receptors or other factors can all prevent transport across the cell membrane. In the final analysis, none of these tests really proves the only thing that matters, which is whether or not enough thyroid hormone is getting into the cells. PATIENTgtgtSo let me get this straight every single one of my blood tests could come back absolutely normal, but I could still be hypothyroid at the cellular level where it counts. Is.
That what you are saying pause buzzer DOCTORgtgtYes. PATIENTgtgtDoctor, all these tests are so complex, and yet unreliable. Is there any simple, easy way to test for thyroid hormone levels at the cellular level DOCTORgtgtNot directly. However, there is one method for detecting and regulating intracellular thyroid hormone levels that requires no lab tests whatsoever. PATIENTgtgtWhat is it DOCTORgtgtOne simply increases medication until the symptoms resolve and metabolism increases. Symptomatic relief and the commensurate increase in metabolism are proof positive that intracellular thyroid hormone levels are adequate. However, that method has not been used for over 40.