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Thyroid at Root of Many Symptoms

Art of Testing

Shomon urges women not to drag (or rev) around feeling bad but to consult a doctor. Probably the first test that will be done is a TSH test for thyroid stimulating hormone, a substance produced by the pituitary gland that regulates the thyroid gland. If the TSH is greater than the upper level of normal (4.5 to 5 mU/L), many doctors will check the "free" T4 level (thyroxin), which costs less than a T4 index, which tests both T3 and T4. A TSH above 2 can mean fertility is impaired, Vliet says.

Kenneth R. Blanchard, MD, an endocrinologist in Newton, Mass., says what he learned in medical school -- to test only TSH -- was flat wrong. He always tests for T3 and T4. "I have seen people living in misery with 100% T4," he emphasizes. Vliet also tests for T3 and T4, as well as antibodies that can cause autoimmune problems. "You can have shortages of T3 and T4 before the TSH goes up or down," she says. "Women with significantly elevated antibodies may need medication before the TSH reaches 4 or 5."

"We're patients, not lab values" is Shomon's motto. She says the range of "bad" test results is too small and that doctors will dismiss the same set of symptoms in one woman as hypochondria if the test readings are a few tenths of a point lower than in another woman with the same complaints. Vliet and Blanchard specialize in nailing down and treating thyroid dysfunction at varying levels for each woman.

Treatment

Treatment of both hypo- and hyperthyroidism is not totally benign. A careful diagnosis is important.

Hypothyroid is an underproduction of thyroxin, so levothyroxine sodium (Synthroid, Levoxyl) is given. "They used to tell you one pill a day and you'll be fine," Shomon says. Now, she and Blanchard recommend giving T3. "In a low dose," Vliet says. "High-dose T3 can cause heart attacks."

As for treating hyperthyroidism, radioactive iodine is sometimes used or the gland is surgically removed. Treating hyperthyroidism is tricky. Vliet herself immediately defers to an endocrinologist.

Shomon urges baseline testing for women at 35, as well as at least a TSH test before getting pregnant, four months postpartum, and before starting on antidepressants or hormone replacement therapy. "If your HMO won't cover the test, you can get an FDA-approved home test." With the fine-tuning required with this delicate gland, however, a doctor's supervision is highly recommended.

Star Lawrence is a medical journalist based in Chandler, Ariz.

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