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Diabetes

Thyroid Stimulating Hormone

04/21/2003

Question:

I recently had a blood test and it showed my TSH, (Thyroid Stimulating Hormone) slightly elevated. I am trying to do some simple things to make it normal. Do you think that an inversion table would help? I am a healthy 27 year old male so I am just wondering if it would have a positive effect. Also, I started adding a little more iodized salt in my diet. Do you have any additional advise and do you think I am on the right track. -Thanks

Answer:

First, let me say that this question is not a diabetes question but comes to me because I am an endocrinologist, or hormone specialist. Thyroid disease is one of the areas of expertise of endocrinologists.

Thyroid stimulating hormone (or TSH) is one of the major tests used in assessing both thyroid over-activity and thyroid under-activity. TSH is produced by the pituitary gland which is located on the undersurface of the brain adjacent and connected by blood vessels to a region called the hypothalamus. The pituitary is sometimes referred to as the "master gland" of the body, acting under brain control, to produce multiple hormones which either act on other hormones or which have a diverse set of actions. The thyroid gland is located in the neck. TSH is produced by the pituitary to stimulate thyroid hormone production.

There are two forms of thyroid hormone, one called T4 (tetra-iodo-thyronine) and the other T3 (tri-iodo-thyronine), based on the number of iodine atoms present in the molecule. While there are many fundamental actions of thyroid hormone in virtually all cells in the body,the functions we see most commonly affected with too much or too little of the hormone include overall level of energy, metabolism, heart rate and contractility and mood, attention span and intellectual function.

People with a severe under-active thyroid condition - hypothyroidism - would feel sluggish, low energy, perhaps depressed, gaining weight and having difficulty with bowel movements. Those with hyperthyroidism may seem "hyper," meaning on edge, short attention span, perhaps short tempered, with potentially dangerous either rapid heart rate or irregular heart rhythm or both. Women may have menstrual irregularities of different types with thyroid abnormalities in either direction. These findings, whether resulting from too much or too little thyroid hormone, can be moderate or subtle, or they can be severe and potentially fatal.

The level of TSH in the blood is a measure of how much thyroid hormone the pituitary "sees" in the blood and it acts like a thermostat: when the level of thyroid hormone is seen as too low, TSH is released by the pituitary in response; when the level of thyroid hormone is too high, TSH release is shut off. It turns out that in some instances the level of TSH is a more sensitive or earlier measure of whether there is the right amount of thyroid hormone than the blood level of the thyroid hormones themselves.

That brings us back to your question and I would now come back with another question, namely "What was the purpose of measuring the TSH in the first place?" It may have been done because the health care provider suspected either hypo- or hyperthyroidism or it may have been done for screening with no diagnosis in mind. The finding of an elevated TSH should prompt a re-evaluation of whether the person tested notices things about themselves (symptoms) or has findings on physical examination (signs) that suggest an abnormal thyroid condition and whether the level of the thyroid hormone is indeed low consistent with the TSH result.

The most common interpretation if the T4 (measured as free T4) is low is that there is hypothyroidism. If the free T4 is not low, this most commonly would be interpreted as "subclinical hypothyroidism," representing a stage on the way to complete loss of thyroid function. In most people with an underactive thyroid, it is due to a disease process that destroys the thyroid gland permanently. In that case, the replacement of thyroid hormone with prescription pills is the standard of care. In a very small fraction of people these days, the underactive thyroid may be due to an inadequate supply of iodine necessary to make thyroid hormone. Iodine supplements would be useful in that small subset.

I have never heard of an inversion table and can`t comment on it directly. If it is basically a mechanical device, I don`t see how it could compensate for a biochemical deficiency of an essential hormone. What I have provided is the most common scenario. There are a number of scenarios, including temporary conditions which may go away which need to be considered. An experienced physician could judge whether all the pieces fit together correctly to support the obvious answer or whether there are features that don`t fit, suggesting the need to look more closely for an alternative less common explanation. I would be cautious about self-medicating without getting medical input to assure the situation is as it appears to be. 

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati