понедельник, 6 декабря 2010 г.

THYROID BLOOD TESTS

THYROID BLOOD TESTS
TSH Test
Most conventional doctors rely on a test known as
the TSH test to diagnose an overactive or
underactive thyroid. The TSH test is a blood test
that measures the amount of thyroid-stimulating
hormone—TSH—in your bloodstream. (The test is
sometimes also called the thyrotropin stimulating
hormone test.) Elevated TSH levels can indicate
hypothyroidism. Low or nonexistent TSH levels
can indicate hyperthyroidism.
You'll need to know what the normal values are for
the lab where your doctor sends your blood because "normal" varies from lab to lab.
Thyroid normal ranges are in tremendous flux right now. Throughout the 1980s and
1990s in North America, the "normal" TSH range was from about 0.3-0.5 at the
bottom end, to a high end of from 5.0 to 6.0. In November of 2002, the National
Academy of Clinical Biochemistry (NACB), part of the Academy of the American
Association for Clinical Chemistry (AACC), issued revised laboratory medicine
practice guidelines for the diagnosis and monitoring of thyroid disease, which
prompted the American Association of Clinical Endocrinologists (AACE) to
recommend a narrower margin of 0.3 to 3.0.In the years since the original NACB guidelines were released, most laboratories and
many doctors have yet to adopt these new guidelines, and the medical world is still
not in complete agreement about changing the guidelines. This means that for
patients who test above below 0.5, or above 3.0, whether or not you get diagnosed
and treated for a thyroid condition depends on how up-to-date both your laboratory
and practitioner are.

DIAGNOSIS AND TREATMENT

The standard line about thyroid disease is that it’s “easy to diagnose, and easy to
treat.” Or, you may hear “just one blood test and we'll find out what we need to
know." While there are some cases where a thyroid condition is fairly simple to
identify, most cases are not quite that easy.
A thorough conventional medical evaluation for thyroid disease should include:
 a thorough review of your thyroid risk factors
 a thorough review of your family history and personal history
 a thorough review of your symptoms
 a medical examination, including feeling for enlargement or masses in the
thyroid, a reflex check, evaluation of skin/hair/eyes, blood pressure, heart rate
check, body temperature, weight, and lymph/node spleen exam
 clinical evaluation for thyroid-specific signs, including loss of eyebrow hair,
facial/hand/feet swelling, myxedemic patches on legs, bulging eyes, and other
signs
 blood tests
 imaging tests as needed

SIGNS AND SYMPTOMS OF THYROID DISEASE

Some of the key signs and symptoms of thyroid disease include...
___ Low body temperature
___ Particularly low or high pulse
___ Unusually low or high blood pressure
___ Enlarged, tender, or sensitive neck or lump in neck
___ Hoarse, husky, or gravelly voice
___ Extreme thirst or hunger
___ Noticeable change in weight (gain or loss) despite no change in diet and
exercise
___ Feeling warm or hot when others are cold, or cold when others are warm
___ Heart palpitations, flutters, skipped beats, strange patterns or rhythms
___ Constipation and or diarrhea/loose stools
___ Fatigued, weakness
___ Pains, aches, and stiffness in various joints, hands, and feet.
___ Carpal tunnel, tarsal tunnel, plantar’s fascitis
___ Puffiness around my eyes
___ Loss of outer eyebrow hair
___ Lesions on lower legs, feet, toes, arms, face, shoulders and/or trunk.
___ Hair loss
___ Dry eyes
___ Swollen hands or feet
___ Dry, sensitive, gritty or achy eyes
___ Changeable moods
___ Brain fog, difficulty concentrating or remembering
___ Depression
___ Anxiety, panic attacks, jumpy
___ Tremors
___ Insomnia
___ Irregular periods
___ Low sex drive
___ Infertility
___ Miscarriage or multiple miscarriages
___ Difficulty breastfeeding
___ Leaking milk when not lactating or breastfeeding
___ Difficult perimenopause/menopause symptoms

Nodules/Lumps

Many people have nodules in the thyroid, but few are palpable (capable of being felt
externally). Thyroid nodules are actually fairly common. An estimated one in 12 to 15
women and one in 50 men has a thyroid nodule. In some cases, nodules on the
thyroid exist without any disease, don't have any active function, and cause no
symptoms. Some nodules impair the thyroid's ability to function properly and cause
hypothyroidism. In some cases, nodules are overactive and produce far too much
thyroid hormone -- these are called "toxic nodules," and can trigger hyperthyroidism.
Particularly large nodules can compromise breathing or swallowing. A very small
percentage of nodules are cancerous. In non-pregnant patients, 90 to 95 percent of
nodules are benign. In pregnant women, however, approximately 27% of nodules are
cancerous.
Symptoms of nodules depend on what action they are having. Some people will have
no symptoms, while others may have more hyperthyroid symptoms such as palpitations, insomnia, weight loss, anxiety, and tremors. Nodules can also trigger
hypothyroidism, and symptoms might include weight gain, fatigue, depression. Some
people will cycle back and forth between hyperthyroid and hypothyroid symptoms.
Others may have difficulty swallowing, a feeling of fullness, pain or pressure in the
neck, a hoarse voice, or neck tenderness. And finally, many people have nodules with
no obvious symptoms related to thyroid dysfunction at all.
Depending on the results of the evaluation, nodules may be left alone and monitored
periodically, assuming they aren't causing serious difficulty, or treated with thyroid
hormone replacement to help shrink them. They will be surgically removed if they are
causing difficulties with breathing, or if test results indicate a suspected malignancy.

Goiter/Enlargement

Goiter is the term used to describe an enlargement of the thyroid gland. The thyroid
gland can enlarge as a response to deficiencies of iodine, thyroid inflammation or
infection, or autoimmune disease. The thyroid becomes large enough so that it can be
seen as enlarged on ultrasounds or x-rays, and may be enlarged enough to thicken the
neck area visibly. Particularly large goiters may be cosmetically problematic, and can
compromise breathing and swallowing, and are often surgically removed. Smaller
goiters may respond to drug treatment.
Symptoms of goiter include a swollen, tender or tight feeling in the neck or throat,
hoarseness or coughing, and difficulty swallowing or breathing.
Goiter can be due to an autoimmune condition that triggers an inflamed thyroid, or
due to too much or too little iodine in the diet. In the U.S., 10 to 20 percent of goiters
are iodine-induced.
 Treatment for goiter depends on how enlarged the thyroid has become, as well
as other symptoms. Treatments can include:
 Observation and monitoring, which is typically done if your goiter is not large
and is not causing symptoms or thyroid dysfunction
 Medications, including thyroid hormone replacement, which can help shrink
your goiter, or aspirin or corticosteroid drugs, to shrink thyroid inflammation.
If the goiter is very large, continues to grow while on thyroid hormone, or symptoms
continue, or the goiter is in a dangerous location, i.e., the windpipe or esophagus, or
cosmetically unsightly, most doctors will recommend surgery. If the goiter contains
any suspicious nodules, you may also need surgery.

Autoimmune Thyroid Disease

There are two different autoimmune diseases in which an immune system
dysfunction targets the thyroid - Graves' disease and Hashimoto's disease. In the
United States, the vast majority of thyroid patients are either hypothyroid or
hyperthyroid due to an autoimmune disease.
Hashimoto's disease is the most common form of thyroiditis, an inflammation of the
thyroid, and so the condition is also often referred to as Hashimoto's thyroiditis. It is
far more common than Graves' disease, and is the cause of most hypothyroidism in the U.S. In Hashimoto's, antibodies react against proteins in the thyroid, causing
gradual destruction of the gland itself. Occasionally, before the thyroid is destroyed, it
has thyrotoxic periods -- known as Hashitoxicosis -- during which the thyroid
overproduces thyroid hormone. Eventually however, the gland's attack on itself
destroys the ability to produce the thyroid hormones the body needs.

Symptoms of Hashimoto's disease usually parallel the hypothyroidism that results, however, the thyroid can
periodically sputter into life during Hashitoxic periods, causing hyperthyroidism symptoms. For most
people, treatment is for hypothyroidism and involves life-long thyroid hormone replacement. Holistic and integrative
approaches tend to look at healing the underlying autoimmune imbalance, and may
include nutritional support for the thyroid (i.e., selenium, tyrosine, B vitamins, etc.)
and overall support for the immune system.
Graves' disease -- sometimes referred to as diffuse toxic goiter because of the usual
presence of a goiter -- typically causes hyperthyroidism. In the U.S., it's thought that
Graves' disease and hyperthyroidism affect slightly less than 1 percent of the US
population, or slightly less than 2.9 million people. Some experts believe, however,
that as many as 4 percent of Americans, or 11.8 million people, may have a mild,
subclinical Graves' disease, with few or no symptoms, but exhibit blood test
evidence of slight hyperthyroidism.

In Graves' disease, autoantibodies bind to the gland, which causes the thyroid to
overproduce hormone, and cause hyperthyroidism. Treatment for Graves' disease
follow hyperthyroidism treatment, and involves antithyroid drugs, radioactive iodine
ablation, or surgical removal of the thyroid. Most Graves' disease patients end up
hypothyroid over time, requiring life-long thyroid hormone replacement.

COMMON THYROID DISEASES AND CONDITIONS(part2)

Conventional treatment in the U.S. focuses on disabling the thyroid permanently, by
administering radioactive iodine (RAI) treatment, which renders most patients
hypothyroid for life. Some physicians in the U.S. use prescription antithyroid drugs
such as propylthiouracil (PTU) and methimazole (Tapazole) and beta blockers to
calm down the thyroid and the immune system, with the hope of remission of the
disease, which occurs in as many as 30% of patients. (Antithyroid drugs are the first
choice, however, for doctors outside the U.S.)
In rarer cases in the U.S., and more commonly outside the U.S., surgery to remove
the thyroid may be the treatment. Holistic and integrative treatments prior to RAI or
surgery focus on supplementing antithyroid drug approaches with natural antithyroid
foods, supplements and herbs that have no side effects, as well as calming and
rebalancing the immune system through nutrition, herbs, supplements, movement
therapy such as yoga, and energy work. Ultimately, most people with Graves' disease
and hyperthyroidism do end up hypothyroid for life as a result of RAI or surgery.