Causes of Hypothyroidism: Congenital Causes
Some people are born with hypothyroidism, for a variety of reasons. Infants with untreated congenital hypothyroidism can develop a number of serious developmental problems as they mature, including mental retardation and stunted growth—a condition once known as “cretinism” (think of that next time you want to call someone a “cretin”, eh? I don’t think I’ve used that particular insult in months, for just that reason!).
Some cases of congenital hypothyroidism seem to stem from developmental issues during pregnancy. The child’s thyroid gland may be underdeveloped or may no have descended to its proper location. In another condition, known as Thyroid Dyshormonogenesis, the infant’s thyroid gland simply fails to produce adequate hormone output, although it appears normal. In cases where the thyroid gland is abnormal, treatment will most likely last the rest of the child’s life.
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TSH: One size does NOT fit all
As I’ve mentioned here before, in 2003 the American Association of Clinical Endocrinologists recommended that the “normal” range of TSH be changed from 0.5–5.0 to 0.3–3.04. However, for those of you who still feel crummy anywhere above 2.0, there’s still hope to convince your doctor: Way back in 2002, the National Academy of Clinical Biochemistry suggested the ceiling for “normal” TSH be lowered to 2.5, “because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L.”
So, my repeated comments here that folks without thyroid problems generally have a TSH around or below 1 is somewhat incorrect. There is a wider range of truly “normal” TSH values than I had heard, but a narrower range of normal TSH than most doctors use when evaluating their patients’ test results. In fact, the NACB stated that, “A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism.”
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A few assorted facts …
I thought I’d just do a “quick review” entry of a few basic facts about hypothyroidism and the treatments for it, based on my own research. Mind you (once again) I am not a doctor. But I figure if multiple reputable sources all agree on a certain point, it’s most likely true.
- The current “normal” range for TSH tests is NOT 0.5–5.5. In November of 2002, the American Association of Clinical Endocrinologists updated the “normal” range to 0.3–3.04. In “real life” people without thyroid problems generally have a TSH around 1.0 or lower.
- Thyroid hormone medication is not a “drug” with dangerous side effects, even if you are pregnant. Synthroid, Armour, Cytomel, Thyrolar and their generic/off-brand equivalents function by replacing thyroid hormones your body is not producing. So—especially if you are pregnant, or in some other physically “high stress” situation—it is important to get your thyroid levels up where they should be, so your body’s metabolism is functioning properly.
- There is no single best thyroid medication for everyone. Some people say they feel better on “natural” medication like Armour, some people say they feel better using synthetic hormone replacements like levothyroxin. Some people need T3 in their medication to feel their best, some people do better on T4 only treatment. Some people can’t tell the difference.
my advice …
People ask for my advice a lot around here. [Which is why I decided to leave the comments turned off when I brought the site back from the dead … I really didn't have time to keep up with them the way I'd like to.] So, first off, I want to re-iterate a few things: I’m not a doctor. I’m not even an “expert” on hypothyroidism… I was diagnosed back in October, less than six months ago. I have only tried one medication (generic levothyroxin) so far. I can only speak from my own personal experience, and what research I’ve done online and in books.
That said… It seems the number one piece of advice I end up handing out is: Get a second opinion or get a new doctor. And I stand by that. The number two piece of advice seems to be: Try a new medication or a different dose. I also stand by that. There are multiple medications available for hypothyroidism, and that wouldn’t be the case if only one of them worked. There are multiple doses available in each medication, and that wouldn’t be the case if it were a one-size-fits-all deal.
So. If you’re on a medication that is not alleviating your symptoms, trying a different med or a different dose would seem to be a logical step, so long as your blood tests aren’t putting you in hyperthyroid range yet. And if your doctor brushes off your complaints about your symptoms, your doctor is not doing his/her job, which is to help you, the patient, maintain optimum health. If your doctor is brushing you off, or refusing to try a different treatment, or saying everything is as good as it’s going to get, even though you still feel terrible… find a new doctor.
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Causes of Hypothyroidism: Hyperthyroid Treatments
A fairly obvious cause of hypothyroidism is previous treatment for a hyperthyroid condition. This probably doesn’t need much discussion, but I thought I should cover it for the sake of thoroughness…
Some hyperthyroid conditions may be treated via thyroidectomy: partial or complete surgical removal of the thyroid. Thyroid cancer and goiter are usually treated this way, as well as thyroid nodules and non-specific hyperthyroidism that doesn’t respond to non-surgical treatment. Obviously, if your thyroid is removed, you will suffer from a resulting shortage of thyroid hormone.
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