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Hypothyroidism and TSH Levels: Books
Purpose of this compilation
To show that using only the TSH (thyroid stimulating hormone) level as a diagnostic tool can miss numerous cases of hypothyroidism or result in undertreatment, and that if it is used, the current acceptable range is to be questioned.
A. Medical doctors and organizations
B. Medical writers
Medical doctors and organizations
1. Ridha Arem, MD: The Thyroid Solution (1999)
Increasingly, more and more physicians believe that you can be suffering from hypothyroidism even though your blood tests, including TSH, are normal. [p. 223]
To achieve a good balance, you need to have your TSH maintained between 0.5 and 2.0 milli-international units per liter while receiving thyroid hormone treatment. A TSH ranging between 2.0 and 4.5 may mean some thyroid hormone deficiency....Often all it takes to restore normal thyroid status is a small increase in the dose, which might have significant effects on the way you feel. [p. 248]
Arem R. The Thyroid Solution. New York: Ballantine Books; 1999.
From the inside back cover:
Ridha Arem, M.D., is Associate Professor of Medicine in the Division of Endocrinology and Metabolism at Baylor College of Medicine in Houston, Texas. He is also Chief of Endocrinology and Metobolism at Ben Taub General Hospital in Houston.
2. RIS Bayliss, KCVO, MD, FRCP and WMG Tunbridge, MD, FRCP: Thyroid Disease: The Facts, 3rd ed. (1998)
Most patients with thyroid deficiency feel at their best when the dosage of thyroxine raises their free thyroxine level towards the upper end of the normal range, or even a little above it. This usually reduces the thyroid stimulating hormone (TSH) level towards the bottom of the normal range or even a little below it, but not so low as to be undetectable. [p. 100]
Bayliss RIS, Tunbridge WMG. Thyroid Disease: The Facts, 3rd ed. New York: Oxford University Press; 1998.
3. Carol Repchinsky, BSF, editor in chief: Compendium of Pharmaceuticals and Specialties (CPS): The Canadian Drug Reference for Health Professionals (2002)
In patients with hypothyroidism resulting from pituitary or hypothalamic disease, the possibility of secondary adrenal insufficiency should be considered, and if present, treated with glucocorticoids prior to initiation of levothyroxine. The adequacy of levothyroxine therapy should be assessed in these patients by measuring FT4I, which should be maintained in the upper half of the normal range, in addition to clinical assessment. Measurement of TSH is not a reliable indicator of response to therapy for this condition. [p. 1632]
When the total serum T4 is low but TSH is normal, a test specific to assess unbound (free) T4 levels is warranted. [p. 1690]
Repchinsky C, editor in chief. Compendium of Pharmaceuticals and Specialties (CPS): The Canadian Drug Reference for Health Professionals. Toronto: Canadian Pharmacists Association; 2002.
4. Richard Shames, MD, and Karilee Halo Shames, RN, PhD: Thyroid Power (2001)
We have used the total T-3 to diagnose a number of otherwise hidden thyroid problems. The total T-3 may be abnormal even when TSH is within normal range. [p. 64]
Likewise, the newer Free T-3, in our opinion, may also be useful in uncovering borderline low thyroid in symptomatic patients, even when TSH is normal. [p. 65]
No one had been able to give her [a patient with body pains, depression, anxiety, feeling chilly, and fatigue] a diagnosis....Her standard thyroid panel was normal. Even the TSH and Total T-3 were within normal range....
...she was given the additional test of thyroid antibodies....This test showed significantly elevated antibody levels.
She was given Synthroid....
...Over the course of a few months, she...felt more energy, less pain, and had fewer anxiety attacks....Her improvement was tremendous. [p. 67]
There is a big economic factor related to blood tests for thyroid problems....
The expense of extra testing is miniscule, however, compared to the enormous expense of evaluating and treating each of a patient's multiple thyroid symptoms. [p. 71]
Shames RL, Shames KH. Thyroid Power. New York: HarperCollins Publishers Inc.; 2001.
From the inside back cover:
Richard L. Shames, M.D., is a graduate of Harvard College and the University of Pennyslvania Medical School....
Karilee Halo Shames, R.N., Ph.D., is a clinical specialist in psychiatric nursing and a certified holistic nurse.
5. Elizabeth Vliet, MD: Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore (1995)
A comment I hear frequently is "you couldn't have thyroid problems because your TSH (thyroid stimulating hormone) is normal." When the cluster of symptoms I described above [menstrual irregularity, worsening PMS, atypical depression, new onset depression later in life, post-partum depression, anxiety syndromes, excessive fatigue] are present in women, I think it is important to go one step further in evaluating the thyroid. I have a series of more than a hundred patients, all but two [who] are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. [p. 57]
...there is a gradual or abrupt elevation in the thyroid antibodies before there is a compensating rise in TSH produced by the brain in response to the failing gland. This means a woman may experience the symptoms of disease months to years before TSH goes up. [p. 58]
...one or more lab measures may still fall in the normal range and yet other, more subtle measures, may be abnormal. [p. 58]
Vliet EL. Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. New York: M. Evans and Company, Inc.; 1995.
From the back cover:
A leading specialist in preventive and behavioral medicine and a long-standing advocate for women's health, Dr. Vliet is...currently on the clinical faculty in the Department of Family Medicine at both the University of Arizona College of Medicine and the University of North Texas Health Sciences Center.
B. Medical writers
Mary J. Shomon: Living Well With Hypothyroidism: What Your Doctors Don't Tell You...That You Need to Know (2000)
The current TSH levels used by laboratories to define the "normal" range of thyroid function, and the use of the TSH test as a primary means of diagnosis need to be significantly reevaluated. The .5 to 5.5. "normal" range for thyroid function does not give enough information for diagnosis anymore. Research reported in the British Medical Journal found that TSH levels above 2 are likely not normal and instead include people at high risk to develop thyroid disease. This means that the real "normal" range is probably far narrower and more concentrated at the lower end. [p. 252]
[Dr. Kenneth Blanchard] What doctors are always told is that the TSH test gives us a yes-or-no answer. In fact, I think that's fundamentally wrong. The pituitary TSH is controlled, not just by how much T4 and T3 is in circulation, but T4 is getting converted to T3 at the pituitary level. Excess T3 generated at the pituitary level can falsely suppress TSH. [p. 144]
Shomon MJ. Living Well With Hypothyroidism: What Your Doctors Don't Tell You...That You Need to Know. New York: Harper Collins Publishers; 2000.
From the inside back cover:
Mary J. Shomon, a thyroid patient herself, writes and manages several professional Web sites on thyroid disease....She is the author of several previous books.