• Corpus ID: 55914114

TSH is Not the Answer: Rationale for a New Paradigm to Evaluate and Treat Hypothyroidism, Particularly Associated with Weight Loss

@inproceedings{Rowsemitt2011TSHIN,
  title={TSH is Not the Answer: Rationale for a New Paradigm to Evaluate and Treat Hypothyroidism, Particularly Associated with Weight Loss},
  author={Carol N. Rowsemitt and Thomas Najarian},
  year={2011}
}
While many endocrinologists continue to debate the appropriate levels of TSH to use as boundaries for normal limits, we believe using TSH to assess thyroid function is counterproductive, particularly in those patients attempting to lose weight. From the published literature and our own clinical experience, we have come to understand that the set point for metabolism is adjusted downward in the hypocaloric state. The decrease in metabolism is often referred to as part of the "famine response… 

Hypothyroidism, Particularly Associated with Weight Loss: Evaluation and Treatment based on Symptoms and Thyroid Hormone Levels

Two specific patient examples of this syndrome are given and the need to understand that there are limitations to the ability to detect every appropriate variable in any one patient is addressed, so that the value of any particular lab reading in anyone patient is not overestimated.

References

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There is no evidence of harm by treatment of NTI patients with up to replacement doses of T3, and the term ESS should be replaced with NTIS.

Fasting decreases thyrotropin responsiveness to thyrotropin-releasing hormone: a potential cause of misinterpretation of thyroid function tests in the critically ill.

It is concluded that fasting induces changes in both peripheral thyroid hormone metabolism and the hypothalamic-pituitary axis in hypothyroid individuals which are qualitatively similar to those that occur in euthyroid subjects; and in certain Hypothyroid subjects, fasting alone can decrease basal TSH values to within the normal range.

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D diagnostic strategies and treatment methods are described which refute traditional objections about aggressive thyroid treatment causing or aggravating osteoporosis and cardiac arrhythmias, and are found to be entirely non-existent when corrections are made for certain mineral, vitamin, amino acid, and sexand growth-hormonal deficiencies.

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It is concluded that at the peripheral level no complete resistance develops against T3 administration; in the low T3 state the hypothalamic-pituitary axis reacts as if euthyroidism exists.

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The results indicate that, in patients on chronic treatment with thyroxine, REE is significantly influenced by the dose of this hormone in a dose range encompassing serum TSH concentrations that are considered acceptable in the management of hypothyroid patients.

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The pattern of TSH response paralleled the observed changes in TIR, indicating dependence of TIR on circulating TSH during fasting and refeeding.

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The blunted TSH response to TRH despite reduction of serum T3 concentration suggests that subtle alterations in hypothalamic-pituitary function may also occur and suggests that alterations in the thyroid hormone binding capacity of serum carrier proteins may occur during fasting.
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