In a message dated 6/14/2008 5:10:57 P.M. Eastern Daylight Time,  
[log in to unmask] writes:

My  question is what is the best minimum range for patients
with the thyroid  gland removed?  >>>>>
Thyroid removed or thyroid present, the best range for the patient is the  
one that gives optimal health. This varies a lot between patients.
 
TSH (thyroid stimulating hormone) is released from the Pituitary gland as a  
signal for the thyroid to provide more thyroid hormone activity. When the  
thyroid hormone activity increases, the TSH should be suppressed, to some  
extent. Sometimes, if thyroid hormones are too high, the TSH will be low.  
Conversely, if the thyroid hormones are too low, the TSH will go up. 
 
OR, that what is usually taught in Med School. What is NOT taught is that  
countless other things effect TSH, and that to look at a lab slip instead of  
your patient is foolish. 
 
When a doc sees a TSH below the "Normal Range," they will  usually lower 
thyroid hormones (or if you are not on thyroid hormones, call  you Hyperthyroid).
 
If that same doc sees a TSH above that range, he will typically increase  the 
thyroid hormones. TSH fluctuates all over the place for no apparent reason,  
and some people get put on strange schedules of T4 with more fluctuations than 
a  E-Trade account.
 
All that usually does the patient little or no good because:
 
1. About 85% of any Diagnosis (including thyroid status) is History (How  has 
your patient been before he came to the office?); 10% comes from some kind  
of examination (How does he appear to the, hopefully, well trained eye?); and  
labs are only worth about 5% of most any diagnosis.  (Freshman year Med  
School)
 
Listening to a patient takes time (pronounced "$$$"), so docs typically  
prefer labs. 
 
2. About 99.97% of that T4 that the average person swallows is bound  to 
(stored in) Thyroxin Binding Globulins. (Braverman text).
 
 In Med School, a mentor said you could probably take a week of your  T4 at a 
time, if you only did it once a week. 
 
3. Many things affect your Pituitary's ability to respond to levels of  
thyroid hormones with the appropriate TSH level. One of these things is  
HYPOTHYROIDISM! 
 
So, if you are Hypothyroid, your Hypothalamus and Pituitary are unlikely to  
function much better than the rest of you. So, why would someone listen  
attentively to a system that is, by definition, impaired?
 
4. Pituitary damage is another cause of low TSH. I inherited a patient who  
had lost much of his pituitary and was put on thyroid by his  Endocrinologist. 
The Family Doc "discovered" that the TSH was absent, told the  poor chap that 
the endo had made him hyperthyroid and promptly took the fellow  off the 
thyroid. 
 
5. That "normal range" is actually based on the (sick) patients who we send  
to the lab because we think that their TSH is too high or too low, and it  
represents the middle 95.5% of those (medically ill) scores. So, much of the  
time when doc says your TSH is normal, he means that you fit in nicely with all  
those other sick people. 
 
6. There is not much money in adequately treating Hypothyroidism.   Patients 
get well, and you see them for occasional medication checks. If you  don't 
adequately treat Hypothyroidism, there are a lot more chronic  illnesses that run 
the gamut from elevated cholesterol, heart attacks, strokes,  obesity, 
diabetes, cancer, depression to a host of other problems that  enrich drug 
companies, doctors, and hospitals alike. The medications you use are  cheap, not on 
patent, and pretty safe. This is opposed to prescription  drugs that are 
hazardous, require frequent office follow ups, and are expensive. 
 
7. Adjusting medication to suit the (sometimes erroneous) lab  slip values is 
less work than optimizing things for your patient. 
 
In all the years that I have haunted this LS, the most  frequent complaint 
has been about docs who treat lab slips while  ignoring their patients.
 
Please, if your doc will not adjust your thyroid (and adrenal  glands are 
often involved, as well), talk things over and find another  doctor, if you need 
to. 
 
Doc Don




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