Studies Show That TSH Is Unreliable in the Diagnosis of Hypothyroidism

TSH testing, the gold standard in hypothyroid diagnosis, may be misleading according to the studies quoted in a new article titled Hormone Replacement Therapy in the Geriatric Patient: Current State of the Evidence and Questions for the Future. Estrogen, Progesterone, Testosterone, and Thyroid Hormone Augmentation in Geriatric Clinical Practice. The article, independently written and published, is a broad study of hormone replacement in geriatric patients. In the thyroid section, written by Kent Holtorf M.D., it details the difference between serum thyroid hormone levels and tissue thyroid hormone levels, particularly in cases of chronic and acute stress.
According to the study models presented in the article, physiological stress, caused by aging or illness, means patients can present with typical hypothyroid symptoms but with serum testing that shows normal TSH and even T3. "As a result, when relying on serum tests only, clinicians do not treat patients presenting with this thyroid picture assuming they are euthyroid," reads the article. However, those same patients may be experiencing diminished T3 levels within the peripheral tissues, due to reactive changes at the cellular level. According to the authors, this leaves "a gaping hole" and misses "the opportunity to help the patients' condition."
The article also addresses the possible benefits of marking reverse T3 levels in serum testing as a means of determining the overall health of the "hypothalamic–pituitary–thyroid– cellular axis," and it warns of the suppression of TSH serum levels in some patients with nonthyroidal illness or who are on medication. This kind of "confusion" only serves to undermine further the reliability of standard thyroid testing.
The article concludes with a summary of treatment options, citing T3 preparations as more effective in cases of chronic or age-related stress. "Many symptomatic patients with low tissue thyroid levels with normal TSH and T4 levels may benefit from T3 thyroid replacement, often with significant improvement in fatigue, depression, weight gain and obesity, heart failure, fibromyalgia, cholesterol levels, and numerous other chronic conditions." Additionally, some of the long-held fears of significant side effects associated with hormone supplementation may be overstated.
Source: Article Contributed by Kent Holtorf, M.D. in Clinical Geriatrics,Dr. Holtorf is the founding director of the Bioidentical Hormone Initiative as well as the National Academy of Hypothyroidism and the medical director of the Holtorf Medical Group, Center for Hormone Imbalance, Hypothyroidism, and Fatigue, located in Los Angeles, Pasadena and Foster City, CA and Philadelphia, PA. He founded the Holtorf Medical Group in 2001 and continues to treat patients from across the country and abroad.