In order to understand how the hormonal system of the body works, it is necessary to understand some of the nuances of human physiology. In comparison with internal organs, for example, the gastrointestinal tract, digestion, heart or brain, it is impossible to touch by touch and say exactly under which rib it is located. The hormonal system is the finest delicate structure. However, minimal disruption in its work can lead to the emergence of a number of health problems.
What is TSH hormone?
The production of hormones and control over their full functioning in the human body is the main task of the thyroid gland. This system of internal secretion predetermines the implementation of many natural processes. Any disruption in the thyroid gland, associated with the nature of the performance of hormones or their amount produced, can be recorded when the appropriate diagnosis is carried out.
The hormone TSH, produced by the thyroid gland, is produced by the pituitary gland, or rather, by its anterior lobe. The purpose of this substance, in fact, is to control and coordinate the functions of the thyroid gland. Just like any other thyroid hormone, it affects the hormonal balance of the body as a whole through its effects on T3 and T4. These substances are also produced by the thyroid gland.
Importance of undergoing a blood test for thyroid-stimulating thyroid hormone
In the case when the hormone of the thyroid gland, this indicates that the level of T3 and T4 in the body is too low. Such indicators may indicate the development of a pathology called "hypothyroidism". The process of its occurrence is determined by these thyroid hormones. in the event that the functioning of the main producing organ has also decreased in direct proportion. Disorders in the thyroid gland are fraught with serious complications in the life of the whole organism.
An increase in the production of hormones leads to damage to the cells of the thyroid gland, which threatens to disrupt the functioning of all organs and systems of the body. Modern means - peptide bioregulators - can help restore damaged cells. In Russia, the first brand of peptide bioregulators was cytamines - a line of 16 drugs aimed at different organs. To improve the function of the thyroid gland, a peptide bioregulator has been developed -. The components for Tyramine are obtained from the thyroid glands of cattle, they are a complex of proteins and nucleoproteins that have a selective effect on the cells of the thyroid gland, which helps to restore its function. Tyramine is recommended for use in case of dysfunction of the thyroid gland, hypo- and hyperfunction, tumor processes in the glandular tissue. As a prophylactic agent, Tyramine is advisable to apply to persons living in areas endemic to thyroid diseases. Taking Tyramine is also recommended for older and elderly people to maintain the function of the thyroid gland.
Analysis of the thyroid gland TSH is extremely important in the process of diagnostic examination of the organ. When drawing conclusions and making a diagnosis, this indicator is taken into account as a determining one, since it is he who is able to quickly respond to the slightest pathological change. While T3 and T4 have not yet responded to the presence of certain markers in the blood, the thyroid hormone TSH has already demonstrated its lightning-fast response to the identified malfunctions in the hormonal system.
In what cases may this diagnosis be required?
There must be compelling reasons for a physician to refer a patient for this type of diagnostic test. Indications for the procedure are the following cases:
- exclusion or confirmation of hyper- or hypothyroidism;
- clarification of the diagnosis concerning the pathology of the thyroid gland or associated organs and systems;
- control over the healing process in order to timely identify the need to make adjustments to the treatment;
- obtaining the results of an additional stimulating test;
- timely management of suppression of T4 present in the so-called cold node and goiter.
Periodic examination for TSH is the key to timely treatment
In addition, it is this analysis of thyroid hormones that can reveal a host of other problems with the most important systems for the human body. TSH in patients who have undergone surgery or have chronic diseases should be constantly monitored by a specialist. The responses of this analysis clearly reflect the state of the thyroid gland.
In case of detection at the initial stage of any serious changes or identification of current unfavorable processes in the organ and with an early start of treatment, the patient's chances of full recovery increase several times. In order to avoid complications and take appropriate measures to prevent deterioration of the patient's well-being, it is necessary to regularly conduct control TSH testing.
Preparation for analysis
It is highly undesirable to ignore the need to pass this simple test for the thyroid hormone TSH. After all, the procedure, which is simple in execution technique, is capable of giving a detailed informative answer. In the fight for the health of a patient with thyroid problems, it is this TSH test that plays a huge role. The norm of his indicators allows you to make sure that the patient is in a satisfactory condition.
Before taking a blood test to detect the hormone TSH, it is advisable to strictly follow some rules.
Adhering to the advice given by doctors about passing a test to determine the level of hormonal balance, the patient will be able to exclude the likelihood of receiving false information in the test results as much as possible.
Basic rules to follow before taking the test
So what do you need to do to get the thyroid hormone TSH tested correctly?
- The study must be carried out on an empty stomach. You can use only clean running water. It is advisable not to eat anything 8-10 hours before undergoing diagnostics.
- The analysis should be preceded by diet. Refusal from fatty, smoked, fried, spicy and sour products will avoid the possible distortion of the research results.
- A few days before undergoing clinical diagnostics, it is important to completely exclude alcoholic beverages, regardless of the strength.
- Do not play sports and do not overdo it with power loads. It is important to exclude any physical activity at least one week before the examination.
- Also, a couple of weeks before laboratory blood diagnostics, it is necessary to exclude the intake of any medications as much as possible. If the current course of therapy cannot be interrupted in any case, or a serious malfunction of the whole organism will occur without the use of drugs, before undergoing the procedure, it is necessary to provide the doctor with the entire list of drugs taken. Since they can potentially affect the blood test data, specialists always try to take them into account.
Why do I need to prepare specifically for the study?
In addition, a recent X-ray or ultrasound scan can distort the results of the examination. Increased levels of TSH (thyroid hormone) can provoke stressful situations. Nervousness, excitement, frustration - all this contributes to the intense release of chemicals in the body.
With a responsible and high-quality approach to the procedure, the result of a blood test for the level of thyroid-stimulating hormone will correspond as much as possible to the real picture of the patient's health. Thanks to accurate information, preventive measures can be taken in a timely manner to prevent thyroid diseases or to begin treatment for an existing progressive pathology. For some patients, such restrictions can cause a lot of resentment, however, in order to obtain reliable data on the state of the organ, desires and ambitions should be neglected. This is the only way to avoid passing a second analysis.
How to decipher the TSH test - is it normal or not?
As a rule, a TSH test is considered mandatory for patients with disorders in the body associated with the functioning of the thyroid gland. Surgical treatment of this organ in the past is also a direct indication for regular testing. To correctly decipher the analysis and determine whether the level of the hormones being investigated is normal, or there are abnormalities in the blood, the endocrinologist relies on several fundamental points.
First, male and female thyroid-stimulating hormone levels should normally differ from each other. In the fairer sex, it can significantly exceed the values that in the blood test in men reflect thyroid hormones (TSH). The norm for women is about 4.2, while for men the indicator rarely exceeds 3.5. However, this is not the limit. During pregnancy, thyroid hormones may also rise. TSH (the norm in women allows you to determine the degree of increase in the concentration of substances in the blood) in expectant mothers sometimes reaches 4.7.
What determines the level of thyroid-stimulating hormone in the blood?
In addition, thyroid-stimulating hormone in the body can change its concentration depending on many features caused by the biorhythm, age, the presence of other chronic diseases, etc. When compiling an anamnesis, it is extremely important to provide a specialist with detailed information on this issue.
A highly qualified doctor is able to draw objective conclusions from the test results and predict the further development of events. He can clearly answer questions about certain indicators in the analysis, whether they are the norm, or serve as direct evidence of severe disorders in the body.
Often, patients themselves try to decipher the testimony of the thyroid hormone TSH test. False conclusions and experiences of benefit have not yet brought anyone, therefore, it is better to interpret the test results for a doctor.
Causes of increased TSH
In case of deviations from the results, it is urgent to take effective measures. It is necessary to figure out if there is a threat to health if the thyroid hormone (TSH) is elevated. What to do in this case depends on the reason that provoked an increase in its concentration in the blood. The main factors that contribute to this:
- certain forms of thyroiditis;
- post-surgical syndrome in case of complete removal of the thyroid gland or a separate part of it;
- benign or malignant formations of the pituitary gland;
- oncology of the thyroid gland;
- cancerous processes of the breast, lungs or other organs;
- interruptions in the work of the adrenal glands;
- complicated degree of toxicosis in the long term of pregnancy;
- absence of the gallbladder due to removal;
- mental and somatic diseases.
How does an increase in thyroid-stimulating hormone manifest itself?
It is difficult to single out numerous manifestations of such disorders as a separate group of characteristic symptoms.
Signs of an increase in the hormone TSH in the body are:
- apathetic state, lethargy, general weakness;
- violations of the cycle "sleep-wakefulness";
- inhibition of reaction, slow thinking;
- inattention;
- psychoemotional disorders that did not appear earlier (tantrums, moodiness, irritability);
- rapid weight gain with almost no appetite;
- nausea, vomiting;
- constipation;
- swelling of the body;
- low body temperature.
Decreased TSH blood counts: causes
With reduced levels of thyroid-stimulating hormone, urgent action should also be taken, since this condition also indicates the presence of problems in the patient's body:
- benign tumors of the thyroid gland;
- Plummer's disease;
- Sheehan's syndrome;
- decreased performance of the pituitary gland;
- the strongest emotional stress;
- incorrect and uncontrolled intake of medications;
- fasting or significant dietary restrictions (due to the lack of enough calories with strict diets, including one-component diets).
Symptoms with low thyroid-stimulating hormone levels
With a reduced TSH level, the patient, as a rule, has an increase in blood pressure, subfebrile temperature. Heart palpitations, trembling limbs, or the entire body are also signs of low blood thyroid-stimulating hormone levels.
Severe headaches in this case are not uncommon, and they often lead to mental disorders, malfunctions of the digestive system. In this case, the person may have an unnatural appetite.
Treatment of disorders provoked by a deficiency or excess of TSH
Taking into account the presence or absence of characteristic symptoms, the attending physician will prescribe the correct specific treatment. You can’t take any drugs on your own. The consequences of unreasonable drug therapy can be dire.
In the case, mainly its synthetic analogue or T4 is used. The dosage and duration of the treatment course is determined by a specialist, since each patient has an individual susceptibility to the actions of drugs of this type. Dangerous disturbances and failures in the functioning of other organs and systems are the result of voluntary treatment. An effective method of controlling the hormonal system in the human body is a systematic examination. This is the only way to take appropriate measures to prevent or treat the disease in time.
In the general population, the prevalence of various TSH concentrations in the blood is characterized by a log-normal distribution: in 70-80% of people, the TSH level is between 0.3 and 2 mU / l, while in 97% it is less than 5.0 mU / l. When excluding from the general sample individuals who are carriers of antibodies to the thyroid gland, who have a goiter or have close relatives with thyroid pathology, it turns out that 95% of the sample obtained does not have a TSH level higher than 2.5-3 mU / L.
In this regard, in recent years in the literature, the question has begun to be actively discussed that it is this range that better reflects the population norms for the TSH level and on its basis the diagnosis of thyroid dysfunction should be built. Here I would like to emphasize right away (and with regard to thyroid pathology, this, alas, has to be emphasized quite often) that these data were obtained in epidemiological studies that did not imply any clinical intervention. These studies, and most notably the most resonant NHANES-III, simply described the prevalence of different TSH levels in the population and found that high normal levels of TSH- this is, indeed, quite often the prerogative of persons who carry antibodies to the thyroid gland. I would like to draw the attention of pediatricians to the fact that children under 12 years old were not included in the NHANES-III study, the results of which are one of the main arguments for changing the standards. This, as well as, indirectly, the well-known regularity about the transient nature of AIT, which is already rare in children, makes the discussion of the problem of changing the TSH level standards in relation to children the most controversial.
If we blindly extrapolate the data of the epidemiological study to clinical practice, it turns out that the diagnosis of hypothyroidism should be established when TSH is greater than 2.0-3.0 mU / L.
However, if in epidemiology, after the identification of any population pattern, the development of certain socially directed measures follows, then for the clinician, the detection of hypothyroidism means only one thing - the appointment of substitution therapy. But epidemiological studies were only concerned with the study of the advantages and disadvantages of prescribing substitution therapy, taking into account the new standards for the level of TSH. So, in this regard, is it legitimate to lower the upper limit for the TSH level as a criterion for diagnosing thyroid dysfunction?
This issue became even more actively discussed after, after a very short time after the publication of Hollowell J.G., et al (2002), the US National Academy of Clinical Biochemistry's laboratory diagnosis manual was published, which proposed using a new standard for the TSH level. I would like to note that the main publisher of the guide was the association of clinical biochemists, not endocrinologists, but it was agreed with the European, American, British and other thyroid associations. But was it an unconditional agreement or a consensus? Considering the opinion of the President of the European Thyroid Association and a number of other European experts, it was rather a consensus. In other words, subscribing to this truly valuable guide, which is primarily addressed to medical laboratory assistants, does not mean agreeing in every little detail.
In Berlin in June 2004, at the symposium of the company "Merck" (The Thyroid and Cardiovascular risk), a report was made by the President of the European Thyroid Association, Professor Wilmar Versing, which was called almost the same as this article: "TTG: is there a need to change the standards ? " (TSH: Is there a need to redefine the normal range?). I would not like to present its content in my own words, so I am presenting the full translation of the abstract of this report, which was published in the materials of the symposium.
“With the help of standards for various laboratory parameters, it is quite difficult to draw the line between norm and pathology, and in clinical medicine, between health and disease. Due to the fact that there is a log-linear relationship between the TSH level and fT4, the level TSH is the most sensitive marker of even a small deficiency or excess of thyroid hormones. Individual differences in the TSH level are significantly less than its interindividual variation, which determines the prevalence of various TSH levels in the population. In other words, a TSH level of 3.5 mU / L could theoretically be normal for one, but slightly elevated for another. It is extremely difficult to get out of this situation, and even more so, it is impossible to find out the individual characteristics of the relationship of the hypothalamus-pituitary-thyroid gland system and, thus, a certain individual level of TSH. Interindividual differences in the level of TSH, to some extent, can explain the fact that in some patients with subclinical hypothyroidism, various disorders characteristic of a deficiency of thyroid hormones are determined, while in others they do not.
In the large study NHANES-III, which was conducted in the United States, it was shown that in the general adult population TSH level is 0.45-4.12 mU / L (2.5 and 97.5 percentiles). These data were obtained after the logarithmic transformation of the TSH level in the reference population. At the same time, persons with thyroid pathology, goiter, pregnant women taking a number of drugs, estrogens, androgens, and lithium, having circulating antibodies to the thyroid gland, were excluded. The percentile of 97.5 for the TSH level was 5.9 and 7.5 mU / L in persons aged 70-79 and over 80 years old. The lower limit of the norm for TSH is 0.4 mU / L, and there is a general consensus in this regard.
The recommendations of the US National Academy of Clinical Biochemistry suggest narrowing the standard for TSH levels to 0.4-2.5 mU / L. The argument for this, again, was the results of the NHANES-III study, which showed that TSH levels between 2.5 and 5.0 mU / L are determined only in about 5% of the population. It is assumed that this may be due to the inclusion in the reference sample of a part of persons with occult autoimmune thyropathies without circulating antibodies to the thyroid gland. Arguments in favor of lowering the upper limit of the TSH norm to 2.5 mU / l:
- the risk of developing hypothyroidism in the future begins to increase significantly in the population, starting with a TSH level of 2 mU / L (Wickham Study);
- in persons with TSH 2-4 mU / l, a number of changes can be detected, such as impaired endothelium-dependent vasodilation, compared with persons with TSH in the range of 0.4-2 mU / l;
Arguments against changing the current TSH level standard:
- lack of clear evidence that prescribing thyroxine to patients with a TSH level of 2.5-4.0 has any advantages from the perspective of long-term prognosis, especially in terms of reducing mortality from cardiovascular pathology;
- the assignment of 5% of the population that do not have any diseases will lead to colossal financial costs, as well as to emotional and personal disorders in these people.
A possible solution to the problem in the future, theoretically, could be the determination of the complex risk of developing various complications (osteoporosis, cardiovascular diseases, depression) for different intervals of TSH levels. As a result, the decision to prescribe thyroxine replacement therapy will be made not only on the basis of the TSH level, but taking into account additional factors such as gender, age, smoking, hypertension, cholesterol level, and diabetes. A similar approach is currently being used to make decisions about the treatment of hypertension and dyslipidemia. Before the results of studies are obtained, stratifying the listed risks for different levels of TSH, I recommend using the existing standards, that is, 0.4 - 4.0 mU / l. " In my opinion, this essay succinctly describes the main contradictions and gives fairly clear recommendations. Nevertheless, let us dwell on some provisions that have simple clinical grounds.
First, about the terminology. Subclinical hypothyroidism in the modern literature, an isolated increase in TSH levels with normal T4 is denoted, and almost all available studies, the results of which can be used as arguments "for" or "against" proceed from the upper limit of the TSH norm of 4-5 mU / l. Absolute synonym for the term " subclinical hypothyroidism"In English literature is the term" minimal thyroid insufficiency". In English it sounds like "mild thyroid failure". Both in the first and in the second case, they proceed from the upper limit of the norm for the TSH level of 4-5 mU / l. We have to write about this, because recently, in some articles published in domestic sources, these terms began to live an independent life and the term "mild thyroid failure" was used for cases of TSH 2-4 mU / l, which cannot be considered correct.
Further, a very important point: today there are fairly clear data on the advisability of treating subclinical hypothyroidism (TSH more than 4 mU / l) only in relation to one group of people - these are pregnant women. During pregnancy subclinical hypothyroidism carries the risk of disturbances in the development of the nervous system in the fetus. For other groups, such data are not available, as stated by prof. Versing. Yes, of course, the repeatedly discussed Rotterdam study has been published, which found an association of subclinical hypothyroidism with aortic atherosclerosis and the risk of myocardial infarction in older women, but this does not mean that the appointment of substitution therapy will reduce these risks and, moreover, increase the duration life.
It is quite obvious that the association of two phenomena (subclinical hypothyroidism and atherosclerosis) does not yet imply a causal relationship between them. Many other works have been published that indicate the development of a number of pathological changes in persons with subclinical hypothyroidism and the regression of these changes against the background of thyroxine replacement therapy. They are described in detail in numerous reviews and monographs on this topic. Nevertheless, as rightly pointed out by prof. Versing, so far there is no evidence of the most important thing: there are no prospective studies that would prove that treatment of subclinical hypothyroidism will lead to an increase in life expectancy and a decrease in mortality from any diseases.
But we can not dwell on this too, since almost all of the listed works operate with the upper limit of the norm for TSH of 4-5 mU / l. In this regard, there is no need to talk about the upper limit of the norm of 2.5 mU / l. In other words, what 2.5 mU / L can we talk about when we do not have a final answer to the question to treat or not to treat? subclinical hypothyroidism, in the diagnosis of which the upper limit of the norm for TSH is embedded in 4-5 mU / l.
Another problem is the increase in the number of people with "abnormally high" TSH, that is, with "primary hypothyroidism". It is quite obvious that a decrease in the upper standard of the norm will lead to an increase in the sensitivity of the test, that is, the diagnosis of hypothyroidism will be established in a larger number of persons with this syndrome. However, it is no less obvious that an increase in the sensitivity of the test will inevitably be accompanied by a decrease in its specificity, due to which a decrease in thyroid function will be erroneously detected in a larger number of individuals than occurs when using a higher upper limit of the TSH norm. In other words, a decrease in the upper standard for TSH will lead to a significant increase in the number of false-positive results of assessing thyroid function.
A recent study by Fatourechi V. et al. (2003) demonstrates a significant, if not a catastrophic increase in the prevalence of hypothyroidism in the population, which can occur due to a decrease in the upper limit of the TSH norm. The authors reviewed all studies of thyroid function that were conducted in 2001 at the Mayo Clinic in Rochester (USA). A total of 109,618 TSH level determinations were performed in 94,429 patients. After excluding patients for whom the necessary information was lacking (3.5%) in a group of 75882 people, an analysis of the prevalence of hypothyroidism was carried out taking into account two upper TSH levels: 3.0 mU / l and 5.0 mU / l ... The obtained and rather eloquent results are presented in the table.
Tab. Influence of changing the upper standard for the TSH level from 5 mU / l to 3 mU / l.
As it follows from the data presented in the table, the prevalence of an increase in the level of TSH, that is, in fact, hypothyroidism, with a decrease in the upper standard, TSH will increase more than 4 times: from 4.6% (quite a familiar figure) to 20%.
Imagine what this indicator will be if we famously reduce the upper TSH rate to 2 mU / l. According to this study, a TSH level of more than 3 mU / L was determined in about 15% of patients under 50 years of age (each 6-7 people).
On paper, the conclusion looks quite impressive that only 5% of people have a TSH level in the range of 2-4 mU / l. What does it look like in real life? Endocrinologists, like no one else, imagine the number of diabetics who come to them for an appointment and the colossal efforts that it takes to work with these patients. In this regard, let's remember what is the approximate prevalence of diabetes mellitus in the population? Just the very same 5% of the population. The population of the Russian Federation in July 2004 was 144 million. Based on this, approximately 7 million 200 thousand of our fellow citizens (not pregnant, not taking estrogens, lithium, etc.) TSH level is in the range of 2-4 mU / l. If we sum up the entire population of cities such as St. Petersburg, Yekaterinburg, Krasnoyarsk and Tomsk, we get just 5% of the population of Russia.
We will diagnose subclinical hypothyroidism to just such a number of people in the situation when we accept the upper norm of the TSH level of 2.0 mU / l. In itself, it may not be scary, although all these 7 million people will fall into our offices. Worse, we do not know what to do with them, because we can hardly cope with those who have a TSH level of more than 4.0 mU / l, given a normal T4, without having a reliable evidence base.
But the problems do not end there either. Let us now recall the main source of the problem, about laboratory diagnostics, the progress of which led us to the realization that there are subclinical thyroid dysfunctions. Many references could be made about interlaboratory variability in TSH determination, no less about variation in TSH determination when using different methods of its assessment. But the clinician, as a rule, from his own experience understands that there are very few “sinless” laboratories, or rather, they do not exist by definition. Let's add here the general state of the "park" of equipment used for laboratory diagnostics in our country. We are not always talking about high-quality automata, and the very fact of having a fully automated analyzer does not exclude the use of "handicraft" sets. The hostage to this is a patient who, on the basis of research data, is prescribed or not prescribed hormone therapy.
Let's talk further and imagine that we, contrary to common sense, decided to prescribe substitution therapy to these 7-plus million apparently healthy people. This automatically implies the cost of thyroid hormone preparations, the cost of a huge number of hormonal studies, and the cost of the work of endocrinologists.
And yet ... how many of these patients will get better, how many will we prolong or make it, as they say, better? It will be worse for those who will be forced to seek medical help, standing in line first in the laboratory, and then, making an appointment with an endocrinologist at 5 o'clock in the morning. But it will be even worse for someone who, against the background of a chronic overdose of thyroid hormone drugs, which is inevitable in a certain part of patients in conditions of a narrowing of the target range of TSH, will develop osteopenia and atrial fibrillation.
What is the place of the interval for TSH of 0.4-2.5 mU / L in clinical practice? Apparently, these are pregnant women who are carriers of antibodies to the thyroid gland and in whom a highly normal TSH is determined in the early stages of pregnancy. Does this have a good evidence base? Apparently not quite, since the question immediately arises about women with highly normal TSH in early pregnancy in the absence of antibodies to the thyroid gland, who do not have goiter, and who receive iodine prophylaxis. How to deal with them?
It can be argued that if the patient has already been diagnosed with hypothyroidism (overt or subclinical, taking into account the "old" TSH standard), then the TSH interval of 0.4-2.0 mU / l should be considered as a target when assessing the adequacy of thyroxine replacement therapy. The logic in this, probably, is the very recommendations of the US National Academy of Biochemistry and recommend doing just that. But is there any evidence that this is the case? Alas, they are not here yet, except for the results of population epidemiological studies.
Returning to the beginning of the article, namely to the question of the relationship between scientific research and clinical recommendations for a wide range of doctors, I would like to say that the issue under discussion is one of the most pressing problems of clinical thyroidology and is being intensively studied. All the baggage of this science, which we actively use, has been accumulated taking into account the TSH standard of 0.4-4.0 mU / l. Even a small change in this standard will entail a revision of many provisions and may become a turning point in the development of this branch of endocrinology. Nevertheless, partly restraining his research impulse, one has to admit that the problem of changing the upper standard for the TSH level is still far from evidence-based and rational implementation in healthcare practice.
- Svetlana
Good afternoon Dmitry! Are there ways to cure AIT and is it possible to take metformin with this diagnosis?
Thank you in advance.
- Dmitry Veremeenko
Metformin is possible. It is theoretically possible to cure. There is no cure in medicine yet
Good afternoon, Dmitry.
Comment on iodine intake. Didn't find information on the site.
As far as I understand, a significant part of Russia is iodine deficient. Considering that iodized salt is one of the sources of iodine, as well as the fact that salt intake is recommended to be limited to a minimum (at least for people with high blood pressure), is there any sense in taking it additionally for children and adults? Thank you.
- Dmitry Veremeenko
If the endocrinologist has not prescribed on the basis of thyroid hormone tests, then no.
2004, University of Calcutta, India. Plants produce many toxic substances to protect themselves from insects and other herbivores. Many foods can be toxic to the thyroid gland. These substances are called goitrogenic, and the chemicals responsible for this effect are called goitrogens. Goitrogenic substances suppress the function of the thyroid gland. They interfere with the production of thyroid hormones. As a result of the compensatory mechanism, the thyroid gland will enlarge to counteract the decrease in hormone production. This enlargement of the thyroid gland is called a goiter. List of food products containing goitrogenic substances: broccoli cabbage, Brussels sprouts, cabbage, cauliflower, greens, horseradish, mustard greens, peaches, peanuts, pears, pine nuts, radishes, rutabagas, soybeans, strawberries, flax seeds, almonds, apples, cherries, nectarines, plums. Cooking can reduce goitrogenic substances in foods. Boiling for half an hour in water almost completely destroys them. Dietary intake of iodine (iodized salt) is able to overcome the effect of cyanogenic glycosides in moderation in cruciferous vegetables. But this may not help if you eat a lot of cruciferous vegetables. Soy can cause autoimmune thyroid disease and is often associated with food intolerances. Thyroid peroxidase, thyroid peroxidase (TPO) is an enzyme expressed mainly in the thyroid gland. It catalyzes two important reactions in the synthesis of thyroid hormones: iodination of tyrosine residues of thyroglobulin and the fusion of iodotyrosines in the synthesis of thyroxine and triiodothyronine.
ncbi.nlm.nih.gov/pubmed/15218979
2018, Shandong University, China. A high fat diet (for 18 weeks), rich in saturated and monounsaturated fatty acids, causes disruption of the lipid profile of the thyroid gland and hypothyroxinemia in male rats. In this case, free thyroxine T4 is lowered, and thyroid-stimulating hormone (TSH) increases.
ncbi.nlm.nih.gov/pubmed/29363248
2016, India. Risk factors for hypothyroidism:
Excess iodine. Iodine can also have direct thyroid toxicity through oxygen free radicals and immune stimulation.
Naturally occurring goitrogens, which are found in cabbage, cauliflower, broccoli, in turnips, form cassava root. Soy or soy fortified foods can also aggravate thyroid problems by lowering the T4 hormone, increasing autoimmune thyroid diseases.
Thyroid peroxidase (TPO) activity can be increased by consumption of polyunsaturated omega-3 fatty acids (fish oil) and monounsaturated omega-9 fatty acids (olive oil), while TPO activity is reduced by saturated and polyunsaturated omega-6 fatty acids (linseed oil ) fatty acids.
Thyroid function can be impaired by high consumption of green tea. In rats, there is a significant decrease in serum T3 and T4 and an increase in TSH levels, along with a decrease in TPO.
A review of 14 studies found that while soy protein and soy isoflavones do not affect normal thyroid function in people with adequate iodine intake, they can interfere with the absorption of synthetic thyroid hormone, causing the hormone to increase.
Peanuts can also cause goiter, but this effect is inhibited by small amounts of potassium iodide.
Wheat bran inhibits TPO activity.
Selenium and vitamin B12 deficiencies are also implicated in autoimmune thyroiditis.
UV filters to protect the skin from ultraviolet radiation can also alter thyroid homeostasis.
ncbi.nlm.nih.gov/pmc/articles/PMC4740614
- Alexander
Dmitry, so now it turns out not to eat, for example, Broccoli and all the cabbage, but what about Sulfarafan?
- Dmitry Veremeenko
There is. It's just that if TSH rises above the norm, you need to consider iodine and selenium preparations with an endocrinologist. They help fight it
- Dmitry Veremeenko
- Alexander
What is the conclusion from all this? And then it's already scary to live.
- Dmitry Veremeenko
What is the conclusion?
- Dmitry Veremeenko
Dmitry, so having AIT, is it undesirable to use broccoli? I would not want to give it up at all.
- Dmitry Veremeenko
AIT means you are on hormones. If you are on hormones, then you don't care already. Only soy makes you increase the proportion of hormones
I have TSH - 6.5, all other thyroid indicators are normal with a margin.
I think that if the TSH remains as it is, this is only a plus, for example, the pulse from such a TSH is low at rest with good health and a normal ECG.
- Dmitry Veremeenko
What are your autoimmune markers and how old are you?
- Heat
My autoimmune markers are not elevated, and I have not been diagnosed with AIT. Inflammatory markers are also low (C-reactive protein fluctuates in recent years from 0.1 to 0.2). True, endocrinologists do not like this TSH, they are prescribed to drink Iodomarin, and some of them even take hormones, although my hormones T4 and T3 are in the middle of the norm, although if I listened to doctors, I would have become disabled 20 years ago.
In terms of age and health, I belong to the 8th option of the anti-aging plan indicated here.I think my TSH is elevated - because I rarely eat and eat a lot of vegetables, including the cruciferous family, I eat little protein, but a lot of fat, and I walk a lot and quickly every day. If my TSH does not rise further, then I see in this current TSH - only a plus.
- Dmitry Veremeenko
FROM such TSH at your age there may be nodes and even tumors of the gland. Low doses of iodine are still worth taking. I will write an article about this soon
- Heat
Dmitry, there is of course a double-edged sword. On the one hand, a relatively high TSH slows down aging, but carries the risk of overgrowth of the thyroid gland, and with a decrease below normal T4 and T3 - the risk of atherosclerosis. On the other hand, low TSH - accelerates aging, while a person may feel that he is full of strength and energy, but he will age faster.
So it turns out and it is necessary to maneuver so that the TSH is not low and at the same time does not fall below the norm of T4 and T3, and the gland does not grow.
And I also saw data that taking iodine in the form of iodized salt or supplements like Iodomarin increases the risks of AIT, apparently such inorganic iodine acts more quickly and strongly than iodine from food, which can contribute to the occurrence of AIT, and this is with normal TSH and hormones, therefore, those taking additional iodine in the form of supplements are recommended to be tested more often for antibodies to the thyroid gland.
- Dmitry Veremeenko
About the risks of iodine - this is so. It would be best to get tested for iodine. And if it is in short supply, then a small dose of norms.
- Heat
- Dmitry Veremeenko
- Heat
Dmitry, please explain why the article and comments talk about TTG as an autonomous indicator? I got used to thinking that its level depends on the level of thyroid hormones: if they are high, it is low, if they are low, it rises and its increase stimulates the work of the thyroid gland. Or is it not that simple?
- Dmitry Veremeenko
Because t3 and t4 are unstable. And TSH is more stable. Many endocrinologists generally only look at it.
- Tatyana
Thanks! Then the situation is clear. I passed it in Helix 2 times with an interval of 2 weeks, the TSH indicators are very different. One endocrinologist diagnosed hypothyroidism (2 times TSH was higher than normal), and the second laughed and said that this does not happen in such a short period, the TSH change can occur no more than 3 months. I passed it to Invitro - TSH is normal. - This is by the way about the quality of Helix's work.
- Dmitry Veremeenko
Apparently they drank beta-blockers the day before ???)))
- Dmitry Veremeenko
- Tatyana
Good afternoon. Dmitry. Can you please tell me if I need to take iodine, if
TTG -0.5, and T4 - 12.7 and T3 - 3.36?
- Dmitry Veremeenko
Hello Dmitry! I'm 24. I have the following indicators: TSH - 1.15 mU / l (reference values: 0.4-4.0), T4 over. - 12.84 (9.00-19.05), AT-TPO - 14.3 U / ml (<5,6). Есть узел (диагноз — аденоматозный зоб). Пока что никакое лечение эндокринологом мне не назначено, показано только следить за Т4 ,ТТГ и узлом. Меня интересует, реально ли понизить/не допустить дальнейшего повышения антител? Если да, то как? И нужно ли что-то делать в моей ситуации, например, придерживаться какой-либо диеты или что-либо ещё? Если да, то какие это могут быть рекомендации?
- Dmitry Veremeenko
good afternoon Dmitry.
TTG -0.5, and T4- 12.7 and T3-3.36
according to hair analyzes according to the method of D. Skalny, I have selenium 0.479 (0.2-2)
iodine 6.87 (0.15-10) zinc at the lower limit 142 (140-500)
little iron 13.22 (7-70)
lithium increased 0.309 (- 1) I take once a week?
does it mean that I should give up lithium and take additional zinc?
and selenium and iodine are not needed?
Thyroid Energy shouldn't be taken?
- Dmitry Veremeenko
Lithium does not need to be discarded. 1 tablet per week will not affect.
Zinc is additionally needed if it is significantly lower than the norm. And so it is not necessary
Good afternoon. I really want to know how you can lower the TSH level without hormones.
Passed tests and was horrified. Ттг = 65.71 IU / L, and Т4 = 8.80.
- Dmitry Veremeenko
Dmitry, hello, I'm 75 years old, there are nodes on the thyroid gland (do not grow), at first the TSH was not greatly increased, but after taking cordarone for a year (a drug for arrhythmia with iodine) TSH rose to 10, the drug was canceled, trioxin was prescribed 25 - 50 mg. 2 years have passed TSH is still increased 7-8 while taking hormones. What do you advise, the doctor only increases the dose of L-thyroxine and does not give a direction for the analysis of other hormones?
- Dmitry Veremeenko
TSH at 75 is the normal TSH for a long-liver
Dmitry, thanks for the answer, did not understand what TSH is normal at 75 years old, and should I drink hormones?
- Dmitry Veremeenko
A 2011 study from Leiden University Medical Center in the Netherlands confirmed the findings of a previous study. Subclinical hypothyroidism is not associated with a risk of increased overall mortality unless it is of an autoimmune nature. Moreover, there is no association between subclinical hypothyroidism and coronary artery disease, heart failure, or mortality from CVD unless the TSH level is higher than 10 mU / L.
Women over 65 years of age, the TSH rate is 0.42–7.15 mU / l (as in centenarians), but control over cholesterol and markers of inflammation.
—
If you are 65 years of age or older, if the thyroid hormones are normal, and only the TSH hormone is elevated to no higher than 10 mU / L, then treatment to reduce TSH lower than 10 mU / L is not required, and, quite possibly, it can only shorten life. The only thing required is to control cholesterol levels and inflammatory markers (c-reactive protein and interleukin-6).
In your case, hormones allow you to control TSH no higher than 10 - well, that's good. Just watch out for high cholesterol and inflammatory markers (c-reactive protein and interleukin-6)
Hello! and with normal thyroid and TSH 12 .. and with good health .. need to drink hormones? I am now 47 ... from the age of 30 I was promoted ... I refused to drink hormones ... and I was slim and felt well ... from 44 I started drinking 50 and gained 10 kg ... my skin became worse ... so it turns out until I drank everything was fine ... and the point of drinking them ... I had to refuse ... but I want to believe the doctors.
- Dmitry Veremeenko
Judging by the research, you need
Dmitriy! For the first time today I passed it on the thyroid gland.
Where to run!!!
TSH - 7.8300 mIU / L (reference 0.350 - 5.500)
T3 - 1.15 nmol / l
FT3 - 2.58 pg / ml
T4 - 61.2 nmol / l
FT4 - 9.77 pmol / l (reference 11.50 - 22.70)
AtTG - 251.6 IU / ml (reference 0.0 - 60.0)
AtTPO - 5600.6 IU / ml (reference 0.0 - 60.00) !!!
I especially liked the last indicator!
I didn’t even find such a thing on the Internet.
ULTRASOUND EXAMINATION OF THE THYROID WITH CDC AND
REGIONAL L / NODES
Acoustic access, location: The thyroid gland is located typically, the contours are even,
clear, heterogeneous cellular structure. Cystic and solid formations
not found; the capsule of the gland is traced throughout.
Dimensions: right lobe: width - 16 mm, thickness - 18 mm, length - 46 mm
volume - 7.1 cm3
left lobe: width - 18 mm, thickness - 19 mm, length - 43 mm
volume - 8.0 cm3
isthmus: 4 mm
The total volume is 15.1 cm3, which does not exceed the age norm.
The vascular pattern of the gland parenchyma in the CDC mode is enhanced.
Topographic and anatomical relationship of the thyroid gland with muscles and
organs of the neck are not changed. Regional l / nodes without features.
CONCLUSION: US - signs of diffuse changes in the structure of the thyroid
glands of the AIT type.
I also did biochemistry, everything is normal there, as always:
C-protein ultra - 0.27
Cholesterol - 4.67
Glyc hemoglobin 5.20%
etc. more than 20 indicators, they are all within the reference range.
(54 years old, 70 kg., 185 cm., BMI-20-21, waist at the navel 85-86, lark - lights out at 22, get up at 5 in the morning)
- Dmitry Veremeenko
Go to an endocrinologist and sit on hormones.
- Maksim
Thank you Dmitry!
I've already signed up!
Can't raw broccoli harm you? Can you stop eating it every day?- Dmitry Veremeenko
Cannot, if you do not eat more than 100 grams per day
- Dmitry Veremeenko
- Maksim
Dmitry, visited an endocrinologist, to my surprise she said that we would not do anything, after 3 weeks he would have to take all thyroid tests again. I felt the thyroid gland, said that there was a node on the left, 2 ultrasound doctors came, one said - a pseudo-node, the other - a normal node, they immediately took a sample for cytology and thyroid tumor markers. There the norm is: thyroglobulin - 17.4 ng / ml (refrence 0.2-70.0) and calcitonin less than 2.00 pg / ml (refrence 0.4 - 27.7). I am waiting for the results of iodine-zinc-selenium from blood plasma.
- Maksim
The results came: little iodine and zinc,
and selenium - before the analysis, for about 3 weeks, I ate 3 Brazil nuts. in a dayStudy Result Units Reference values
Iodine (serum) 0.042 * μg / ml (0.05 - 0.10)
Selenium (serum) 0.104 μg / ml (0.07 - 0.12)
Zinc (serum) 0.613 * μg / ml (0.75 - 1.50)I may not be right
but this is how I like it better when you get tested first,
and then you take vitamins, and not vice versa.
And the cytology is ready: nodular colloid goiter, good-looking. image. Bethesda-II diagnostic category.
Dynamic observation recommended.
I read it on the Internet - taking into account the analyzes - there is little iodine. I'll go eat seaweed!
- Maksim
Visited the doctor again. Prescribed iodomorin 200 mcg x 1 tablet. per day x 3 months and Aquadetrim 2500 IU every day.
They said that the analysis on D3 can show that there is a lot of it, but it is not a fact that the body is using these reserves correctly.
This is indirectly shown by the analysis of parathyroid hormone.They also said that such a knot (16 mm) will most likely remain so, will not increase, but will not decrease either.
Good day everyone!
Who can advise how to increase T3 free? At the moment, I have it = 3.1. T4 and TSH are within normal limits, but the ratio of T3 to T4 is below normal.
Thank you
Dmitry, please specify where you can read in more detail about the increased risk of atherosclerosis with low T4 and T3?
Also in the comments somewhere you wrote about the effect of taking synthetic T3 hormone on papillomas. This information is very necessary. Please give me a link or a tip where it can be read.
Many thanks
- Dmitry Veremeenko
ncbi.nlm.nih.gov/pubmed/18443261
Dmitry, hello. Please advise whether you need to drink hormones - TTG-4.46 (norm 0.4-4.2), cholest. -4.58, with protein reactant 0.09, rheumatic factor 3.7 (0- 14), glycine hemoglobin-5%, atherogenic coefficient-2%, glucose 4.38. Age 55 years. Thank you.
- Dmitry Veremeenko
I will add that over 8 months TTG has grown from 3.16 to 4.46.
- Dmitry Veremeenko
This is a question for an endocrinologist.
Good afternoon, my TTG 1.97. I score with a comma! The algorithm produces an excess, although there is a norm of 0.4-4.5. This is mistake???
- Dmitry Veremeenko
I just scored 1.97 into the algorithm - that is, separated by commas. Everything is working. No overshoot. Perhaps you do not have the Excel program, but the algorithm opens through Open Office?
Hello Dmitry! The article is very informative, thank you very much. In 2010, I had an operation - mastectomy (cancer of the left breast pT2NOMO. NALT, ME dated 06/29/2010. 4 courses of APCT according to the FAC scheme. I did not take any harmonic and other drugs. Clinical examination went according to plan. In 2017, thyroid ultrasound showed a volume of 1 , 9 cm3, homogeneous tissue, low echogenicity, medium-grained. I do strength training in the gym. Weight at 53 years old - 56.5 kg. I feel great. Not long ago I was examined: ultrasound - thyroid gland volume 4.5 cm3, homogeneous, but already coarse-grained Conclusion: hypoplasia of the thyroid gland Hypotheriosis?
Has passed on hormones: TSH (III-generation) 7.65 at 0.46-4.7 mlU / L; Free thyroxine T4 - 10.65 at 8.9 - 17.2 pg / ml; Free triiodothyronine T3 - 4.73 at 4.3 - 8.1 pmol / l; Prolactin 443.7 at 64-395 mlU / l; Antibodies to Thyroid Peroxidase (AT-TPO)> 1000.0 at 0-35 IU / ml.
Could explain and give recommendations. Thank you.
- Admin_nestarenieRU
Fill in the data here and the algorithm will tell you
http://not-aging.com
TSH 1.51 mU / l, age 37 years. Please tell me is this the norm?
- Dmitry Veremeenko
this is normal
- Olesya
Thank you for reassuring me.
- Olesya
The question is not clear to me. What is fundamentally wrong. Where are the links to research?
In fact, only 7 out of 40 subjects, when taking additional iodine, had antibodies and that may be because there was not enough selenium And again, you need to understand that these are people with ALREADY existing autoimmune theroiditis There, in addition to iodine deficiency, there are a lot of other concomitant ailments and just stupidly adding additional iodine is not You’ll help It’s like with calcium preparations That is, you are talking about hypothyroidism and you cite as evidence a study of people with For example, prolonged iron deficiency leads to depletion of the thyroid gland and vice versa. acidity due to insufficiency of parietal cells Castle factor is a product of the activity of these cells. Is it clear where the B12 deficiency comes from? And B12, in turn, is a cofactor of iron absorption along with vitamin C, etc. Further Due to the low level of ferritin, the enzyme deiodinase is blocked (converts low-level T4 into active T3) The enzyme thyroid peroxidase is also iron-dependent. The biological effect of thyroid hormones is reduced - hello, HYPOTHYROSIS So many women and children suffer from anemia! And they are offered to live with hypothyroidism and not take iodine in the form of supplements So you tell me what to do And then the whole article is about not taking iodine
And you need to do this: Run running to get tested for B12, ferritin, iron, TSH, ATPO-TG, free T4, zinc, ctkty and eliminate all deficiencies
- Dmitry Veremeenko
Good afternoon, TSH 3.54, free T3 2.52 pg / ml, free T4 0.908 ng / dl. Age 40. Contact an endocrinologist or is everything within the normal range? Thank you.
- Dmitry Veremeenko
how much is T3 and T4 in pmol / l?
- Ekaterina
I have indicators in such units, but I found the conversion coefficients and calculated. It turns out T3 - 3.87 pmol / l, T4 - 11.69 pmol / l.
- Dmitry Veremeenko
Then it is subclinical hypothyroidism. That is, not yet hypothyroidism. It is worth monitoring cholesterol, markers of inflammation, but it is not worth treating specifically.
- Ekaterina
Thank you very much for your reply. It's just that there are almost all the symptoms of hypothyroidism, and she's already desperate to lose weight despite the constant control of nutrition and exercise in the gym. But that means that is not the reason.
- Larissa
Dmitry, I have a TTG 3.03. T4 is normal. They prescribed eutirox 25 mg from which I felt really bad. She stopped drinking it herself. Say what markers of inflammation mean. After the dental implantation operation, I have a slightly increased content of both leukocytes and erythrocytes. What to do? I am 60 years old.
- Dmitry Veremeenko
It is absolutely impossible to reduce TSH 3.03 at your age. At your age, if the thyroid hormones are normal, and only the TSH hormone is elevated no higher than 10 mU / L, if at the same time you do not have increased thyroid antibodies (there is no autoimmune process), then the treatment, judging by the data of this article, is not is required and, quite possibly, can only shorten life. The only thing required is to control cholesterol levels and inflammatory markers (c-reactive protein and interleukin-6).
ncbi.nlm.nih.gov/pmc/articles/PMC4480281
- Ekaterina
- Dmitry Veremeenko
- Ekaterina
Dmitry, please tell me, what is the point of including the analysis for interleukin 6 in DNKOM in the panel, if, according to the open source rate, this indicator (indicated in the algorithm) should be less than 1.07 pg / ml, and DNKOM can give only an approximate result "<2". Может, стоит дождаться когда они подтянут свои возможности к нашим потребностям?
The full functioning of the thyroid gland of the expectant mother is of great importance in the process of normal development of the fetus.
It is regulated by the pituitary gland through the production of thyroid-stimulating hormone (thyrotropin, TSH). Let's figure out what role TSH (thyroid stimulating hormone) plays during pregnancy.
Thyrotropin is a hormone synthesized by the anterior pituitary gland.
Its main function is to stimulate the production of thyroid hormones by the thyroid gland - triiodothyronine (T3) and thyroxine (T4).
This is due to the effect of TSH on receptors located on the surface of thyroid follicular cells.
Thyroid hormones are responsible for the metabolism, thermoregulation of the body, cell growth, the work of the cardiovascular, nervous, reproductive, and digestive systems.
There is an inverse (negative) relationship between the levels of TSH and T4 in the blood: with a decrease in the concentration of T4, the synthesis of TSH increases and vice versa. So the pituitary gland controls the thyroid gland so that the level of its hormones is within physiological limits.
Evaluation of the amount of TSH allows you to judge the correct functioning of the thyroid gland. Why is it important during pregnancy? Until the 10th week of intrauterine development, the child's endocrine system does not produce thyroid hormones on its own, he receives them from his mother. With their deficiency or excess, the process of laying all organs and systems of the baby is disrupted.
The work of the thyroid and pituitary gland changes after conception. Chorionic gonadotropin (hCG), synthesized by the embryonic membrane, stimulates an increase in the production of T3 and T4. As a consequence, TSH decreases early in pregnancy. When carrying more than one baby, it can go to zero.
After the 12th week, hCG decreases, as a result, the production of thyroid hormones decreases and TSH increases. Its slow, gradual growth is observed throughout pregnancy.
The TSH concentration fluctuates during the day: the upper peak falls at 2-4 am, the lower one - at 17-19 hours. If a woman does not sleep at night, then the thyrotropin level drops.
The TSH level is important during pregnancy planning. If there is an increase or decrease in the concentration of thyroid hormones, this negatively affects the maturation of follicles, the development of the corpus luteum, and the preparation of the uterus for egg implantation.
A girl may face infertility or miscarriage.
TSH levels during pregnancy are normal
The rate of thyrotropin varies depending on the duration of pregnancy:
- 1 trimester - 0.1-0.4 mU / l;
- 2 - 0.3-2.8 mU / l;
- 3 - 0.4-3.5 mU / l.
For comparison: the permissible limits for the level of the hormone for non-pregnant women are 0.4-4 mU / l.
Different centers use different methods for determining the level of TSH. Therefore, the figures may differ from the above. In the form with the result of the analysis, the boundaries of the norm are indicated, it is on them that you need to be guided.
In addition to the TSH level, it is advisable to determine the concentration of free thyroxine during the period of gestation. Its norm is 11.5-22 pmol / l. In pregnant women, T4, as a rule, is at the maximum border or slightly exceeds it.
A slight deviation of TSH and T4 levels from the norms, as a rule, does not indicate the presence of a serious pathology. In any case, the interpretation of the results is the responsibility of the physician. To establish the causes of hormonal fluctuations, other diagnostic methods are required - ultrasound of the thyroid gland, biopsy (if a node is found), and so on.
The hormone levels in the body must be balanced. Both increased and decreased their content leads to various pathologies. This topic will focus on the causes of low TSH.
Deviations from the norm
TSH increased
Exceeding the upper limit of the thyrotropin norm indicates that the thyroid gland of a pregnant woman produces an insufficient number of thyroid hormones. This condition, called hypothyroidism, can lead to miscarriage or a baby with a reduced IQ. In addition, excess TSH, which is observed for a long time, can provoke the proliferation of glandular tissues.
The main reasons for the increase in TSH:
- chronic autoimmune thyroiditis;
- thyroid surgery;
- radioiodine therapy;
- iodine deficiency;
- pituitary tumors;
- adrenal gland diseases;
- severe gestosis;
- poisoning with toxic substances;
- the use of certain medicinal substances - iodine preparations, antipsychotics, beta-blockers.
The tactics of correcting the TSH level is determined by the reasons for its growth. Most often, iodine-containing drugs are prescribed (in mild cases) or an artificial analogue of thyroxine - levothyroxine.
Low TSH in pregnancy
As already noted, the decrease in TSH levels in the first trimester is a physiological phenomenon. But if a low concentration of the hormone is observed at a later date, this may indicate an excessive production of thyroid hormones - hyperthyroidism. The diagnosis is confirmed by analysis for T3 and T4.
Hyperthyroidism can lead to thyrotoxicosis - poisoning of the body. The consequences of this can be placental abruption, termination of pregnancy, the formation of various defects in the fetus.
Reasons for a decrease in TSH:
- diffuse toxic goiter;
- stress, starvation, exhaustion of the body;
- toxic thyroid adenoma;
- trauma and pathology of the pituitary gland;
- taking some hormonal drugs.
With thyrotoxicosis, thyrostatics are prescribed - substances that suppress the hyperfunction of the thyroid gland. The main drugs are methimazole and propylthiouracil. In severe cases, part of the gland is removed.
A significant deviation of the thyrotropin level from the norm during pregnancy is an alarming sign that can be caused by various pathologies. Their treatment must be supervised by a doctor.
Signs of deviation from the norm
Clinical manifestations of an increase or decrease in thyrotropin levels depend on the functional status of the thyroid gland. With slight fluctuations, they may be subtle.
Signs of hypothyroidism:
- fatigue, weakness;
- depressed mood;
- insomnia or too long sleep;
- loss of appetite, which is accompanied by excessive weight gain;
- pallor;
- chills;
- decreased memory and concentration;
- constipation.
Hyperthyroidism symptoms:
- tachycardia, hypertension;
- nervousness;
- feeling hot;
- diarrhea;
- weight loss with increased appetite;
- trembling limbs.
Many of the symptoms described can also be observed during a normal pregnancy. Do not neglect a routine examination by an endocrinologist and an analysis for the TSH level.
TSH analysis during pregnancy
The TSH test is not included in the list of mandatory studies during pregnancy. It can be recommended by an endocrinologist or therapist if endocrine problems are suspected. Training:- For 3 days, stress factors, heavy physical exertion should be excluded, and also not to overheat or overcool. In addition, smoking and alcohol are prohibited.
- For 5-7 days, in agreement with the attending physician, it is necessary to stop taking hormones and iodine preparations, including vitamin complexes that contain it.
Blood sampling from a vein to calculate the TSH level is carried out in the morning (before 11:00) on an empty stomach: you can not eat for 12 hours, drink water is allowed. Sleep well is important.
If monitoring of the dynamics of thyrotropin levels is required, it is advisable to take tests at the same time in the same laboratory.
The thyroid-stimulating hormone test is an effective way to assess the functioning of the thyroid gland. After conception, it acquires particular importance, since thyroxine and triiodothyronine affect the formation of the central nervous system of the unborn child. Deviations from the norm in the study result cannot be a reason for termination of pregnancy. Modern methods of treatment allow you to completely neutralize hormonal imbalance and ensure the full development of the baby.
The hormones TSH and T4 regulate the thyroid gland. concentration in the blood in men, women and children, we will consider in more detail. And also brief information about what factors can affect the thyroid gland.
The symptoms and treatment of nodular goiter of the thyroid gland will be considered in the heading.
Video on the topic
Thyroid-stimulating hormone(TSH or thyrotropin) is a hormone secreted by the anterior lobe of the pituitary gland, a gland located on the lower surface of the brain. The main function of TSH is the regulation of the thyroid gland, the hormones of which control the work of all metabolic processes in the body. Under the influence of thyrotropin, the concentration of thyroid hormones - thyroxine (T4) and triiodothyronine (T3) - increases or decreases.
Thyroid stimulating hormone includes two components - α and β. The α-chain is the same as that of gonadotropic hormones that regulate the work of the gonads - chorionic (hCG), follicle-stimulating (FSH), luteinizing (LH). The β-component affects only the thyroid tissue. TSH binds to thyroid cells, causing their active growth (hypertrophy) and reproduction. The second function of thyrotropin is to increase the synthesis of T3 and T4.
Thyroid stimulating hormone regulates the production of thyroid hormones through feedback... With a decrease in T3 and T4, the pituitary gland releases more TSH to stimulate the thyroid gland. On the contrary, at high concentrations of T3 and T4, the pituitary gland decreases the synthesis of TSH. This mechanism allows you to maintain a constant concentration of thyroid hormones and a stable metabolism. If the relationship between the hypothalamus, pituitary and thyroid gland is disturbed, the order in the work of these endocrine glands is disrupted and situations are possible when, at high T3 and T4, thyrotropin continues to grow.
For thyroid-stimulating hormone, a circadian rhythm of secretion is characteristic. The peak TSH concentration occurs at 2-4 am. Gradually, the amount of the hormone decreases, and the lowest level is recorded at 18 hours. With the wrong daily routine or when working on the night shift, the synthesis of TSH is disrupted.
The material for determining TSH is venous blood. The level of the hormone is determined in the blood serum by the immunochemical method. The waiting period for the analysis result is 1 day.
The role of TSH in a woman's body
Disorders associated with the synthesis of TSH occur in women 10 times more often than in men.The endocrine system is a complex mechanism in which hormones constantly interact and mutually regulate each other's levels. Thyrotropin is interconnected not only with thyroid hormones, but also with sex and gonadotropic hormones, the effect of which on the female body is very great. Thus, a change in the level of TSH affects most organs and systems of the female body.
Effect on the thyroid gland
Thyrotropin regulates the hormonal activity of the thyroid gland and the division of its cells. High levels of thyroid hormones in the blood provoke the hypothalamus to produce thyrostatin... This substance causes the pituitary glandreduce the synthesis of TSH. The thyroid gland, which is sensitive to thyrotropin levels, also reduces the production of T3 and T4.
With a decrease in T3 and T4, the hypothalamus produces thyroliberin which causes the pituitary gland to release more TSH. An increase in thyrotropin levels stimulates the thyroid gland - hormone synthesis, size and quantity increase thyrocytes(thyroid cells).
1. Persistent TSH deficiency arises:
- with diseases of the hypothalamus and pituitary gland. He calls secondary hypothyroidism, accompanied by a slowdown in all metabolic processes.
- with thyrotoxicosis. In this case, TSH deficiency is a reaction of the pituitary gland to high concentrations of T3 and T4.
- with a pituitary tumor and other pathologies provokes a diffuse increase in the thyroid gland, the formation of a nodular goiter and symptoms hyperthyroidism(thyrotoxicosis).
- with a decrease in thyroid function - an attempt by the endocrine system to stimulate the production of T3 and T4.
Regulation of menstruation
TSH determines the level of thyroid hormones, as well as the synthesis of gonadotropic and sex hormones, which directly affect a woman's gynecological health and her menstrual cycle. 1. With chronic TSH deficiency, associated with the pathology of the pituitary gland and hypothalamus, secondary hypothyroidism develops. Low T3 and T4 levels cause a decrease testosterone-estrogen-binding globulin(TESG). This substance binds testosterone, rendering it inactive. A decrease in TESG leads to an increase in the concentration of testosterone in the female body. Among estrogens, estriol comes out on top, which is a less active fraction in comparison with estradiol. Gonadotropic hormones react poorly to it, which entails a number of disorders. Their manifestations:
- lengthening of the menstrual cycle associated with slow growth and maturation of the follicle in the ovary;
- scanty discharge with menstruation, they are explained by insufficient development of the endometrium and a decrease in the amount of uterine mucus;
- uneven spotting- one day scanty, the next - abundant;
- uterine bleeding not related to menstruation.
2. Chronic excess of TSH with a pituitary adenoma, it can cause the opposite changes characteristic of hyperthyroidism:
- shortening the interval between periods, irregular menstrual cycle in violation of the secretion of female sex hormones;
- amenorrhea- the absence of menstruation against the background of violations of the synthesis of gonadotropic hormones;
- scanty discharge accompanied by soreness and weakness on critical days;
- infertility caused by a violation of the secretion of gonadotropic hormones.
The formation of secondary genital organs
The release of female sex hormones and gonadotropic hormones depends on the level of TSH.1. With a decrease in TSH instead of active estradiol, the inactive form comes out on top - estriol... It does not sufficiently stimulate the production of follicle-stimulating hormones (FSH) and luteinizing hormones (LH).
Insufficient production of these hormones in girls causes:
- delayed puberty;
- late onset of menstruation;
- sexual infantilism - lack of interest in sex;
- the mammary glands are reduced;
- the labia and clitoris are reduced.
- enlargement of the mammary glands;
- hair growth of the pubis and armpits;
- early onset of menstruation.
Why is the TSH test prescribed?
A blood test for thyrotropin is considered the most important test for hormones. In most cases, it is prescribed in conjunction with the thyroid hormones T3 and T4.
Indications for appointment
- Reproductive dysfunction:
- anovulatory cycles;
- lack of menstruation;
- infertility.
- Diagnosis of thyroid diseases:
- enlargement of the thyroid gland;
- nodular or diffuse goiter;
- symptoms of hypothyroidism;
- symptoms of thyrotoxicosis.
- Newborns and children with signs of thyroid dysfunction:
- poor weight gain;
- retardation of mental and physical development.
- Pathologies associated with:
- violation of the heart rhythm;
- baldness;
- decreased sex drive and impotence;
- premature sexual development.
- Monitoring the treatment of infertility and thyroid diseases.
- Pregnant women in the first trimester if latent hypothyroidism is detected.
Signs of increased TSH
Elevated thyrotropin is often detected with hypothyroidism. In this regard, the signs of elevated TSH coincide with the symptoms of hypothyroidism. - Weight gain. The slowdown in metabolic processes leads to the deposition of nutrients in the subcutaneous fat layer.
- Edema eyelids, lips, tongue, limbs. Puffiness occurs due to water retention in the tissues. The largest amount of fluid is retained in the spaces between the cells of the connective tissue.
- Chilliness and chills are associated with a slowdown in metabolic processes and the release of insufficient energy.
- Weakness of the muscles. It is accompanied by a feeling of numbness, "goose bumps" and tingling. Such effects are caused by impaired circulation.
- Disturbances in the work of the nervous system: lethargy, apathy, depression, nocturnal insomnia and daytime sleepiness, memory impairment.
- Bradycardia- slowing down the heart rate below 55 beats per minute.
- Skin changes... Hair loss, dry skin, brittle nails, reduced skin sensitivity are caused by impaired peripheral circulation.
- Deterioration of the digestive system. Manifestations: decreased appetite, enlarged liver, constipation, delayed gastric emptying, accompanied by a feeling of fullness, heaviness. Changes occur when the motor activity of the intestines deteriorates, the processes of digestion and absorption are slowed down.
- Menstrual irregularities- scanty painful menstruation, amenorrhea, absence of menstruation, uterine bleeding not associated with menstruation. A decrease in the level of sex hormones is accompanied by a loss of sex drive. Often there is mastopathy - a benign proliferation of breast tissue.
With an increase in TSH in connection with a pituitary adenoma, the following may occur:
- headaches, more often in the temporal region;
- visual impairment:
- loss of color sensitivity in the temporal region;
- deterioration of lateral vision;
- the appearance of transparent or dark spots in the field of view.
Signs of decreased TSH
Decreased TSH often occurs in hyperthyroidism (thyrotoxicosis), when thyroid hormones suppress thyrotropin synthesis. In this case, the symptoms of TSH deficiency coincide with the signs of thyrotoxicosis.- Slimming with good appetite and normal physical activity, it is associated with increased metabolism.
- Goiter - bulge on the front of the neck in the region of the thyroid gland.
- Elevated temperature up to 37.5 degrees, a feeling of heat, sweating in the absence of infectious and inflammatory diseases.
- Increased appetite and frequent bowel movements... Patients eat a lot, but lose weight. A quick release of the intestines, without diarrhea, is caused by the acceleration of peristalsis.
- Violation of the heart. Tachycardia is a rapid heartbeat that does not disappear during sleep. It is accompanied by an increase in blood pressure. With a prolonged course, heart failure develops;
- Fragility of bone tissue. People suffer from bone pain, frequent fractures and multiple caries associated with imbalance in mineral balance and loss of calcium.
- Neurasthenic mental changes... The increased excitability of the nervous system is accompanied by tremors in the body, fussiness, irritability, rapid mood swings, decreased concentration, obsessive fears, panic attacks, and bouts of anger.
- Muscle weakness, increased fatigue, muscle atrophy. Attacks of weakness of certain muscle groups of the trunk or extremities.
- Eye symptoms... Eyes wide open, characterized by rare blinking and a feeling of "sand in the eyes".
- The skin is thinning... It is wet to the touch, has a yellowish tint, which is associated with impaired peripheral circulation. Characterized by fragility of hair and nails, their slow growth.
How to prepare for a TSH test
Blood from a vein for TSH is donated in the morning from 8 to 11. To exclude fluctuations in the hormone, you must:- do not eat for 6-8 hours before taking the test;
- do not smoke for 3 hours before the study;
- exclude the intake of medications that affect the work of the pituitary gland (the list is given below);
- eliminate stress and emotional stress per day;
- refrain from excessive physical exertion per day.
On what day of the menstrual cycle is blood taken for analysis?
There is no dependence of the TSH level on the phases of the menstrual cycle. In this regard, blood sampling for TSH is performed on any day.Normal TSH values in women by age
In different laboratories, the limits of the norm may differ, therefore, an endocrinologist should be involved in the interpretation of the results.Under what pathologies are TSH values increased?
An increase and decrease in TSH may be associated with disorders in the hypothalamus-pituitary-thyroid gland system or exclusively with thyroid problems. In most cases, an increase in TSH occurs in response to a decrease in thyroid hormone levels.
List of diseases
1. Pathology of the thyroid gland, accompanied by a decrease in T3 and T4, cause an increase in TSH through feedback.
- Conditions after removal of the thyroid gland and treatment of the thyroid gland with radioactive iodine.
- Autoimmune thyroiditis... An autoimmune disorder in which the immune system attacks the cells of the thyroid gland, resulting in decreased production of thyroid hormones.
- Thyroiditis... Inflammation of the thyroid gland, which is accompanied by a decrease in its hormonal function.
- Thyroid injury- as a result of tissue damage and swelling, hormone production worsens.
- Severe iodine deficiency... Its absence causes a decrease in the production of T3 and T4, which entails an increase in TSH.
- Malignant tumors thyroid gland.
- Hyperprolactinemia... The hormone prolactin, like TSH, is produced by the anterior pituitary gland. It is not uncommon for the synthesis of these two hormones to increase simultaneously.
- Congenital adrenal insufficiency... In this case, the increase in TSH is associated with low cortisol levels.
- Hypothalamic hyperfunction- it produces an excess of thyroliberin, which leads to excessive synthesis of the pituitary gland.
- Thyrotropinoma- a benign tumor of the pituitary gland that produces TSH.
- Insensitivity of the pituitary gland to hormones T3 and T4... A genetic disease manifested by symptoms of thyrotoxicosis. The pituitary gland increases the synthesis of TSH with good thyroid function and a normal titer of thyroid hormones.
- Insensitivity of body tissues to thyroid hormones. A genetic disease manifested by a delay in mental and physical development.
- severe colds and infectious diseases;
- hard physical work;
- strong emotional experiences;
- neonatal period;
- old age;
- anticonvulsants - phenytoin, valproic acid, benserazide;
- antiemetic - metoclopramide, motilium;
- hormonal - prednisone, calcitonin, clomiphene, methimazole;
- cardiovascular - amiodarone, lovastatin;
- diuretics - furosemide;
- antibiotics - rifampicin;
- beta-blockers - metoprolol, atenolol, propranolol;
- antipsychotics - butyrylperazine, perazine, clopentixol, aminoglutethimide;
- narcotic pain relievers - morphine;
- recombinant TSH preparations.
Under what pathologies are TSH levels reduced?
A decrease in TSH is much less common than an increase in the level of this hormone. Predominantly below normal thyrotropin is a sign of an increase in thyroid hormones of the thyroid gland, which occurs in hyperthyroidism and thyrotoxicosis. 1. Diseases of the thyroid gland, accompanied by hyperthyroidism(thyrotoxicosis), in which a high level of T3 and T4 inhibits the synthesis of TSH.
- diffuse toxic goiter (Graves disease);
- multinodular toxic goiter;
- the initial phase of thyroiditis - inflammation caused by infection or immune attack;
- thyrotoxicosis during pregnancy;
- thyroid tumors that produce thyroid hormones;
- benign tumors of the thyroid gland.
- Disruption of the hypothalamus. It produces excess thyrostatin, which blocks TSH synthesis.
- Bubble drift(abnormal development of pregnancy) and chorionic carcinoma (malignant tumor of the placenta). The decrease in thyroid-stimulating hormone is caused by a significant increase in the level of hCG (chorionic gonadohormone).
- Pituitary- a disease that occurs when the immune system attacks the cells of the pituitary gland. Violates the hormone-forming function of the gland.
- Brain inflammation and injury, operations, radiation therapy. These factors cause edema, impaired innervation and blood supply to various parts of the brain. The result can be a disruption in the functioning of cells that produce TSH.
- Tumors of the hypothalamus and pituitary gland in which the tumor tissue does not synthesize TSH.
- Brain tumors squeezing the pituitary gland and disrupting the production of hormones.
- Cancer metastases in the pituitary gland- a rare complication in cancer patients.
- stress;
- injuries and diseases accompanied by attacks of acute pain;
- beta-adrenergic agonists - dobutamine, dopexamine;
- hormonal - anabolic steroids, corticosteroids, somatostatin, octreotide, dopamine;
- drugs for the treatment of hyperprolactinemia - metergoline, bromocriptine, piribedil;
- anticonvulsants - carbamazepine;
- hypotensive - nifedipine.
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