Thyroid treatment hinges on multiple factors

By

Community

June 24, 2019 - 10:04 AM

Dear Dr. Roach: I am an 82-year-old woman in good health. I recently had labwork that showed my TSH level is 6.14. I was told that I would need thyroid medicine because eventually I would feel tired and cold all the time. I do not have either of these symptoms. I’m usually warm when others say they are cold. I wake up at 6:30 and am ready for the day. Do I have an underactive thyroid? I don’t think so. — R.K.

 

Answer: I don’t think you have an underactive thyroid either. 

The thyroid stimulating hormone level is a measure of the pituitary hormone TSH, which stimulates the thyroid gland to release thyroid hormone (thyroxine, or T4). Many people, especially older women, have a high TSH level and normal thyroxine levels. There is some controversy about whether people in your situation need to be treated. Certainly, people with symptoms that are clearly from low thyroid benefit from treatment. There is also new evidence suggesting that younger people may benefit from treatment in order to reduce risk of heart disease. This effect was observed when TSH levels were higher than yours (above 7).

My personal practice is to not treat people with high TSH, normal thyroxine and no symptoms unless the TSH levels are above 10. Treating people under 65 with TSH above 7 might also make sense. Some of my colleagues will measure anti-thyroid antibodies, since people who have high levels of these antibodies are more likely to go on to develop symptomatic low thyroid levels.

Related
June 9, 2022
December 9, 2021
April 22, 2020
November 21, 2019