Disease screening TSH

TSH (thyroid stimulating hormone) screening is currently the most cost-effective option in the field of early screening for thyroid disease. The additional routine physical examination only costs 30-80 yuan, and only one tube of venous blood can detect more than 80% of subclinical thyroid dysfunction. It is especially recommended. Pregnancy preparation/pregnant women, people with a family history of thyroid disease, long-term work and rest disorders/emotional anxiety, unexplained fatigue/hair loss/abnormal weight fluctuations are given priority. Early intervention can avoid long-term serious risks such as infertility, miscarriage, impaired intellectual development of children, dyslipidemia, heart failure, etc.

A while ago, I accompanied my distant cousin to get the pregnancy physical examination report. She had no problems at all, except that her TSH was 0.7 higher than the reference value for the general population. She sat on the chair in the corridor with the report and cried, wondering if she would have to take medicine for the rest of her life, and the child she would carry would be stupid. In fact, I have encountered this situation too many times in clinical practice. Many people's understanding of TSH is either "never heard of it at all" or "it's a big deal if it's abnormal." It's very polarized.

You can think of the thyroid gland as the "power plant" of body metabolism. T3 and T4 are the electricity produced for the whole body, and TSH is the supervisor sent by the headquarters - when the electricity is not enough, the supervisor will vigorously urge the power plant to produce more. If the electricity exceeds the limit, it will stop. Therefore, often before the power plant has any organic problems and the power supply (T3T4) is still stuck in the normal range, the number of supervisors (TSH) will fluctuate abnormally first. This is why it is much more sensitive than directly checking T3T4, and the problem can be found in the subclinical stage without any symptoms.

When it comes to whether TSH abnormalities require intervention, there is currently no completely unified standard in the industry. Traditional endocrinology guidelines will clearly delineate the threshold: if TSH is higher than 2.5mIU/L in women preparing for pregnancy/pregnancy, higher than the upper limit of the reference value in the general population (most institutions set it as 4.2mIU/L), and accompanied by positive thyroid peroxidase antibodies, it is recommended to supplement low-dose thyroid hormone intervention in a timely manner to avoid further aggravation of the problem. However, in recent years, many doctors in the field of functional medicine and chronic disease management have also expressed different views: If the TSH is only slightly elevated (about 0.5-1 higher than the upper limit), the antibodies are all negative, and there are no clear symptoms such as fatigue, cold sensitivity, hair loss, and constipation, you can completely adjust your lifestyle for 3 months without taking medicine. After all, too many people have abnormal TSH due to staying up late at night, drinking ice milk tea every day, and being anxious and insomnia. It is not an organic disease of the thyroid gland.

I met a 26-year-old Internet operation girl last year. She worked on the Double 11 project for 21 consecutive days. She drank two cups of iced Americano and one cup of pearl milk tea a day. During the physical examination, her TSH spiked to 5.9mIU/L. Her antibodies were all negative. Originally, the doctor prescribed Eucalyptus. Le, she was afraid of the side effects of taking medicine, so she gritted her teeth and quit her late-night job. She went to bed at 10:30 every night, and did aerobics three nights a week. She gave up all sweet drinks and replaced them with room-temperature soy milk. When she came back for a review after three months, her TSH dropped directly to 2.0mIU/L. She was fine without taking any medicine.

This does not mean that all abnormalities can be improved by adjusting life. We must also pay attention to those that should be taken seriously. Not long ago, there was a 42-year-old male patient with high blood lipids who took statins for more than half a year. His blood lipids did not drop at all, and he became more and more fatigued. He could not even climb the third floor to gasp for breath. After a round of examinations, no problem was found. Finally, a doctor asked him to do a follow-up TSH test. It had reached 8.1mIU/L. This is typical subclinical hypothyroidism. Within 2 months of taking a small dose of Euthyrox, his blood lipids dropped to the normal range, and even the symptoms of fatigue disappeared. Many people think that thyroid problems are exclusive to women. In fact, men and the elderly are also more likely to suffer from thyroid problems. In particular, the elderly are prone to fatigue, cold sensitivity, and memory loss. They always think that it is normal for older people. In fact, nearly 20% of cases are due to missed diagnosis of hypothyroidism.

Oh, by the way, there is another pitfall that many people have stepped on: when you get the TSH report, you only look at whether there are up and down arrows, and don’t look at the physiological stage you are in at all. For example, the TSH reference value during pregnancy is much lower than that of ordinary people. It is appropriate to control it at 0.1-2.5mIU/L in the first trimester. It is easy to miss the diagnosis using the reference value card of ordinary people. In addition, don’t panic if TSH is abnormal occasionally. Staying up late the night before, taking ibuprofen, or even eating too much kelp and seaweed may affect the results. It is best to recheck again every 2-4 weeks. If it is abnormal twice, it is not too late to consider intervention.

In fact, TSH screening is really one of the most cost-effective additions to the physical examination. It costs dozens of dollars. There is no need to be so anxious that you can’t sleep just because of a slight abnormality, and don’t take it lightly because there are no symptoms. After all, the thyroid gland controls your metabolism from your hair to your heels. If you detect small problems early, whether you adjust your work schedule or take medicine, it will save you a lot of trouble than waiting until major problems arise and then treat them.