Thyroid hormones: testing once is not enough!
Around five million people in Germany take thyroid medication every day. They contain the hormone thyroxine, which is vital for numerous body functions, such as metabolism. However, endocrinologists are sceptical about the high number of prescriptions.
“Some of the patients receive them unnecessarily,” estimated Prof. Joachim Feldkamp from Bielefeld Mitte University Hospital at a recent press conference by the German Society for Endocrinology. “Some people have been taking hormones for years without knowing why they are taking them,” the endocrinologist knows from practice.
Do not stop taking hormones without consultation!
Of course, there are many patients for whom the benefit of replacement therapy is beyond question because, for example, their thyroid was removed due to cancer or destroyed by radioiodine treatment. “In such cases it is clear that the hormones are necessary,” says Feldkamp. Stopping hormones on your own is therefore risky.
In many cases, medication is also necessary if the organ is underactive. One of the most common causes is the autoimmune disease Hashimoto’s thyroiditis, which can be associated with hypothyroidism.
An indication that the thyroid is not working adequately is the TSH value in the blood. TSH stands for “thyroid stimulating hormone”, a messenger substance from the pituitary gland that regulates the activity of the thyroid gland. If the TSH levels are elevated, this indicates hypothyroidism. But a single value can quickly mislead doctors.
TSH value depends on many factors
It is normal for the TSH value to fluctuate. In fact, it is influenced by numerous factors. This starts with the time of day the blood is taken: “The values are significantly higher at night and early in the morning,” says the endocrinologist. And even in winter there is a little more TSH in the blood than in summer. This was not only observed by Arctic researchers: TSH levels also rise in winter in more temperate winter latitudes.
But being overweight (obesity) can also change the TSH value: “It adapts to the increased need. This should not be treated with thyroid hormones,” says Feldkamp. If people lose weight or have stomach surgery, the TSH level also drops spontaneously.
Other factors that affect TSH levels include acute lack of sleep, physical exertion and infections.
Higher values in children and in old age
It is also important to take age into account: children and young people have higher values than adults – the guideline values cannot therefore be transferred to them, says Feldkamp. The values naturally also increase with age. You have to be careful with hormone therapy: If the thyroid hormones are overdosed, side effects such as bone loss and cardiac arrhythmias can occur.
And then there is the matter of biotin. The active ingredient is sold as a dietary supplement. Many people who suffer from hair loss, for example, take this . However, taking it distorts the laboratory tests – and thus leads to incorrect diagnoses.
“Individual measurements should be treated with caution”
“It is a challenge to correctly interpret hormone level values,” says Feldkamp. Individual measurements should therefore be treated with great caution. “They almost never justify a treatment decision,” says Feldkamp.
He recommends not initiating therapy after a single blood test. “A slightly elevated TSH value should be checked again – after at least two, preferably six months. In 50 to 60 percent of cases, the values return to normal even without treatment,” says the endocrinologist.
In practice, things often look different: Because the doctor immediately suspects a pathological underactive thyroid behind every high TSH value, thyroid hormones are sometimes prescribed prematurely.
Symptoms say more than a measurement
When administering hormones, doctors should also consider whether the patient actually suffers from the corresponding symptoms. These include a depressed mood, an increased need for sleep and a lack of motivation. But weight gain, concentration problems and hair loss are also possible signs of hypothyroidism.
If you have symptoms like these, Feldkamp also recommends checking the values. He does not support routine checking of TSH levels without any reason.
In the UAE
The UAE boasts one of the world’s most advanced healthcare systems, thanks to its mandatory private health insurance. This enables rapid access to cutting-edge medications, but it can inadvertently lead to overmedication. Therefore, it’s prudent to seek a second opinion and explore alternative options before committing to a long-term medication regimen, even when recommended by your physician. Being proactive in managing one’s health and engaging in informed discussions with healthcare providers is essential to ensure the most suitable and effective treatments, minimizing potential side effects, and optimizing overall well-being.