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This in turn means that a level of free T4 near the bottom of normal might be too low for some people (who usually live higher in the normal range) and equally a level near the top of normal might be too high for someone who normally lives near the bottom of normal. In normal health, the thyroid gland makes thyroid hormones which broadly keep all the cells and organs of the body ‘ticking over’ at the correct rate. With too little thyroid hormone in the body, everything slows down and symptoms may include tiredness, slowness in thinking, weight gain, constipation and dry skin. Conversely with too much thyroid hormone everything speeds up and people may notice a fast heartbeat and increased risk of heart rhythm problems, weight loss, sweating and shakiness.
Every day, more businesses accept bitcoins because they want the advantages of doing so. Equally, when a decision has been made to start levothyroxine replacement it is difficult to know exactly what free T4 level to aim for. Traditional recommendations suggest aiming for the “upper half of the normal range” – but if we did this in everyone then by definition half the people treated might be running higher than their previous normal level. There are potential risks from giving too much or too little levothyroxine so ideally we would like to get things as normal as possible.
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In order to find out more about this, we reviewed the results of thyroid blood tests in all patients with pituitary tumours in our department and we have recently published the results in the UK medical journal Clinical Endocrinology. We looked at results of tests in over 500 pituitary patients, almost 150 of whom were taking levothyroxine – and we compared the levels we found with over 20,000 sets of thyroid blood tests in patients with problems with the thyroid gland itself who had a normal pituitary. We were pleased to find that we had indeed measured free T4 levels in almost everyone, and that very few people had levels outside the normal range.
Assorted antibiotics, sulfa drugs, cold and allergy medicines and pain killers are among the medications that can make people more vulnerable to sun and heat. Endocrinologists are aware of this problem, and will usually always request a free T4 measurement from the laboratory in patients with pituitary disease. However, your GP may not be so lucky if they request “TFTs” and will often only get back a TSH result. In my experience, this often leads to inappropriate reductions in levothyroxine dosage by the primary care team – when a low TSH level is interpreted as a sign of too much levothyroxine (which is true in people with thyroid problems) rather than as simply a sign of the pituitary deficiency which is being treated.
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- Assorted antibiotics, sulfa drugs, cold and allergy medicines and pain killers are among the medications that can make people more vulnerable to sun and heat.
- With too little thyroid hormone in the body, everything slows down and symptoms may include tiredness, slowness in thinking, weight gain, constipation and dry skin.
- However, your GP may not be so lucky if they request “TFTs” and will often only get back a TSH result.
- We suspect that the same thing will be happening in many other places.
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The administration of Scalar Light, a divine light, upon photographs of people, animals, plants and objects has not been evaluated by the US Food and Drug Administration and / or any other US Governmental derivatives thereof, known or unknown. Furthermore, no governmental agency in the world has defined Scalar Light or regulated the administration of Scalar Light upon photographs of people, animals, plants and objects. Presently, the scientific community has not been able to duplicate the Scalar Light instruments utilized to administer Scalar Light upon photographs of people, animals, plants and objects. However, even endocrinologists have problems knowing exactly what a lowish free T4 level means because of the wide range of free T4 in normal people. A common dilemma is whether a level in the lower part of the normal range represents a deficiency (for someone who would run in the higher part of normal if nothing was wrong with their pituitary) or is simply the normal level at which that person has always been.
Thyroid hormones are easy to measure and easy to replace, but we may all need to be more generous in what we consider to be really “normal” if we want to achieve optimal thyroid levels in all pituitary patients. Thyroid blood tests (“thyroid function tests” or “TFTs”) commonly measured by the laboratory include free T4 and TSH. The range of free T4 seen in normal healthy people is very wide (broadly from 10 to 25 pmol/L) but each individual normally runs at a fairly constant level somewhere within this range.
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If the pituitary fails to make enough TSH then free T4 levels in the blood will fall – but since the problem is at pituitary level then TSH levels in the blood do not rise appropriately. In severe cases free T4 will fall below the normal range, while TSH levels can be normal or low (see diagram). If the patient then receives levothyroxine replacement for their thyroid the free T4 levels will rise, and TSH levels often fall to below normal. Thyroid hormones in the blood are thyroxine (measured as “free T4” on the blood sample) and triiodothyronine (“free T3”) – these are produced by the thyroid and the amount produced is controlled by levels of the pituitary Thyroid-Stimulating Hormone (“TSH”). Doctors who are not specialists in endocrinology often have difficulty interpreting thyroid blood tests in patients with pituitary disease which can lead to failure to diagnose a mild deficiency and inappropriate changes in levothyroxine dosage in patients taking replacement.
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