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The therapeutic target range TSH level for patients on treatment ranges between 0.3 and 3.0 μIU/mL. [18] For hypothyroid patients on thyroxine, measurement of TSH alone is generally considered sufficient. An increase in TSH above the normal range indicates under-replacement or poor compliance with therapy.
The use of desiccated thyroid is usually accompanied with the practice of dosing according to symptoms instead of dosing to achieve "ideal" lab results (e.g. serum levels of TSH). While there is debate as to what the ideal serum levels are, dosing according to symptoms often results in higher dosages.
The diagnosis of hyperthyroidism is confirmed by blood tests that show a decreased thyroid-stimulating hormone (TSH) level and elevated T 4 and T 3 levels. TSH is a hormone made by the pituitary gland in the brain that tells the thyroid gland how much hormone to make. When there is too much thyroid hormone, the TSH will be low.
In overt primary hypothyroidism, TSH levels are high and T 4 and T 3 levels are low. Overt hypothyroidism may also be diagnosed in those who have a TSH on multiple occasions of greater than 5mIU/L, appropriate symptoms, and only a borderline low T 4. [47] It may also be diagnosed in those with a TSH of greater than 10mIU/L. [47]
TSH levels are determined by a classic negative feedback system in which high levels of T3 and T4 suppress the production of TSH, and low levels of T3 and T4 increase the production of TSH. TSH levels are thus often used by doctors as a screening test, where the first approach is to determine whether TSH is elevated, suppressed, or normal. [25]
Natural desiccated thyroid hormones are derived from pig thyroid glands, and are a "natural" hypothyroid treatment containing 20% T 3 and traces of T 2, T 1 and calcitonin. Also available are synthetic combinations of T 3 /T 4 in different ratios (such as liotrix) and pure-T 3 medications (INN: liothyronine). Levothyroxine Sodium is usually the ...
Levothyroxine is also used to treat subclinical hypothyroidism, which is defined by an elevated TSH level and a normal-range free T 4 level without symptoms. [14] Such people may be asymptomatic [ 14 ] and whether they should be treated is controversial. [ 13 ]
When treatment is first initiated, TSH levels may be monitored as often as a frequency of every 6–8 weeks. [71] Each time the dose is adjusted, TSH levels may be measured at that frequency until the correct dose is determined. [71] Once titrated to a proper dose, TSH levels will be monitored yearly. [71]
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