Thursday, April 30, 2009
"My Physician found my TSH was high, and started me on thyroid hormone. Why am I worried about this ? Isn't there more investigation needed?"
The answer to this Ask the Doctor email is yes. The finding of an elevated TSH or even a slowly increasing TSH over a few years is a clue to the onset of hypothyroidism. The abnormal TSH should be the starting point to investigate the cause of the failing thyroid and to evaluate the structure of the gland. TSH elevation even in the upper normal range has been found to be a risk factor for thyroid cancer. All newly diagnosed patients with TSH 2.5-10 are in the risk pool for cancer. The primary physician may not even feel the patient's neck before starting therapy. The thyroid gland is almost always abnormal to physical examination by a clinical thyroidologist. Firm gland with cobble stone surface is usually missed by the primary physician. Before allowing the physician to treat you, you need a complete thyroid evaluation looking for nodules. The endocrine neck ultrasonographer thyroidologist will do a detailed study of the thyroid, lymph nodes and parathyroid areas. If a suspicious nodule or lymph node is found, an ultrasound guided FNA will be done. Modern thyroidology concepts include hands on ultrasound real time done by your thyroidologist or endocrinologist, not by a radiology tech, who prints out pictures for a radiologist to look at after the fact. The original evaluation when the abnormal TSH is found is the best time to see a clinical thyroidologist, notjust start thyroid hormone.