Campaign 77 / News from Sweden.

[Guest guest]

Hello Sheila,

Just wondering why I can't read this item. It comes up, saying the link is broken. Just tried other subjects and can't get into any of them.

Jean.

Worcester.

[Guest guest]

I have no

idea Jean. Perhaps

somebody else more technically minded than me can help with your question -

because I have just checked out the TSH folder and clicked on 'News from

Sweden' and it opened just fine for me.  Here is the content:

NEWS

FROM SWEDEN – SWEDISH THYROID GUIDELINES and TSH

Marie in Sweden has sent me the

following translation of a Newsletter that has been sent out to every active GP

in Sweden in October 2009. It discusses new Swedish Guidelines on when to treat

a patient with symptoms of hypothyroidism. Thought you would all be interested.

Sweden is bringing down the TSH reference range to 0.5-2.5 - but the UK still

uses the reference range 0.5 to 10.00. Sweden is known to have a pretty

well functioning health system, by far better than the NHS. They have the

longest life expectancy and the lowest infant mortality rates in the world.

So, if you are being denied a diagnosis

because your TSH is within the UK reference range, how about popping over to

Sweden, America, Belgium, Germany or Australia to get a diagnosis.

Luv - Sheila

Primärvårdens Nyheter is an independent

journal aimed at the Swedish primary care sector and in particular clinically

active general practitioners. The journal has been the leading news forum for

the Swedish primary care sector for over 15 years. Each issue is dedicated to a

special thematic topic.

Primärvårdens Nyheter

(Primary Care News) 9-10-2009

Doctors need to get better

at recognizing and treating subclinical hypothyroidism. It is especially

important to treat if the woman is pregnant, or is trying to conceive. This

according to Ove Törring, Associate Professor and senior consultant specialized

in endocrinology and internal medicine.

Törnell, 55, from

Söderhamn, experienced typical symptoms of a low thyroid function for seventeen

years. She had gained a lot of weight in a short period of time, suffered from

fluid retention, physical pains, and severe memory- and concentration

difficulties and was extremely tired. Nothing was found to be abnormal despite

of several visits with different doctors, and she was often told that her

symptoms had to do with aging. 1997, at age 43, she was given the diagnosis

Chronic Fatigue. In 2001 one doctor noticed that her TSH was slightly elevated

and prescribed Thyroxine.

-It was as if someone switched

on the lights. I had not been present for so many years and with medication I

was finally given my brain back and could begin to think again. My energy

improved and even my other symptoms got better, but it has taken time, says

Törnell.

It is not uncommon that

patients with hypothyroidism have had symptoms and seen doctors inquiring about

treatment for a long period of time before their TSH reaches the limit for what

is regarded as abnormal and treatment has been put in place. In the United

States the TSH limit for what is considered to be low thyroid function was

lowered in 2006 from 4.0 mlU/L to 3.0 mlU/L. The Karolinska hospital in Solna

[stockholm] lowered the same limit from 4.5 mlU/L to 3.5 mlU/L in 2007. If

individuals with evident TPOab are excluded from the population sample when the

reference range is set, the range becomes even narrower; 0.3-3.5 mlU/L instead

of 0.3-4.2 mlU/L. 10 to 20 percent of the Swedish population has evident TPOab,

which increases the risk of developing hypothyroidism significantly.

A TSH of above 1.0 can give

symptoms

A 20 year longitudinal thyroid

study of the population found that those with a TSH of 2.0 mlU/L and above run

an increased risk of developing hypothyroidism. And this is independent of

whether individuals have evident TPOab or not. The American National Academy of

Clinical Biochemistry, NACB, announced in 2003 the guideline that patients with

a TSH over 2.5 mlU/L, on two occations at least 3 weeks apart, may be in an

early phase of hypothyroidism.

-And when 95% of the healthy

population fall within the reference range 0.5-2.5 mlU/L, this will most likely

become the new guideline for when treatment should be considered, which in my

opinion is completely correct, said Ove Törring, active at the Karolinska

Institute and Söder Hospital in Stockholm.

The reference range for TSH is

an average based on a population sample.

-This can imply, for those

individuals who normally have a low TSH-T4-relation setpoint that a TSH value

that is increased for them still is a TSH value that falls within the normal

reference range. A Danish study shows that a healthy individual's TSH keeps

relatively constant and that an increase of 1.0 mlU/L can be associates with

symptoms for the sufferer, said Ove Törring.

Subclinical that is

non-subclinical Subclinical

hypothyroidism is a condition with a normal T4 and T3 together with an elevated

concentration of TSH, but where the patient does not have any symptoms. This

definition is unfortunate since many studies have shown that individuals with

subclinical hypothyroidism can indeed have symptoms, e.g.

" non-subclinical. " The definition " mild hypothyroidism " is

therefore more frequently used.

-Symptoms are often general.

The patient might seek care for depressive symptoms, fatigue and other symptoms

that can appear as normal ageing, and it is easy to miss that it is rather an

early state of hypothyroidism. Since depressive symptoms are common in

hypothyroidism even in its early phase, one should consider taking thyroid

tests initially before an SSRI is prescribed, according to Ove Törring.

Increasing TPOab can then be an

indicator, but it's not a requirement. An American study published in the

journal Thyroid in 2000, where 552 patients via ultrasound or cytology were

diagnosed with autoimmune activity in the thyroid, 21

percent lacked evident TPOab.

Important as well is the family history. If the patient has thyroid disease or

another autoimmune disease in the family, the indication for treatment

increases.

A one year trial on

Thyroxine If you as a doctor are

unsure of whether you have a subclinical patient in front of you or not, it is

better that the patient gets a trial with Thyroxine rather than to be without

treatment, according to Ove Törring.

-The only thing that can happen

from a careful increase of Thyroxine is that the patient does not notice any

improvement. Often one year should pass before you can be really sure that the

medication has had no effect, and the patient's TSH should have been around 1

mlU/L for several months.

TPOab-positive youth who have

experienced tiredness, unengaged and found it difficult to keep up with school

work, as well as women with infertility or recurrent miscarriages, are two

groups who Ove Törring has successfully treated with Thyroxine, despite that

these individuals have had a TSH within the reference range; from 1.8 mlU/L and

above. With Thyroxine treatment the youth felt better and were more successful

in school and most women conceived and carried full term.

-I believe that individuals who

have been classified as " burned out " also may suffer from undiagnosed

subclinical hypothyroidism. When the metabolism drops stress levels increase

and the patient's cognitive abilities to handle problems and crises at home and

at work are reduced. And the higher the stress level, the more the immune

system is compromised, which can increase the already present inflammatory

process in the thyroid.

-I have had many patients who

have experienced " burn out " years before hypothyroidism was

concluded, says Ove Törring.

Large difference with small

dose differentials

-When fine tuning it is

sometimes necessary to adjust the dose with 25 micrograms more or less two to

three times per week, in order to find the correct dose for the patient's

wellbeing.

The advantages of treating

subclinical hypothyroidism is, according to Ove Törring, healthier patients

with better quality of life, fewer visits by patients with cases that the

health system doesn't manage to solve, " infertile " women can often

become fertile, education and work tasks become easier to handle with a brain

that doesn't run at a low gear and people don't have to experience a " burn

out " . During the last decade several studies have been published showing a

correlation between subclinical hypothyroidism and risk factors for heart- and

vascular disease; this through various mechanisms associated with the

development of arteriosclerosis.

TSH-control important during

pregnancy

For pregnant women it is even

more important not to have reduced metabolism. And this is true especially

during the first trimester since several structures of the fetus' central

nervous system are created then, which requires a sufficient concentration of

thyroid hormones for normal development.

-Pregnant women must not have a

TSH value exceeding 2.5 mlU/L, in which case they shall be treated with

Thyroxine. Pregnant women who are already medicated for hypothyroidism must

make sure that they are below 2.5 mlU/L during the entire pregnancy. The vast

majority need to increase the Thyroxine dose somewhat even at an early stage of

the pregnancy.

By Emese Gerentser

From: thyroid treatment

[mailto:thyroid treatment ] On Behalf Of Jean

Hickton

Sent: 17 September 2011 15:04

thyroid treatment

Subject: Campaign 77 / News from Sweden.

Hello Sheila,

Just wondering why I can't read this item. It comes up, saying the

link is broken. Just tried other subjects and can't get into any of them.

Jean.

Worcester.