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Dr Mariano briefly on suboptimal Thyroid numbers - T4, T3, TSH

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by , 11-10-2012 at 01:18 AM (2046 Views)

A Total T4 is crucial to obtain since it gives me an idea of how much thyroid hormone a person may need. The other values only give me an idea of how the other systems interact with thyroid hormone. For example, if the brain is healthy enough to produce TSH, then TSH tells me how much of a thyroid hormone deficit it is running.

From a behavioral point of view (not an endocrinologist or internist point of view), my own observations as to the approximate lab criteria for suboptimal thyroid function (i.e. the hypothyroidism of mental illness) are:

Free T3 < 3.3
Total T4 < 8.0
TSH > 2.0

These reflect peripheral not brain levels of thyroid hormone. There can be a disparity since the brain and the rest of the body are separate compartments walled off by the blood brain barrier. Only a drastic maneuver such as a lumbar puncture and analysis of central nervous system fluid would tell the difference. In some illnesses, these values can be very different. The brain can be hypothyroid but the body can have enough. This can lead to persistent energy or mood problems and brain dysfunction through brain-related mechanisms.

In psychiatry, even if one isnít hypothyroid, thyroid treatment can still be done to help improve mood. Under some circumstances, such as bipolar disorder, a hyperthyroid state stabilizes mood.

Generally, thyroid treatment is risky without adequate nutritional support and without consideration of nervous system-adrenal function and treatment of problems there if indicated. It isnít something one does without medical supervision and monitoring.