He came to the ER with chest pain, shortness of breath, and atrial fibrillation with a heart rate of almost 120 beats per minute. It wasn’t a heart attack, and it wasn’t some rare disease. He was emergently ill because his physician overreacted to blood tests, and prescribed a thyroid pill he didn’t need.
According to an article in JAMA Internal Medicine, the 72-year-old patient described above had gone to his doctor several months earlier, with mild, nonspecific physical complaints. The doctor ordered a blood test, which showed a slight elevation in his TSH, or “thyroid stimulating hormone.” TSH is the molecule your body releases when your thyroid isn’t producing enough hormone. When TSH is elevated, it can be a sign that your thyroid gland is underperforming.
In this patient’s case, even though his TSH level was high, the level of thyroid hormone was normal in his blood. That means his situation isn’t straightforward. Suppose his TSH had been elevated at the same time as his thyroid hormone was low. And suppose that he was also showing specific signs of thyroid problems—maybe he was cold all the time, or had a slowing of his heart rate. This constitution of signs and symptoms would be strongly suggestive of hypothyroidism—that extra TSH in his bloodstream might not be up to the task of prodding his thyroid to do its job. In that case, it would be reasonable for his primary care physician to prescribe thyroid hormone replacement, and see if he got better.
(To read the rest of this article, please visit Forbes.)
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