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declining kidney function. Hashimoto’s thyroiditis (autoimmune inflammation of the thyroid) is the most common cause of SCH.


Hypothyroidism and SCH are also associated with: high cholesterol, triglyc- erides, and blood pressure; atherosclerosis; increased risk of cardiovascular disease; increased inflammation; weakness of the immune and respiratory systems (due to reduced white blood cell activity); iron-de- ficiency anemia (due to decreased produc- tion of circulating blood cells in response to lowered tissue oxygen needs); and meta- bolic syndrome.


Traditional thyroid function tests and their interpretations are controversial, do not always tell the whole story, and can thus be misleading. It is therefore important to examine the thyroid with more than a single test, and blood test criteria for thyroid disease should serve as only one parameter. Doc- tors have multiple tests available for thyroid disease diagnosis, including:


1. Thyroid-Stimulating Hormone (TSH): While TSH level has long been the favored thyroid dysfunction test, the strategy for its use in diagnosis has been debated and changed over the past 10 years. No single TSH measurement should be deemed conclusive, and TSH alone should not be used to determine medication dosing.


Part of the difficulty in relying on TSH


values lies in the fact that they fluctuate with various factors, including time of day (higher in the morning than in the afternoon), infec- tion (increases TSH synthesis), seasons (rises during colder months, drops in the warmest months), a rise in estrogen (from pregnancy, birth control pills, or hormone replacement therapy), head injuries (which can damage the hypothalamus and pituitary glands), and fasting (decreases TSH).


The “normal” diagnostic TSH references


available to clinicians generally range from 0.45-4.50 µIU/mL, and different medical/sci- entific associations and academies differ on acceptable upper limits. Studies suggest an optimal range of 0.5-2.0 µIU/mL since TSH above 2.0 may be associated with increased cardiovascular risk, and values below the normal range suggest TH excess (hyperthy- roidism or Grave’s disease).


2. Free T4 & T3 (Normal FT4 = 0.7-1.9 ng/ dl) (Normal FT3 = 230-619 pg/d) In symptomatic hypothyroidism, both will be below normal.


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