What do deviations from the norm of TSH in women say. Blood test for TSH, how, when and why is it performed? If ttg approaches the upper limit

In order to understand how the hormonal system of the body works, it is necessary to understand some of the nuances of human physiology. In comparison with internal organs, for example, the gastrointestinal tract, digestion, heart or brain, it is impossible to touch and say exactly under which edge it is located. The hormonal system is the finest delicate structure. However, a minimal failure in its work can lead to a number of health problems.

What is the "hormone TSH"?

The production of hormones and control over their full functioning in human body- the main task of the thyroid gland. This system of internal secretion predetermines the implementation of many natural processes. Any disturbance in the functioning of the thyroid gland, associated with the nature of the performance of hormones or their amount produced, can be fixed during the appropriate diagnosis.

The TSH hormone produced by the thyroid gland is produced by the pituitary gland, or rather, its anterior lobe. The purpose of this substance, in fact, is to control and coordinate the functions of the thyroid gland. Just like any other thyroid hormone, it affects the hormonal balance of the body as a whole through its effect on T3 and T4. These substances are also produced by the thyroid gland.

The importance of having a blood test for thyroid stimulating hormone

In the case of thyroid hormone, this indicates that the level of T3 and T4 in the body is too low. Such indicators may indicate the development of a pathology called "hypothyroidism". The process of its occurrence is determined by these thyroid hormones. in the event that the functioning of the main producing organ has decreased in direct proportion. Disturbances in the work of the thyroid gland are fraught with serious complications in the life of the whole organism.

An increase in the production of hormones leads to damage to the cells of the thyroid gland, which threatens to disrupt the functioning of all organs and systems of the body. Can help repair damaged cells modern facilities- peptide bioregulators. In Russia, the first brand of peptide bioregulators was cytamines - a line of 16 drugs aimed at different organs. To improve the function of the thyroid gland, a peptide bioregulator has been developed -. Components for Tyramine are obtained from the thyroid glands of cattle, they are a complex of proteins and nucleoproteins that have a selective effect on thyroid cells, which helps to restore its function. Tyramine is recommended for use in violation of the thyroid gland, hypo- and hyperfunction, tumor processes in the glandular tissue. As prophylactic Tyramine should be used by people living in areas endemic for thyroid disease. Tyramine is also recommended for seniors and the elderly to maintain thyroid function.

Thyroid TSH analysis is extremely important in the process diagnostic examination organ. When drawing conclusions and making a diagnosis this indicator is taken into account as a determining one, since it is he who is able to quickly respond to the slightest pathological change. While T3 and T4 have not yet responded to the presence of certain markers in the blood, the TSH hormone of the thyroid gland has already demonstrated with its lightning-fast reaction about the identified malfunctions in the hormonal system.

In what cases may this diagnosis be required?

There must be good reasons for a physician to refer a patient for this type of diagnostic test. Indications for the procedure are such cases:

• exclusion or confirmation of hyper- or hypothyroidism;
• clarification of the diagnosis regarding the pathology of the thyroid gland or related organs and systems;
• control over the recovery process in order to timely identify the need to make adjustments to the treatment;
• obtaining the results of an additional stimulation test;
• timely management of T4 suppression present in the so-called cold nodule and goiter.

Periodic TSH testing is the key to timely treatment

In addition, this analysis of thyroid hormones can reveal a lot of other problems with the most important systems for the human body. TSH in patients undergoing surgical intervention or those with chronic diseases should be under the constant supervision of a specialist. The responses of this analysis clearly reflect the state of the thyroid gland.

If any serious changes are detected at the initial stage or current unfavorable processes in the organ are detected and if treatment is started early, the patient's chances for a full recovery increase several times. In order to avoid complications and take appropriate measures to prevent the deterioration of the patient's well-being, it is necessary to regularly conduct control TSH testing.

Preparing for Analysis

It is highly undesirable to ignore the need for this simple test for the TSH hormone of the thyroid gland. After all, a procedure that is simple in execution technique is capable of giving a detailed informative answer. In the fight for the health of a patient with thyroid problems, this TSH test plays a huge role. The norm of its indicators allows you to make sure that the patient is in a satisfactory condition.

Before taking a blood test for detection hormone TSH, it is advisable to strictly follow some rules.

By following the advice that doctors give about taking a test to determine the level of hormonal balance, the patient will be able to exclude as much as possible the likelihood of receiving false information in the results of the analysis.

Basic rules to follow before taking the test

So, what do you need to do to get your TSH test right?

1. It is necessary to pass the study on an empty stomach. You can use only clean running water. 8-10 hours before the diagnosis, it is advisable not to eat anything.
2. The analysis should be preceded by a diet. Refusal of fatty, smoked, fried, spicy and sour products will avoid the likely distortion of the study results.
3. A few days before passing clinical diagnostics it is important to completely eliminate alcoholic beverages, regardless of the strength.
4. Do not play sports and do not overdo it with power loads. At least a week before the examination, it is important to exclude any physical exercise.
5. Also a couple of weeks before laboratory diagnostics blood, it is necessary to exclude the use of any medications as much as possible. If the current course of therapy cannot be interrupted in any case, or a serious malfunction of the whole organism occurs without the use of drugs, before undergoing the procedure, it is necessary to provide the doctor with the entire list of medications taken. medicines. Since they are potentially capable of affecting blood test data, specialists always try to take them into account.

Why is it necessary to prepare specifically for the study?

In addition, the recent passage of x-rays, ultrasound can distort the results of the examination. Elevated levels of TSH (thyroid hormone) can provoke stressful situations. Nervousness, anxiety, frustration - all this contributes to an intense release chemical substances in the body.

With a responsible and high-quality approach to the procedure, the result of a blood test for the level of thyroid-stimulating hormone will maximally correspond to the real picture of the patient's health. Thanks to accurate information, it is possible to carry out timely preventive actions to prevent thyroid disease or begin treatment of an already existing progressive pathology. In some patients, such restrictions can cause a lot of indignation, but in order to obtain reliable data on the state of the organ, desires and ambitions should be neglected. This is the only way to avoid re-analysis.

How to decipher the analysis on TTG - norm or not?

As a rule, a TSH test is considered mandatory for patients with disorders in the body associated with the functioning of the thyroid gland. Surgery this body in the past is also a direct indication for regular analysis. In order to correctly decipher the analysis and determine whether the level of the hormones being investigated is normal, or there are deviations in the blood, the endocrinologist relies on several fundamental points.

Firstly, male and female levels of thyroid-stimulating hormone should normally differ from each other. In the fairer sex, it can significantly exceed the values ​​\u200b\u200bthat in a blood test for men reflect thyroid hormones (TSH). The norm for women is about 4.2, while in men the figure rarely exceeds 3.5. However, this is not the limit. During pregnancy, thyroid hormones can also increase. TSH (the norm in women allows you to determine the degree of increase in the concentration of substances in the blood) in expectant mothers sometimes reaches 4.7.

What determines the level of thyroid-stimulating hormone in the blood?

In addition, thyroid-stimulating hormone in the body can change its concentration depending on many features due to the biorhythm, age, the presence of other chronic diseases etc. When compiling an anamnesis, it is extremely important to provide the specialist with detailed information on this issue.

A highly qualified doctor is capable of making objective conclusions from the test results and predicting further developments. He can clearly answer questions about certain indicators in the analysis, whether they are the norm, or serve as direct evidence of severe disorders in the body.

Often, patients themselves try to decipher the test results for the TSH hormone of the thyroid gland. False conclusions and experiences of benefit have not yet been brought to anyone, therefore it is better for a doctor to interpret the testimonies of the analysis.

Causes of elevated TSH

In case of deviations from the results, it is urgent to take effective measures. You should figure out if there is a threat to health if the thyroid hormone (TSH) is elevated. What to do in this case depends on the reason that provoked an increase in its concentration in the blood. The main factors that contribute to this are:

• separate forms of thyroiditis;
• post-surgical syndrome in case of complete removal of the thyroid gland or its individual lobe;
• benign or malignant formations pituitary gland;
• thyroid cancer;
• cancerous processes of the breast, lungs or other organs;
• malfunctions of the adrenal glands;
• complicated degree of toxicosis at a long gestational age;
• absence of the gallbladder due to removal;
• mental and somatic diseases.

How does an increase in thyroid-stimulating hormone manifest itself?

Numerous manifestations of such disorders are difficult to single out as a separate group. characteristic symptoms.

Signs of an increase in the TSH hormone in the body are:

• lethargy, lethargy, general weakness;
• disruption of the sleep-wake cycle;
• inhibition of reaction, slow thinking;
• inattention;
• psycho-emotional disorders that do not manifest themselves earlier (tantrums, capriciousness, irritability);
• rapid weight gain with an almost completely absent appetite;
• nausea, vomiting;
• constipation;
• swelling of the body;
• decreased body temperature.

Decreased blood test values ​​for TSH: causes

Decreased thyroid-stimulating hormone levels should also be treated urgently, as given state also indicates the presence of problems in the patient's body:

• benign formations of the thyroid gland;
• Plummer's disease;
• Sheehan's syndrome;
• decreased performance of the pituitary gland;
• severe emotional stress;
• incorrect and uncontrolled reception medicines;
• starvation or significant dietary restrictions (due to the lack of sufficient calories with strict diets, including single-component diets).

Symptoms of low thyroid-stimulating hormone

When the TSH level is low, the patient usually has an increase in blood pressure, subfebrile temperature. Rapid heartbeat, trembling limbs or the whole body are also signs of low levels of thyroid-stimulating hormone in the blood.

Severe headaches in this case are not uncommon, and they often lead to mental disorders, malfunctions of organs digestive system. In this case, a person may experience an unnatural appetite.

Treatment of disorders provoked by a lack or excess of TSH

Taking into account the presence or absence of characteristic symptoms, the attending physician will prescribe the correct specific treatment. You cannot categorically take any drugs on your own. The consequences of unreasonable drug therapy can be the most deplorable.

In the case, mainly its synthetic analogue or T4 is used. Doses and duration of the treatment course are set by a specialist, since each patient has an individual susceptibility to the actions of drugs of this type. Dangerous disorders and malfunctions in the functioning of other organs and systems are the result of arbitrary treatment. effective method control over the hormonal system in the human body is a systematic examination. Only in this way can appropriate measures be taken in time to prevent or treat the disease.

Hormones - what is it? They are the most important substances that take part in the regulation of various processes: these are metabolism, reproductive activity, and the mental and emotional state of a person. TSH in women is a thyroid-stimulating hormone, the indicators of which can indicate changes in the body.

General data on thyroid-stimulating hormone, together with T3 and T4

TSH - what does this abbreviation mean? Thyroid-stimulating hormone, or thyrotropin, is the most important regulator that controls the functioning of the thyroid gland. It is responsible for the production of thyroxine (T4) and triiodothyronine (T3). The latter, in turn, are responsible for the activities reproductive system, metabolic processes of fats, proteins and, the correct functioning of the heart muscle and the functioning of blood vessels.

TSH, together with T3 and T4, promotes the production of glucose, participates in heat metabolism, and controls the process of producing red blood cells.

A feature of thyroid-stimulating hormone is that the level of its content fluctuates and has a daily character. Its highest value is recorded at 3 am, and from 9 am to 6 pm this figure decreases.

Thyrotropin is produced by the pituitary gland, which is located in the brain. The norm of thyroid hormones in women and men has different standards, and in different ages they differ.

Important! The norm of T3 and T4 in TSH for women depends on their age. If the TSH value deviates from normal level, then this may indicate diseases of the adrenal glands or pituitary gland, due to which thyroid starts to work incorrectly. Fluctuations in the content of TSH and deviation from the norm are also observed during periods of hormonal instability - during pregnancy, during the lactation period, and also during menopause.

The norm of TSH in women depending on age

Permissible TSH level in women, this is an indicator that directly depends on age, hormonal status, the presence of acquired or congenital pathologies. For 20 years, 40 years, 50 years, the allowable indicator is different. To determine the TSH norm in women by age, a table of acceptable norms will help, for different age ranges and during pregnancy:

It should be noted that, as the body ages, the function of the thyroid gland decreases, therefore, in women after 50 years (more often at the age of 60-70 years), the lower limit of the TSH indicator is 0.4 μIU / ml, the upper limit is 10 μIU / ml.

Fluctuations in the rate of TSH are associated with different needs for this hormone at different stages of life.

In addition to the level of TSH, it is also necessary to take into account the indicators of T3 and thyroxine (T4). The norm for the first is about 3.5 - 0.8 μIU / ml, free T3 - 2.62-5.69 pmol / l.

The norm of T4 in women is 0.8-1.8 μIU / ml, free T4 is 9-19 pmol / l.

This hormone, thyroxine T4, plays a big role in the sexual development of girls. Its level affects the synthesis of sex hormones.

If TSH is lowered, then the following deviations are observed in girls:

• slowing down the process of puberty;
• delay in the onset of menstruation;
• growth mammary glands slows down;
• the size of the clitoris and labia are smaller;
• there is no natural interest in sexual activity.

When girls younger than 8 years old have a prolonged increase in TSH, puberty comes prematurely. This is manifested in the enlargement of the mammary glands in early age, early onset of menstruation and hairy axillary and pubic areas.

Note! In women during pregnancy, the norm of thyrotropin hormone differs from the data indicated in the table. In each trimester, its indicators change:

• in the first trimester, the TSH indicator ranges from 0.1-0.4 μIU / ml;
• in the second - 0.2-2.8 μMe / ml;
• in the third - from 0.4 to 3.5 μIU / ml.

During the examination, specialists turn Special attention on changes in the hormones TSH and T4, T3. It is recommended to regularly check their levels during pregnancy, after the age of 40 (before menopause), and also after 60 years.

In what cases should I take an analysis for the content of TSH?

Knowing what TSH is responsible for, it is necessary to be aware of the importance of timely hormonal studies for a woman's health in different years of her life and her reproductive capabilities.

An analysis for the content of TSH in the blood of women should be taken if certain deviations are observed:

• psychological and neurological disorders: and, sleep disturbances, irritability, apathy, causeless aggression;
• constant lethargy and weakness;
• decreased libido;
• pain in the throat;
• active up to baldness;
• inability to get pregnant for a long time;
• - absence of menstruation for several menstrual cycles;
• the temperature often drops below 36 degrees;
• weight gain in the absence of appetite;
• increased appetite, which is difficult to control;
• persistent, not passing headaches;
• the thyroid gland contains seals;
• muscle dysfunction;
• small trembling all over the body, especially in the upper limbs.

Also, TSH analysis of adult women is carried out in the following cases:

• if you suspect the presence of autoimmune diseases;
• when planning pregnancy in order to prevent genetic abnormalities in the child;
• during the treatment of certain diseases to monitor the effectiveness of ongoing activities;
• if violations of the functioning of the thyroid gland were previously detected as a routine examination.

As a result of the study, the specialist may find that the levels of the TSH hormone are normal, increased or decreased. Deviations are reflected in the female reproductive system and its general condition.

The main reasons for the increase in the level of thyrotropin and the approach to treatment

If women have elevated TSH, what does it mean? Elevated TSH in women is the result of a number of pathological disorders in the work internal organs. These include:

• tumor processes affecting the pituitary gland;
• adrenal insufficiency;
• damage to the thyroid gland - tumor, trauma, radiation;
• preeclampsia is a complication of the course of the second half of pregnancy, which is characterized by the appearance of protein in the urine, an increase in arterial blood pressure, hidden and visible edema.

Other factors that increase the concentration of thyroid-stimulating hormone TSH include the following:

• lack of iodine in the body;
• excessive physical exercise;
• surgical interventions associated with the thyroid gland;
• taking certain medications - neuroleptics, antiemetics and anticonvulsants;
• mental disorders;
• surgery performed to remove the gallbladder;
• genetic predisposition.

If the acceptable TSH level in women is increased, the following symptoms are observed:

• failure menstrual cycle- scanty discharge, accompanied by painful sensations, uterine bleeding, complete absence menstruation;
• feeling of chilliness, chills;
• heart rate slows to less than 55 beats per minute;
• noticeable weight gain;
• disruption of the functioning of the digestive system, which manifests itself in delayed gastric emptying;
• swelling of the eyelids, lips, limbs;
• muscle weakness.

Note! In the case when a high level of thyrotropin is associated with pituitary adenoma, specific symptoms are observed - vision falls, regular pains in the head appear, localized in the temporal region, dark or transparent spots appear in the field of view.

If thyroid-stimulating hormone is present in a concentration exceeding 4 µIU/ml, combination therapy is indicated, which includes taking potassium iodide and thyroid hormone.

Also, if TSH is elevated, a diet is prescribed, compliance with which will restore the balance of hormones, saturate the body with substances such as manganese, selenium and cobalt - they contribute to the absorption of iodine by the body. With an overestimated rate, a properly organized nutrition system is necessary - this is a guarantee of the restoration of metabolic processes.

Factors reducing the level of TSH in a woman's body

If a woman's TSH is low, this may indicate:

• benign tumor process affecting the area of ​​the thyroid gland;
• damage to the pituitary gland, provoked by mechanical action;
• Graves' disease;
• hypothalamic-pituitary insufficiency;
• Plummer's disease.

In addition, TSH can increase due to emotional overstrain, stressful situations, and a calorie deficit.

In conditions under which the permissible value of the TSH hormone is lowered, the following manifestations are observed:

• sudden unreasonable weight loss;
• fragility of bone tissue, which manifests itself in bone pain, frequent fractures, multiple caries;
• palpitations, accompanied by an increase in arterial;
• feeling of sand in the eyes;
• fragility of nails and their slow growth;
• sweating and feeling hot;
• increased appetite;
• quick change of mood;
• frequent stool;
• attacks of weakness of individual muscles of the body and limbs.

Low TSH requires treatment. Usually, the doctor prescribes medications that contain thyroid-stimulating hormone in different doses. During therapy, it is recommended to exclude foods rich in fats and cholesterol from the diet, to increase the amount of vegetables consumed.

How to determine the level of thyrotropin hormone?

The causes and consequences of a change in the normal level of TSH is an important issue when considering this problem. Violation can lead to such complications as infertility, spontaneous abortion, fetal pathologies acquired during fetal development, premature detachment of the placenta.

To determine whether the level of TSH in women is normal, it is necessary to undergo a special test. Before this diagnostic procedure it is necessary to familiarize yourself with the rules on how to correctly take an analysis to determine the indicators of TSH and T4 free, as well as T3.

• To obtain a qualitative result, women need to donate blood in the morning, from 8 to 12, because the largest number the hormone is produced during this period;
• it is advisable to carry out the test on an empty stomach, and two days before it, refuse fatty foods;
• a few days before the procedure, it is recommended to stop drinking alcohol, as well as smoking;
• two days before the test, you should not use drugs containing steroid and thyroid hormones;
• before diagnosis, you should refrain from emotional overstrain.

A test for determining TSH and T4 free, as well as T3, will identify diseases that pose a serious threat to a woman's full life. It is important to undergo this procedure in a timely manner for pregnant women, as well as for those who have a hereditary predisposition to hormonal disorders. This rule also applies to women over 50, in whom, as the body ages, all internal processes slow down. An increased or decreased TSH hormone in women in almost all cases indicates abnormalities in the functioning of internal organs.

Knowing what thyroid-stimulating hormone is responsible for in women, it is necessary to realize the importance timely diagnosis its level, detection of pathologies and their treatment. The norm of TSH in women differs by age, which is associated with a change in the need for it throughout life. To determine whether these indicators are normal, only a specialist can use a test for t3 t4 tg normal in women.

In the general population, the prevalence of different TSH concentrations in the blood is characterized by a log-normal distribution: in 70-80% of people, the TSH level is between 0.3 and 2 mU/l, while in 97% it is less than 5.0 mU/l. With the exclusion from the general sample of individuals who are carriers of antibodies to the thyroid gland, who have goiter or have close relatives with thyroid pathology, it turns out that in 95% of the sample obtained, the level of TSH does not exceed 2.5-3 mU / l.

In this regard, in last years in the literature, the question of whether this range better reflects the population norms for the level of TSH and that it should be used to diagnose thyroid dysfunctions has been actively discussed. Here I would like to emphasize right away (and with regard to the pathology of the thyroid gland, this, alas, has to be emphasized quite often) that these data were obtained in epidemiological studies that did not imply any clinical intervention. These studies, and most notably the most resonant NHANES-III, simply described the prevalence various levels TSH in the population and found that the high normal level TSH- it is, indeed, quite often the prerogative of persons-carriers of antibodies to the thyroid gland. I would like to draw the attention of pediatricians to the fact that the NHANES-III study, the results of which are one of the main arguments for changing the standards, did not include children under 12 years of age. This, as well as, indirectly, the well-known pattern of transient AIT, which is already rare in children, makes the discussion of the problem of changing the TSH level standards in relation to children the most controversial.

If we blindly extrapolate the data of an epidemiological study to clinical practice, it turns out that the diagnosis of hypothyroidism should be established with TSH greater than 2.0-3.0 mU/l.

However, if in epidemiology, after the identification of any population pattern, the development of some socially oriented measures follows, then for the clinician, the identification of hypothyroidism means only one thing - the appointment of replacement therapy. But epidemiological studies have only studied the advantages and disadvantages of prescribing replacement therapy, taking into account the new standards for TSH levels. So is it legitimate in connection with this lowering the upper limit for the level of TSH, as a criterion for diagnosing impaired thyroid function?

This issue began to be discussed even more actively after, after a very short period of time after the publication of Hollowell J.G., et al (2002), the laboratory diagnostic manual of the National Academy of Clinical Biochemistry of the USA was published, which proposed the use of a new standard for the level of TSH. I would like to note that the main publisher of the guidelines was the association of clinical biochemists, and not endocrinologists, but it was coordinated with the European, American, British and other thyroid associations. But was it an unconditional agreement or a consensus? Considering the opinion of the president of the European Thyroid Association and a number of other European experts, it was rather a consensus. In other words, to subscribe to this really valuable guide, which is primarily addressed to laboratory doctors, does not mean to agree on everything to the smallest detail.

In Berlin in June 2004, at the Merck Symposium (The Thyroid and Cardiovascular Risk), a report was made by the President of the European Thyroid Association, Professor Wilmar Wersing, which was titled almost the same as this article: “TSH: is there a need to change the standards ? (TSH: Is there a need to redefine the normal range?). I would not like to state its content in my own words, so I am giving a full translation of the abstract of this report, which was published in the symposium proceedings.

“With the help of standards for various laboratory parameters, it is quite difficult to draw a line between the norm and pathology, and in clinical medicine between health and disease. Due to the fact that there is a log-linear relationship between the level of TSH and fT4, the level TSH is the most sensitive marker of even a small deficiency or excess of thyroid hormones. Individual differences in the level of TSH are significantly less than its interindividual variation, which determines the prevalence of various levels of TSH in the population. In other words, a TSH level of 3.5 mU/L could theoretically be normal for one but slightly elevated for another. It is extremely difficult to get out of this situation, and even more so, it is impossible to find out individual characteristics relationship of the hypothalamus-pituitary-thyroid gland system and, thus, a certain individual level of TSH. Interindividual differences in TSH levels, to some extent, can explain the fact that some patients with subclinical hypothyroidism have various disorders characteristic of thyroid hormone deficiency, while others do not.

In the large NHANES-III study, which was conducted in the United States, it was shown that in the general population of adults TSH level is 0.45-4.12 mU / l (2.5 and 97.5 percentiles). These data were obtained after the logarithmic transformation of the TSH level in the reference population. At the same time, persons with thyroid pathology, goiter, pregnant women, taking a number of drugs, estrogens, androgens, lithium, having circulating antibodies to the thyroid gland were excluded. The 97.5 percentile for TSH levels was 5.9 and 7.5 mU/L in individuals aged 70-79 years and older than 80 years. The lower limit of normal for TSH is 0.4 mU/L, and there is general consensus in this regard.

The recommendations of the US National Academy of Clinical Biochemistry suggest narrowing the standard for TSH levels to 0.4-2.5 mU/L. The argument for this again was the results of the NHANES-III study, which showed that the level of TSH between 2.5 and 5.0 mU / l is determined only in about 5% of the population. It is assumed that this may be due to the inclusion in the reference sample of some individuals with occult autoimmune thyroid disorders without circulating antibodies to the thyroid gland. Arguments that are in favor of lowering the upper limit of the normal TSH to 2.5 mU / l:

• the risk of developing hypothyroidism in the future begins to increase significantly in the population, starting with a TSH level of 2 mU/l (Wickham study);
• in individuals with TSH 2-4 mU/l, a number of changes can be detected, such as a violation of endothelium-dependent vasodilation, compared with individuals with TSH in the range of 0.4-2 mU/l;

Arguments against changing the current TSH level standard:

• lack of clear evidence that the appointment of patients with a TSH level of 2.5-4.0 thyroxine has any advantages in terms of long-term prognosis, especially in terms of reducing mortality from cardiovascular pathology;
• the inclusion of 5% of the population who do not have any diseases will lead to enormous financial costs, as well as to emotional and personal disorders in these people.

A possible solution to the problem in the future, theoretically, could be to determine the complex risk of developing various complications (osteoporosis, cardiovascular diseases, depression) for different TSH level intervals. As a result, the decision to prescribe thyroxine replacement therapy will be made not only on the basis of the TSH level, but taking into account additional factors such as gender, age, smoking, hypertension, cholesterol levels, and diabetes. A similar approach is currently being used to make treatment decisions. arterial hypertension and dyslipidemia. Until the results of studies that stratify the listed risks for various levels of TSH are obtained, I recommend using the available standards, that is, 0.4 - 4.0 mU / l. In my opinion, this essay succinctly describes the main contradictions and gives fairly clear recommendations. Nevertheless, let us dwell on some provisions that have simple clinical justifications.

First, about terminology. subclinical hypothyroidism in modern literature, they denote an isolated increase in TSH levels with normal T4, and almost all available studies, the results of which can be used as arguments for or against, come from the upper limit of the TSH level of 4-5 mU / l. An absolute synonym for the term " subclinical hypothyroidism” in English literature is the term “ minimal thyroid insufficiency". In English it sounds like "mild thyroid failure". Both in the first and in the second case, they proceed from the upper limit of the norm for the TSH level of 4-5 mU / l. We have to write about this, because recently in some articles published in domestic sources, these terms began to live an independent life and the term "mild thyroid failure" was used for cases of TSH 2-4 mU/l, which cannot be considered correct.

Further, very important point: to date, there are fairly clear data on the advisability of treating subclinical hypothyroidism (TSH more than 4 mU / l) for only one group of people - pregnant women. During pregnancy subclinical hypothyroidism carries a risk of developmental disorders nervous system at the fetus. For other groups, such data are not available, as Prof. Versinga. Yes, of course, the repeatedly discussed Rotterdam study has been published, which found an association of subclinical hypothyroidism with aortic atherosclerosis and the risk of myocardial infarction in older women, but it still does not follow at all that the appointment of replacement therapy will reduce these risks and, moreover, increase the duration life.

It is quite obvious that the association of two phenomena (subclinical hypothyroidism and atherosclerosis) does not yet imply a causal relationship between them. Many other works have been published that testify to the development of a number of pathological changes in persons with subclinical hypothyroidism and regression of these changes on the background of thyroxine replacement therapy. They are described in detail in numerous reviews and monographs on this topic. However, as Prof. Versing, there is no evidence yet about the most important thing: there are no prospective studies that would prove that the treatment of subclinical hypothyroidism will lead to an increase in life expectancy and a decrease in mortality from any disease.

But even this can not be particularly dwelled on, since almost all of the listed works operate with an upper limit of normal for TSH of 4-5 mU / l. In this regard, there is no need to talk about the upper limit of the norm of 2.5 mU / l. In other words, what kind of 2.5 mU / l can we talk about when we do not have a final answer to the question to treat or not to treat subclinical hypothyroidism, in the diagnosis of which the upper limit of the norm for TSH is 4-5 mU / l.

Another problem is the increase in the number of individuals with "abnormally high" TSH, that is, with "primary hypothyroidism." It is clear that a decrease in the upper norm of the norm will lead to an increase in the sensitivity of the test, that is, the diagnosis of hypothyroidism will be established in a larger number of individuals with this syndrome. However, it is no less obvious that an increase in the sensitivity of the test will inevitably be accompanied by a decrease in its specificity, due to which a decrease in thyroid function will be erroneously detected in a larger number of individuals than is the case when using a higher upper limit of normal TSH. In other words, a decrease in the upper limit for TSH will lead to a significant increase in the number of false positive results in the assessment of thyroid function.

A recent study by Fatourechi V. et al. (2003) demonstrates a significant, if not catastrophic, increase in the prevalence of hypothyroidism in the population, which can occur due to a decrease in the upper limit of the normal TSH. The authors analyzed all studies of thyroid function that were conducted in 2001 at the Mayo Clinic in Rochester (USA). A total of 109,618 TSH measurements were performed in 94,429 patients. After excluding patients for whom the necessary information was missing (3.5%) in a group consisting of 75882 people, an analysis was made of the prevalence of hypothyroidism, taking into account the two upper standards for the level of TSH: 3.0 mU/l and 5.0 mU/l . The obtained and rather eloquent results are presented in the table.

Tab. Influence of a change in the upper standard of the TSH level from 5 mU / l to 3 mU / l.

As follows from the data presented in the table, the prevalence of an increase in the level of TSH, that is, in fact, hypothyroidism, with a decrease in the upper standard, TSH will increase by more than 4 times: from 4.6% (quite a familiar figure) to 20%.

Let's imagine what this indicator will be if we famously lower the upper TSH rate to 2 mU / l. According to this study, TSH levels greater than 3 mU / l were determined in approximately 15% of patients under 50 years of age (every 6-7 people).

On paper, the conclusion that only 5% of people have a TSH level in the range of 2-4 mU / l looks quite impressive. What does it look like in real life? Endocrinologists, like no one else, imagine the number of diabetic patients who come to see them and the colossal efforts that work with these patients costs. In this regard, let's remember what is the approximate prevalence diabetes in the population? Just the same 5% of the population. Population Russian Federation as of July 2004, it was 144 million people. Based on this, approximately 7 million 200 thousand of our fellow citizens (not pregnant, not taking estrogens, lithium, etc.) TSH level is in the range of 2-4 honey / l. If you sum up the entire population of cities such as St. Petersburg, Yekaterinburg, Krasnoyarsk and Tomsk, you get exactly 5% of the population of Russia.

It is to such a number of people in the situation that we accept the upper norm of the TSH level of 2.0 mU / l that we will diagnose subclinical hypothyroidism. In itself, this may not be terrible, although all these 7 million people will fall into our offices. Worse, we do not know what to do with them, because with difficulty, without having a reliable evidence base, we cope with those who have a TSH level of more than 4.0 mU / l, subject to a normal T4.

But the problems don't end there either. Let's now remember the main source of the problem, about laboratory diagnostics, the progress of which led us to the realization that there are subclinical thyroid dysfunctions. Many references could be made about interlaboratory variability in determining the level of TSH, no less, about the variation in determining the level of TSH when using different methods his ratings. But the clinician, as a rule, understands from his own experience that there are very few “sinless” laboratories, or rather, they do not exist by definition. Let's add here general state"park" of equipment used for laboratory diagnostics in our country. We are not always talking about high-quality automatic machines, and the very fact of having a fully automated analyzer does not exclude the use of "handicraft" sets. The hostage of this is the patient who, on the basis of the study data, is prescribed or not prescribed hormone therapy.

Let's think further and imagine that we, contrary to common sense, decided to appoint these 7-odd millions of apparently healthy people replacement therapy. This automatically implies the cost of thyroid hormone preparations, the cost of a huge number of hormonal studies, the cost of the work of endocrinologists.

And one more thing… how many of these patients will get better, how many will we prolong their lives or make them, as they say, better? It will be worse for those who will be forced to apply for medical care, defending the queue first in the laboratory, and then, making an appointment with the endocrinologist at 5 o'clock in the morning. But it will be even worse for someone who develops osteopenia and atrial fibrillation against the background of chronic overdose of thyroid hormone preparations, which is inevitable in a certain part of patients in conditions of narrowing the target range of TSH.

What is the place of the interval for TSH in 0.4-2.5 mU / l in clinical practice? Apparently, these are pregnant women who are carriers of antibodies to the thyroid gland and who have early dates pregnancy is determined vysokonormalny TSH. Does it have a good evidence base? Apparently not entirely, since the question immediately arises of women with highly normal TSH in early pregnancy in the absence of antibodies to the thyroid gland, who do not have a goiter, and who receive iodine prophylaxis. How to be with them?

It can be argued that if a patient has already been diagnosed with hypothyroidism (manifest or subclinical, taking into account the "old" TSH standard), then the TSH interval of 0.4-2.0 mU/l should be considered as a target when assessing the adequacy of thyroxine replacement therapy. There is probably logic in this, and the very recommendations of the US National Academy of Biochemistry recommend doing just that. But is there any evidence that this is the case? Alas, they are not here yet, except for the results of population epidemiological studies.

Returning to the beginning of the article, namely to the question of the relationship between scientific research and clinical guidelines for a wide range of doctors, I would like to say that the issue under discussion is one of the most urgent problems of clinical thyroidology and is being intensively studied. All the baggage of this science, which we actively use, has been accumulated taking into account the TSH standard of 0.4-4.0 mU / l. Even a small change in this standard will entail a revision of many provisions and may become a turning point in the development of this branch of endocrinology. Nevertheless, partly restraining my research impulse, we have to admit that the problem of changing the upper standard of the TSH level is still far from evidence-based and rational implementation in healthcare practice.

Of great importance in the process of normal development of the fetus is the full functioning of the thyroid gland of the expectant mother.

It is regulated by the pituitary gland through the production of thyroid-stimulating hormone (thyrotropin, TSH). Let's figure out what role TSH (thyroid-stimulating hormone) plays during pregnancy.

Thyrotropin is a hormone synthesized by the anterior pituitary gland.

Its main function is to stimulate the production of thyroid hormones by the thyroid gland - triiodothyronine (T3) and thyroxine (T4).

This happens due to the effect of TSH on receptors located on the surface of the thyroid follicular cells.

Thyroid hormones are responsible for metabolism, thermoregulation of the body, cell growth, the work of the cardiovascular, nervous, reproductive, and digestive systems.

There is an inverse (negative) relationship between the levels of TSH and T4 in the blood: with a decrease in the concentration of T4, the synthesis of TSH increases and vice versa. So the pituitary gland controls the functioning of the thyroid gland so that the level of its hormones is within physiological limits.

Evaluation of the amount of TSH allows you to judge the correct functioning of the thyroid gland. Why is this important during pregnancy? Until the 10th week of intrauterine development endocrine system the child does not produce thyroid hormones on his own, he receives them from his mother. With their deficiency or excess, the process of laying all the organs and systems of the baby is disrupted.

The work of the thyroid gland and pituitary gland changes after conception. Chorionic gonadotropin (hCG), synthesized by the germinal membrane, stimulates an increase in the production of T3 and T4. As a result, at the beginning of pregnancy, TSH decreases. When carrying more than one child, it may tend to zero.

After the 12th week, hCG decreases, resulting in a decrease in thyroid hormone production and an increase in TSH. Its slow gradual growth is observed throughout pregnancy.

The concentration of TSH fluctuates during the day: the upper peak occurs at 2-4 am, the lower one - at 17-19 hours. If a woman does not sleep at night, then the level of thyrotropin drops.

The level of TSH is important at the stage of pregnancy planning. If there is an increase or decrease in the concentration of thyroid hormones, this negatively affects the maturation of follicles, the development corpus luteum preparing the uterus for egg implantation.

A girl may experience infertility or miscarriage.

TSH levels during pregnancy are normal

The norm of thyrotropin varies depending on the duration of pregnancy:

• 1 trimester - 0.1-0.4 mU / l;
• 2 - 0.3-2.8 mU / l;
• 3 - 0.4-3.5 honey / l.

For comparison: the permissible limits of the hormone level for non-pregnant women are 0.4-4 mU / l.

Different centers use different methods for determining the level of TSH. Therefore, the figures may differ from the above. The form with the result of the analysis indicates the boundaries of the norm, it is on them that you need to focus.

In addition to the level of TSH, it is advisable to determine the concentration of free thyroxine during the period of bearing a child. Its norm is 11.5-22 pmol / l. In pregnant women, T4, as a rule, is at the maximum limit or slightly exceeds it.

A slight deviation in the levels of TSH and T4 from the norm, as a rule, does not indicate the presence of a serious pathology. In any case, the interpretation of the results is the task of the doctor. To establish the causes of hormonal fluctuations, the use of other diagnostic methods is required - ultrasound of the thyroid gland, biopsy (if a node is detected), and so on.

The level of hormones in the body must be balanced. Both increased and reduced content of them leads to various pathologies. This topic will be devoted to the causes of low TSH.

Deviations from the norm

TSH elevated

Exceeding the upper limit of the norm of thyrotropin indicates that the thyroid gland of a pregnant woman produces an insufficient number of thyroid hormones. This condition, called hypothyroidism, can lead to miscarriage or a child with a reduced IQ. In addition, an excess of TSH, which is observed for a long time, can provoke the growth of gland tissues.

The main reasons for the increase in TSH:

• chronic autoimmune thyroiditis;
• thyroid surgery;
• radioiodine therapy;
• iodine deficiency;
• pituitary tumors;
• diseases of the adrenal glands;
• severe gestosis;
• poisoning with toxic substances;
• the use of certain medicinal substances - iodine preparations, neuroleptics, beta-blockers.

The tactics of correcting the level of TSH is determined by the reasons for its growth. Most often, iodine-containing drugs are prescribed (in mild cases) or an artificial analogue of thyroxine - levothyroxine.

Low TSH during pregnancy

As already noted, a decrease in TSH levels in the first trimester is a physiological phenomenon. But if a low concentration of the hormone is observed on late term, this may indicate excessive production of thyroid hormones - hyperthyroidism. The diagnosis is confirmed by analysis of T3 and T4.

Hyperthyroidism can lead to thyrotoxicosis - poisoning of the body. The consequences of this may be placental abruption, abortion, the formation of various defects in the fetus.

Reasons for a decrease in TSH:

• diffuse toxic goiter;
• stress, starvation, exhaustion of the body;
• toxic adenoma of the thyroid gland;
• injuries and pathologies of the pituitary gland;
• taking certain hormonal drugs.

With thyrotoxicosis, thyreostatics are prescribed - substances that suppress the hyperfunction of the thyroid gland. The main drugs are methimazole and propylthiouracil. In severe cases, part of the gland is removed.

A significant deviation in the level of thyrotropin from the norm during pregnancy is an alarming sign that can be caused by various pathologies. Their treatment must be supervised by a doctor.

Signs of deviation from the norm

Clinical manifestations of an increase or decrease in the level of thyrotropin depend on the functional status of the thyroid gland. With slight fluctuations, they can be hardly noticeable.

Signs of hypothyroidism:

• fatigue, weakness;
• depressed mood;
• insomnia or too much sleep;
• loss of appetite, which is accompanied by excessive weight gain;
• pallor;
• chills;
• decreased memory and concentration;
• constipation.

Symptoms of hyperthyroidism:

• tachycardia, hypertension;
• nervousness;
• sensation of heat;
• diarrhea;
• weight loss with increased appetite;
• trembling in limbs.

Many of the symptoms described can be observed in a normal pregnancy. Do not neglect the planned examination by the endocrinologist and the delivery of an analysis for the level of TSH.

TSH analysis during pregnancy

1. For 3 days, stress factors, heavy physical exertion should be excluded, as well as not overheating or overcooling. In addition, smoking and alcohol are prohibited.
2. For 5-7 days, in agreement with the attending physician, it is necessary to stop taking hormones and iodine preparations, including vitamin complexes that contain it.

Blood sampling from a vein to calculate the level of TSH is carried out in the morning (before 11:00) on an empty stomach: you can not eat for 12 hours, you are allowed to drink water. It is important to sleep well.

If monitoring of the dynamics of thyrotropin levels is required, it is advisable to take tests at the same time in the same laboratory.

Thyroid-stimulating hormone analysis - effective method evaluation of thyroid function. After conception, it is of particular importance, since thyroxine and triiodothyronine affect the formation of the central nervous system of the unborn child. Deviations from the norm according to the result of the study cannot be a reason for terminating the pregnancy. Modern methods Treatments allow you to completely neutralize the hormonal imbalance and ensure the full development of the baby.

The hormones TSH and T4 regulate the functioning of the thyroid gland. concentrations in the blood in men, women and children, we will consider in more detail. As well as short information about what facts can affect the functioning of the thyroid gland.

Symptoms and treatment of nodular goiter of the thyroid gland will be considered in the rubric.

Related video

Maintaining normal levels of thyroid-stimulating hormone is important for health, since it regulates the functioning of the thyroid gland. The coherence of the work of other body systems depends on the functioning of this tiny organ. The concentration of TSH in the blood fluctuates not only as you grow older, but throughout the day, and deviations from the norm up or down indicate the presence serious illnesses. So, what should be the level of the hormone TSH and when should you take tests?

Daily and age norms

During the day, there are significant fluctuations in the hormone TSH, and the norm in this case is from 0.5 to 5 mU / ml. Greatest value TSH concentration reaches from midnight to 4 am. Minimum indicators observed in the daytime after 12 noon.

Important! Despite the rather large difference between the lower and upper limits of the norm, the amount of hormones T3 and T4 remains at the same level.

The norm depends not only on the time of day, but also on age. The highest rates fall on infants up to 1 month of age, ranging from 1.1 to 11 mU / l. Then, gradually, the concentration of TSH becomes lower, and after 14 years and in adult women, the lower and upper limits are 0.4 and 4 mU/l, respectively.

Norms for women

Why do you need to take an analysis?

Since TSH regulates the functioning of the thyroid gland, its concentration can be used to judge the work of this organ. If there are symptoms of endocrine disorders, the specialist will refer the patient for examination. In what cases is an analysis for the level of TSH given:

• prolonged depression;
• fatigue and indifference to the outside world;
• excessive emotionality, irritability;
• hair loss;
• decreased libido;
• inability to conceive (provided that both partners are healthy);
• enlarged thyroid gland;
• delayed physical and mental development in childhood.

All of these symptoms are associated with hormonal disorders, but sometimes TSH is sent for analysis in the following cases:

• to prevent intrauterine growth retardation;
• to assess the risk of congenital diseases;
• for the diagnosis of physical and mental development;
• to monitor the effectiveness of treatment;
• at hormone therapy to monitor changes in the body;
• as a prophylaxis in order to prevent chronic pathologies of the thyroid gland.

Decreased TSH

If a woman does not have any diseases associated with the hormonal system, regular preventive examinations can be carried out twice a year.

The accuracy of the blood test allows you to make the correct diagnosis and start the necessary treatment. In order for the results of the study to be as accurate as possible, you should carefully prepare for the procedure:

1. Two days before the analysis, you can not smoke and drink alcohol.
2. Tests must be taken before noon, because after this time the level of TSH in the blood is at a minimum, which can lead to false results.
3. Blood should be taken on an empty stomach, but if for some reason this is not possible (pregnancy or some diseases with a strict diet), this item can be skipped.
4. A few days before donating blood, you need to reduce physical activity.
5. Thanks to modern technologies the results of the analyzes are obtained as accurate and detailed as possible. A transcript with indicators of the norm and deviations from it is applied to the result obtained. This allows faster and more accurate diagnosis.

When the level is raised

Exceeding the upper limit of the TSH norm is often associated with a malfunction of the pituitary gland responsible for the production of this hormone. But there may be other reasons:

• dysfunction of the adrenal glands;
• inflammation or swelling of the thyroid gland, pituitary gland;
• complications during pregnancy;
• mental illness;
• improper distribution of physical activity;
• lack of iodine;
• genetics.

Here are the main symptoms that indicate an excessive concentration of TSH in the blood:

• severe sweating;
• weight gain;
• insomnia;
• body temperature can drop to 35;
• tiredness and fatigue;
• thickening of the neck.

Decryption

To bring the level of TSH back to normal, treatment is prescribed using drugs based on thyroxine (Euterox, Thyreotom, etc.). The dosage of the drug is prescribed only by the attending physician; in no case can you take them yourself without a prescription - this can only aggravate the problem.

Important! If a drug treatment did not work, surgical methods can be used.

AT traditional medicine there are also drugs that help lower TSH levels. Usually this herbal decoctions chamomile and rosehip. However, the application medicinal herbs for treatment, it is imperative to agree with the doctor and first find out if there is an allergy to any of the components.

If the level is too low

If TSH is significantly lower than normal, most often this indicates problems with the thyroid gland, in particular in the presence of benign and malignant tumors. Other possible diseases:

• meningitis;
• encephalitis;
• Plummer's disease;
• Graves' disease, etc.

Often a woman with low TSH may complain of:

• severe headaches;
• constant feeling of hunger;
• weakness;
• sleep disorders;
• tachycardia;
• trembling in the limbs;
• swelling, especially on the face;
• menstrual irregularities;
• high BP.

If at least a few of these symptoms appear, you should definitely consult a doctor and check the blood for TSH.

Miscellaneous indicators

With a low level of the hormone, the emphasis in treatment is on the disease that provoked the hormonal disorder. Medical therapy appointed only after passing all the necessary studies. TSH can also be increased by folk remedies by eating red and black mountain ash, sea kale, etc.

TSH concentration in pregnant women

The norm of thyroid-stimulating hormone is constantly changing with each trimester, while small deviations are not a reason for a visit to a specialist. So, TSH is always lower during pregnancy with two, three or more children. But if the concentration of the hormone sharply and greatly increased in the first weeks of pregnancy, you should consult a doctor.

In different trimesters, the concentration of TSH is different, here are the limits of the norm for each period (mU / l):

• the first - from 0.1 to 0.4;
• the second - from 0.2 to 2.8;
• the third - from 0.4 to 3.5.

The lowest concentration of TSH occurs in the first weeks of pregnancy. This is due to an increase in the amount of immanent hormones produced by the thyroid gland. Further, until childbirth, the level of thyroid-stimulating hormone will gradually increase, this is important for the normal development of the fetus. Increased rates TSH can be caused by severe toxicosis in the late period.

Treatment

With increased or reduced content TSH treatment is prescribed only by a doctor, and for each patient it is strictly individual. To make a diagnosis, in addition to a blood test, an ultrasound examination of the thyroid gland is necessary to identify the presence of pathology.

The course of treatment with medications is long from six months to many years throughout life. The complexity of the treatment is complemented by the fact that it is important to select the necessary doses with filigree accuracy. Even a small mistake in the dosage of the drug can lead to serious consequences.

In no case should you self-medicate and self-diagnose.

The same applies to folk remedies- many mistakenly believe that there will be nothing terrible from "herbs", but this is not so. Lots of herbs active substances, which, instead of the expected benefits, may well be harmful if the dosage is incorrect or the storage methods are incorrect.

So, it is necessary to monitor the norm of TSH. It is best to consult a doctor not when the first symptoms of abnormalities appear, but to undergo regular examinations on a voluntary basis. Disease prevention is much better than long, complicated and often expensive treatment.