new here...I'm having TRH test done M

iVillage Member
Registered: 06-24-2003
new here...I'm having TRH test done M
7
Tue, 07-27-2004 - 4:14pm
on Friday morning...my first visit to the endo was a few weeks ago...after reviewing results of 2 previous TSH tests done by other drs (one my OB in Feb, one in March by my reg. dr) the endo said that the TSH was "high normal" and she would check for hormonal imbalance. One was .7 the other .366, if I remember correctly. Anyway, she told me at that visit to schedule blood work after my next period began. When I called yesterday I was told that it should be done on any day between days 5-8 (Friday will be day 6 for me). Could someone please explain the reason behind the timing of the test? What exactly is she looking for?

I read online last night that TRH stands for Thyrotropin-releasing Hormone and that blood will be drawn at 15, 30, & 45 minute intervals, which makes sense since the receptionist told me the test would last about an hour.

I had a 3rd baby 7 months ago and have been suffering from lots of things ever since...finally self-referred myself to the endo. Both my OB and the reg. dr said my TSH results were normal. The endo said that even though so many of the issues I'm having are "baby-related" they should have disappeared or lessened by now. They include heavy hair loss, depression, irritability, and heavy flooding periods. I am very emotional. Maybe it is all about the "female" hormones but if it is, wouldn't that be thyroid related anyway? Back in Feb, when I shared my troubles with my OB, he said that what I shared didn't sound hormonal to him, although he didn't say what it WAS! I saw a therapist (my marriage was suffering!) who told me it sure sounded like hormones were the culprit to her. My reg. dr. tested my thyroid at my request (w/out my having to supply all my "symptoms"). The endo asked me about any miscarriages (I've had 2) and I mentioned that my OB did a TSH test afterward at the same time as genetic testing, etc but I don't know the results of that one, he told me the TSH was normal. She also asked about skin changes (it's become dry all over, my face is flaky but still really oily) and headaches (they are occassional).

It's just ALL so confusing and I would surely appreciate any thoughts/experiences that anyone could share. thanks very much, Cathy

iVillage Member
Registered: 11-09-2001
Tue, 07-27-2004 - 6:45pm
Hi Cathy - Well, your doctor is following the precribed course of testing your thyroid when your tsh level is in the high normal range but it sure is unusual!! I don't think anyone posting here has ever mentioned having this test done. But it probably makes a lot of sense to diagnose hypothyroidism when you get that result.

TRH is produced by the hypothalmus gland in an attempt to get the pituitary gland to produce more thyroid stimulating hormone (TSH), which causes the thyroid to make more of it's own hormone, thyroxine. TRH is the chemical that allows the brain to interact with the pituitary, monitoring your thyroid hormone levels among other things. The test is done as you described, TRH is injected into a vein and TSH is checked every 15 minutes for one hour. This comes right from The Thyroid Solution, by Dr. Arem: "An exxagerated increase in TSH response to TRH usually indicates low grade hypothyroidism even though the basal TSH level is normal." He also says, "In about half of the patients who are both depressed and hypothyroid, the hypothyroidism is detected by TRH testing." So you can see there's a interesting connection between your post partum feelings and your thyroid tests.

I don't know why it has to be done on a certain day of your cycle but that's also interesting - it must make a difference somehow. Preganany and childbrith is often a trigger for thyroid conditions. DOes nyone in your family have hypo or hyperthyroidism? Miscarriages due to thyroid conditions are also, sadly, very common. It may be possible that you have had an underlying thyroid condition for quite a while but didn't know it.

I'm really curious what your TSH readings were on your tests? Do you know? If not, can you call and get them? Otherwise, it sounds like your doctor is handling your situation well. I hope this helps you to feel better about what you're going through. I know it can be very difficult when you're feeling emotionally low and doctors don't explain what's going on. If you have any other questions, please ask! Cathy :)

iVillage Member
Registered: 06-24-2003
Wed, 07-28-2004 - 9:16am
hi Cathy, thank you very much for responding!

In Feb. the TSH was .710 and in March it was .366. I don't know what the level was when I had the battery of tests after my m/cs, though. These were done by 2 different drs. Is it 'normal' that these numbers were so different from one month to the next? I forgot to ask the endo when I was there but will on Friday.

I surely hope this dr. can help. thanks very much, Cathy, for your help. :-) Cathy

iVillage Member
Registered: 11-09-2001
Wed, 07-28-2004 - 9:31am
Hi - yes, it's normal for thyroid levels to fluctuate but what is puzzling to me is that your TSH levels seem to indicate that you are hyperthyroid not hypo. A hypo TSH level on the upper range of normal would be more like 6.7, 7.2, 5.9, 8.0. See the difference? .710 and .366 or below a 1.0 which is the lower limit for a normal thyroid and therefore your numbers are closer to hyper, an overactive thyroid. Did you have very high numbers on your T3 and T4 tests? That would also indicate that you are producing more thyroid hormone than your body can use - another sign that you are hyperthyroid.

A second book that I've just checked on the TRH test, Living Well With Hypothyroidism, by Mary Shomon, says , "In an article in Alternative Medicine magazine, Dr. Rafael Kellman called the TRH stimulation test the 'gold standard for accurately detecting an underactive thyroid." In a TRH test, TSH is measures prior to the injection of TRH. About a half hour after the injection, TSH is measured again. The TRH injection should have stimulated the pituitary gland to secrete TSH. If the pituitary gland does not secrete TSH at all and TSH doesn't elevate, then a pituitary abnormality may be investigated, or this may indicative of hyperthyroidism. If the second TSH level is high, the test may point to hypothyroidism."

So I don't mean to confuse you but it sounds from your TSH numbers that perhaps the doctor is testing for hyperthyroidism. Is it possible that you misunderstood her? I know that's probably a stupid question! I'm sorry for asking, it's just that the numbers don't match ........ unless I'm misunderstanding the numbers!! But I don't think I am. What do you think? Cathy

iVillage Member
Registered: 08-20-2003
Wed, 07-28-2004 - 12:15pm

Hi--my story is very similar to yours.


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Registered: 06-24-2003
Wed, 07-28-2004 - 2:07pm
arg, now I am confused, too...I don't recall having a test for T3 and T4 unless they were included in the TSH test? I think not, though, b/c on my lab report only TSH is listed. Is that part of the "thyroid panel" that I have read about?

It is possible that I misunderstood what the dr. said, although I'm almost certain that she said "it looks like your thyroid level is high-normal", but if I understand what you shared correctly then my numbers would be low-normal or low?

to further confuse things, here is a link to one of the few online articles I found when I did a search for TRH the other night:

http://www.allonhealth.com/hypothyroidism-test.htm

which actually contradicted other things that I read. I will call the dr's office today b/c now I'm really confused. I mean, the reason I went to the endo was to get this all cleared up and find out what is wrong with me when my body tells me one thing and the 2 drs previously have told me "you're ok", and having read that the range of what most drs. think is 'normal' has changed. anyway, I'll call her and definitely keep you posted on anything I find out about that or the results from Friday.

Thanks so much! :-) Cathy

iVillage Member
Registered: 11-09-2001
Wed, 07-28-2004 - 5:18pm
Hi Cathy - I just typed a long response and deleted it by accident!! GRRRRRRR! I looked at the site you posted and it's the kind of site where they are trying to sell you something - along with their "philosophy" of what's going on with your thyroid, they have to break down what's normally done so they can position themselves as better!! There's an element to this condition, and I guess it's probably true of many other things, that can be kind of "radical" in their approach and this sounds like that to me. For myself, i try to take what's best in their approach - that stress, diet, exericse and vitamins play a critical part in how we feel - and leave the rest. LOL! That's just me. i also think it's very important to know everything you can about thyroid conditions, to have resources available to answer questions, and to participate in your own care and treatment. You can't just trust your doctor on this stuff. It makes all the difference to your health for you to know what's going on.

I think what happens is that doctors tend to be so ignorant about this condition overall that they leave themselves open to this kind of thing - an ongoing criticism, really, of their methods and treatment. Because you see how hard it can be to try to figure out what's going on with your health!

That said - I think you're right to call and find out what's going on. Yes, a thyroid panel includes all the different types of blood tests. If you just have the TSH results, that's good enough because I would hate to think I'm confusing you!! So let me know as soon as you find out, ok? Cathy

iVillage Member
Registered: 11-09-2001
Wed, 07-28-2004 - 5:25pm
i just had another thought as I was posting that to you. If you're doctor said, it looks like your thyroid is high-normal, what she may have meant is that it looks like you are producing a lot of thyroid hormone, which would give you a LOW tsh reading.

When you are not producing enough thyroid hormone, your pituitary has to kick in with thyroid stimulating hormone - that's what TSH stands for. The higher the number on your TSH test, the LESS your thyroid is functioning, because it's showing that the pituitary is having to work overtime trying to get your thyroid to make enough hormone. (It goes agains what you would think.)

The lower the number on your TSH test, the more hormone your thyroid is producing on it's own and there's no need for the pituitary at all!! So high normal thyroid level could mean that your thyroid is producing enough hormone on it's own, and perhaps just little too much to be just under the normal bottom limit of 1.0, which is what you are if your numbers are correct! Phew! I hope I didn't confuse you more here but I think that may be the answer. Or else, I'm going to be really embarrassed and have to slink off the board for a day or so. LOL! Cathy :)