TSH: One size does NOT fit all
Posted on: June 10, 2006 | Posted in: Medical Information
As I’ve mentioned here before, in 2003 the American Association of Clinical Endocrinologists recommended that the “normal” range of TSH be changed from 0.5–5.0 to 0.3–3.04. However, for those of you who still feel crummy anywhere above 2.0, there’s still hope to convince your doctor: Way back in 2002, the National Academy of Clinical Biochemistry suggested the ceiling for “normal” TSH be lowered to 2.5, “because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L.”
So, my repeated comments here that folks without thyroid problems generally have a TSH around or below 1 is somewhat incorrect. There is a wider range of truly “normal” TSH values than I had heard, but a narrower range of normal TSH than most doctors use when evaluating their patients’ test results. In fact, the NACB stated that, “A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism.”
So, while I was feeling pretty good on levothyroxine with a TSH of ~.8, it may well be that I’ll end up feeling even better on Armour with a TSH of 1.5, while YOU might feel just peachy on levo when your TSH is at 2.0.
Once again, the conclusion seems to be: Don’t let your doctor tell you that you’re on the right amount or type of medication just because your “numbers are in normal range.” Even within the narrowest “normal” target TSH range, different individuals will feel better at different levels. It’s a trial and error process to find the right medication for you, so if you don’t feel better keep trying!
You can download the NACB guidelines here: http://www.nacb.org/lmpg/thyroid_LMPG_PDF.stm (in PDF format)
You can download the AACE guidelines here: http://www.aace.com/newsroom/press/2003/index.php?r=20030118 (html format)
If your doctor insists on telling you that a TSH reading of something like 4 is “normal” and refuses to adjust your medication, print out those two articles, highlight the sections referencing the not-so-new new guidelines, and bring it in to his/her office!
technorati tags: thyroid, hypothyroid, health, medical, mivox