Guest Author - James Lowrance
Over the past few weeks, I have been receiving a number of e-mails from thyroid patients responding to articles I have written on the subject of "TSH testing". They are complaining of not feeling well, in spite of being on thyroid medication and have included their most recent, follow-up lab results in their e-mails to me. In almost every one of these, their TSH levels are in the “normal” range for diagnosing hypothyroidism but they are not in the normal range for treating hypothyroidism and incredibly, they are stating in these e-mails that their Doctors are saying that there is no difference between the two! Well, there most definitely is a difference between the two and we only need to look at reliable resources to know this and hopefully more Doctors will be updated in regard to these facts.
The “diagnostic” TSH levels, as revised by the AACE (American Association of Endocrinologists), in 2002, is roughly 0.3 to 3.0. The “treatment” TSH level they recommend, is 1.0 to 2.0 for titrating (adjusting thyroid medication levels) however, many patients feel better, at the 1.0 and even down to the lowest TSH normal level of just above 0.3. Some patients even need a TSH that is slightly below the normal treatment level, due to slightly sluggish pituitary function that causes a TSH level that doesn’t accurately represent the actual thyroid hormone levels but these cases require close monitoring by their Doctors. For the general population of hypothyroid patients, the treatment range of 1.0 to 2.0, is the standard.
Unfortunately, if a Doctor uses the diagnostic TSH range, a patient may be receiving inadequate treatment because this would mean that he or she would recognize even the highest-normal TSH, as being sufficient treatment, when it is not. For example, if a patient is treated on thyroid hormone replacement medication and their dose only suppresses their TSH down to 3.0, the Doctor who is not using the treatment TSH, will recognize this level as being sufficient and the patient may continue to experience hypothyroid symptoms. This scenario is even worse, when the lab a Doctor is using, is still using the old “diagnostic” TSH level of 0.5 to 5.0, that was revised by the AACE, in 2002, to help diagnose developing hypothyroidism, being the current; 0.3 to 3.0.
During my first two years of treatment for hypothyroidism, my first Doctor kept my TSH between 3.01 and 4.95 and stated that even that higher level was “perfect”. Well, it was not only inadequate thyroid dosing, but I was virtually spinning-my-wheels and getting nowhere with reducing my symptoms. Once finding a more well informed Doctor, who put me on combo T-4/T-3 and dosed me, to reduce my TSH level to between 0.5 and 1.0, I felt better than I had in three years!
This Endocrinologist, who treats me now, agrees with many other Endos that will treat patients, getting their TSH levels down to lowest normal. A Thyroid Forum I used to post on a lot, that has a Board Certified Endocrinologist who answers questions on it, repeatedly confirmed that his patients felt better with a TSH around1.0 and that many of them he would replace with doses that would get their TSH to between 0.5 and 1.0.
The point I am making with this short article, is the fact that the TSH that is used to diagnose thyroid disease, should not be the range used for treating hypothyroidism and both patients and Doctors should be aware of this.
