Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
new range for TSH
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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new range for TSH

Why has the medical community been so slow to recognize and adopt the new range recommended for TSH?  From .5 - 5.0 the new range is .3 - 3.0.  This means there are millions of people with hypothyroidism symptoms that are not being treated.  This is very puzzling to me.
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0.3-3.0 is a suggested range by some experts but there is not good evidence that treating everyone with a TSH above 3 is necessary or beneficial.  We need to individualize these decisions in patients with TSH levels in the 3-10 range based on symptoms, patient preference, goiter/nodule, antibodies, pregnancy, etc.  Also it is important to retest TSH at least 6 weeks after the first abnormal reading to make sure it is not transiently high -- which is often the case.

The 0.3-3.0 range is not part of the ATA or AACE guidelines for deciding when to start someone on medication -- the debate in those guidelines is whether or not to treat subclinical hypothyroidism at all (ie, TSH above the reference range used but below 10) and suggests, as I have above, that the decision be individualized.

The 0.5-2.5 TSH goal applies to target range in routine hypothyroid treatment for patients already on levothyroxine.

This is not a straight-forward, one-size-fits-all situation -- just like most of medicine which is an applied science and not an exact science.
6 Comments
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Avatar_f_tn
Since last year my numbers have been running higher then the “ 0.3-3.0 is a suggested range”.
And after getting second, third, forth option about my numbers my new physician had started me on a low dose of Levothyroxine.

Can you tell me some of the common side effects of Levothyroxine? I hate to bother my doctor every time I notice any changes. What are the normal side effects some people are feeling or seeing?

Can you state what you have the "most and rare" complaints reported to you?

Thank you in advance.
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Avatar_m_tn
I noted from a 2003 press release from the ATA --- "Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range5 . Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now."   This sounds like patients with TSH above the 3.04 limit should definitely be considered for treatment, especially if they have symptoms of hypothyroidism, rather than treatment being the exception.  Instead, it has been the experience of myself and numerous friends that the labs are still using the old range on lab reports, and doctors are routinely deciding that patients are "in the normal range" and paying no  attention to symptoms and  declining to provide treatment.  It has also been my experience that testing myself for basal body temperature has been a better indicator of whether I need more thyroid to relieve my symptoms.  Just getting the TSH into the high end of the range didn't do it for me.
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97953_tn?1193367871
Once again the guidelines suggest that 0.3-3.0 be considered a normal reference range but clearly state that not all TSH >3 need treatment -- it must be individualized.  I think we are saying the same thing.....
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Avatar_m_tn
I agree that not all patients over 3.0 TSH must be treated, and that there are other considerations.  By the same token, I think that all patients should at least be evaluated against the .3 -3.0 range, as a first step This is not even happening as it should.  Of course I can only speak from the experience of myself and a number of friends, but  believe me, the labs haven't even adopted the new range, and Gen. Practice  doctors seem to rely on the labs' ranges.  My Dr.  has been helping me, but has no room for further patients, so to help my friends I have had to resort to calling other Doctors' offices and quizzing their staff as to whether they use the new range, do they also rely on patients' symptoms, and do they recognize basal body temp. as a good diagnostic.  So far, I have found one out of 12 that did.  I think you can confirm my feeling about this by noting patients comments on this subject and also on the thyroid forum site.  I'm sure that your patients are happy with your efforts, but I'd bet my last dollar that the majority are not happy with their doctors.  Most of the reason for taking up so much of your time here is to try to get people to realize help is out there somewhere, but they are going to have to take more control over their treatment by understanding symptoms, test ranges, asking for copies of lab tests, checking their basal temperature, etc., and make things happen, or they may get no relief for their suffering.  Thanks for your time and your concern.  
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Avatar_m_tn
As an exmple of the poor efforts  by an endo, please note the following from the thyroid forum, written by skeeter42.

I've been waiting for 3 months to get into this new endo....what a waste.  he didn't want to listen to a thing I said or the things that I have learned on here.  He doesn't believe that your TSH has to be suppressed to 1.0 or so.  He thinks that if my levels are in normal range than there is no need to change anything even though I still feel bad.  He didn't even test my T3 or T4.  I asked him to do the Free T3 and T4 and he said it didn't matter.  He did test my calcium and my TSH and my TSH only.  This time it was 3.18 on the range of 0.35 - 5.50.  That was with my medicine.  My last level was 2.68 I believe and it was fasting.  so I have no idea where to turn.  I'm still so very tired and my legs are weak and hurt all the time.  What is everyone else's opinion.  I don't understand why he didn't do the other tests and why he wouldn't run the tests I asked for.  Does anyone else have these symptoms with a TSH within the normal limits.  Please help.....
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