Do I have a thyroid problem?

[Rachel R]

I had a partial thyroidectomy 3 years ago to remove a tumor (benign.) Also, I have been having problems with memory and fatigue. My Primary Care Physician tested my TSH, and it was 4.88. According to the lab report the normal range is 0.40-5.50, but when I looked on the American Thyroid Association and the American Association of Endocrinologists, there were a lot of articles that said that might be a slightly high TSH level.  Should I see an endicrinologist?

[Mark Lupo, M.D.]

Repeat TSH in 2 months -- if still above 4 then you have borderline hypo and in the presence of antibodies (and your symptoms) a trial of meds may be necessary.

[cindy27]

There is much controversy over the TSH range although I think that most endocronologists aim for TSH of .5 to 1.5 or 2.0.

In 2002, The American Association of Clinical Endocronologists issued a Position Statement on "Subclinical Hypothyroidism" which recommended an upper limit of 4.5.

In 2003, the AACE guidelines were narrowed to .3 to 3.0.

Unfortunately, most laboratories continue to state the "normal TSH range" of .5 to 5.5.

Compounding the problem is the prevelance of primary care physicians who simply glance at the "Flag" column printed on lab results and if they don't see "H" (high) or "L" (low), disregard the findings, thereby missing potential cases of hyper- or hypo- thyroidism. (A recent survey indicates that physicians, on average, have less than 8 minutes to spend with each patient.  This can translate to reduced diligence).

Good luck.

[edra]

A TSH of 4.88 is really too high.  Most state-of-the-art docs want to see a TSH of about 1-2. I know that the AACE upper guideline of 3.0 is too high for me.  E.G. after I'd already had a major depression and panic attack due to thyroid, my TSH was at 3.5.

Since you're clearly too high on TSH, your doc should order FT3 and FT4 tests.  TSH may be OK for diagnosis, but looking at FT3 and FT4  is a good idea for treatment.

I found that I couldn't get good thyroid treatment by going to an endo; it seems like most of them specialize in diabetes these days.  I go to a Physician's Assistant for my treatment; he's more state-of-the-art than the endos I tried.

If your doc puts you on T4 and your memory doesn't get better, try adding a tiny bit of T3 (Cytomel) as Arem details in his book "Thyroid Solution".

[GravesLady]

Your symptoms might be due to your TSH being too high for you. The Lab range is so wide there is a lot of room for adjustments. We all will not feel the same at the same level, in other words, one shoe does not fit all.

If your doctor is willing to work with you, to .listen to you and hears you, then he should beable to handle minor thyroid issues such as level changes, etc. but any further/deeper thyroid issues an endo might be best. But if you would feel more comfortable working with an endo. then by all means that is the doctor to see.

I have read where Hypo/Hashi feel best between TSH 1-2 with some feeling even better at the high end, while Hyper/Graves's feel best with TSH at the low end.  It really depends on the persons system and there is a wide range to work with, so don't settle if you are still feeling a little off.