Confused about test results

[Anny526]

Hi, I recently had my TSH level checked and was told it was normal at 4.95. I had seen the reports about the range being changed in 2003 so I called my dr. to ask about it. They told me that every lab has a different chemical(or something) that it uses to test so they all have their own ranges and Labcorp uses a range of .5-5.5 so mine is within that range. Now I see others on this forum have used Labcorp with similar results and been told that that is using the out of date range... so does anyone know for sure if Labcorp is using the old range or if that is the correct one for however they test? I am going back tommorow to get the T3 and T4 tests also since they did not run those. Thanks!
Anny

[Anny526]

Thanks for the kind words! I saw my dr. this am and she ordered a "full thyroid panel". I specifically asked for the free T3 & T4 tests since someone mentioned that- and good thing I asked because they said the T3 was the free test but the T4 was not so they added that. Would a "full panel" include the antibody test?
   My dr. was definitely aware of the chages happening in the range # recommendations(she said it was similar to what she's seen happen with blood pressure and diabetes numbers over the years) and she was very receptive to the idea that for me personally I may need meds to get my tsh lowered. We are going to get the test results and I'm seeing another dr. for a condition that may be causing some of my symptoms and then we will make a plan for treatment. All in all I feel good about her response and hopeful that we can get this all under control.
    Thanks again everyone and any additional comments or info are welcome!
Anny

[Letterer]

The TSH the brain's interpretation of thyroid finction, it's a hormone regulated by the pituitary. The FT4 and FT3 are hormones produced by the thyroid itself. The pituitary will signal for more TSH if FT's are suboptimal, or for less TSH if they're running too high. It's important to look at all three and their relationship to each other, plus antibodies if any, to get a more complete picture of function. Antibodies can really mess with this relationship since they attack the thyroid and can cause dysfunction.

Get your FTs and antibodies (TPO & TG ) run. A shared opinion among many on this forum as well as a couple others I frequent is that FTs should be in the 50-80% range of the lab reference values, and a TSH around 1 is where alot of people say they feel healthier.

There's a lot of controversy about when to treat thyroid dysfunction, so learn as much as you can about it so you can work with your doctor.

For me personally, I had to go through a couple different docs who looked only at the TSH and dismissed the rest. I then met an endo who looked at everything ("normal" TSH of 2.48, but T4 & T3 at about 20%, TG antibodies < 2000, symptoms and a family history). We're trying low doses of Levoxyl to boost my FTs. We're also testing adrenals to look for adrenal fatigue.

Get your labs run, always get copies of the lab results for yourself. Post them when you've got them (include the ranges), there are a lot of caring people on this and the other forums who will respond. I hope you start to feel better soon!

[DLA]

Yes, it is an old reference range and yes, all the tests are run the same so it doesn't matter where it is.  

As you can see there is a lot of hostile debate over this, but the general believe and experience of thyroid patients is that the higher the number the more damage it is doing to your body.   Even the AACE agrees with this.

Most people on here feel better between 0.5-2.0.  Would make sure I get treatment if I were you to bring it down so it doesn't do the damage it can.

Dac

[GravesLady]

I can't post the whole internet!

I give references, so others can Google and read for themselves. After all I did,  I am sure others are just as capable.

Working in a Lab doesn't constitute being a medical doctor or medical scientist nor does having a thyroid disease .  Not to mention that there are more than just one or a few, at this forum who have thyroid disease as well!  True disease!

The issue is between personal wants and beliefs verses medicals and scientific trails. I am personally in anticipation as well as eager for the above medicals/thyroid associations, etc., to concede to the so called  
(however non-scientific or medical)  TSH level 0.3 to 3.0.  AACE was shot out of the saddle on that one by their own personal medical panel.

I agree on an individual's TSH set point, to which set points are not all the same.  That is why the TSH diagnose level is so wide i.e. TSH 10.  Then there are variables, one in which an abnormal TSH can eventually become normal again without treatment intervention.

However, the purpose to treat is to treat those who are either already overt or more likely to progress to overt thyroid i.e., TSH over 10.  Once diagnosed properly with true hypothyroidism, treatment will not stop the progression of overt thyroid. Hence the treated target TSH level 0.3 to 3.0, in which popular medical theory states is too low, in hopes to prevent one going into overt levels of hypothyroidism.
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al.,
2003))".

"Data supporting associations of subclinical thyroid disease with symptoms or adverse clinical outcomes or benefits of treatment are few. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L) are minimal and we recommend against routine treatment of patients with TSH levels in these ranges"JAMA. 2004
Dr. Hossein Gharib, an endocrinologist at the Mayo Clinic and a director of the American Association of Clinical Endocrinologists "concedes that there is no rigorous scientific evidence to support treating patients with subclinical hypothyroidism. But, he said, "What I've found in my personal practice is that it alleviates symptoms even if it's just placebo effect." (placebo Per: The Merriam-Webster Dictionary - "I shall please: an inert medication used for its psychological effects.....  and,  Taber's Cyclopedic Medical Dictionary: I shall please: Inactive substance given to satisfy patient's demand for medicine,......".


As far as symptoms,  I personally feel a good doctor would test all symptoms and rule out possible other health conditions before declaring thyroid. There are a lot of health conditions that share thyroid symptoms.
Therefore, before a diagnosis of hypothyroidism can be made, other causes must be ruled out.
"I see patients all the time who are miserable and unhappy and want to blame something," Dr. Cooper said. "There are tears and anger when you tell them that it's not their thyroid that's causing their problems."

Well, that's my best shot for now, its getting late. I'll leave the rest to the more educated and knoweldgeable, who can put issues into better words and meanings.

I know you all love me, well, some of you, I hope ;)

GL

[chigirl29]

Go to an endo.  Also--I had postpartum thryoiditis first--and then it lead to Grave's.  I did research and found that I have an autoimmune thyroid condition.
PP thyroiditis is the immune system attacking.

Have your antibody levels checked and then run more thyroid tests.

[Anny526]

Thanks for the responses. I can't say this doesn't confuse me even more though. My history is that I do have a family history, I myself had postpartum thyroiditis after at least 2 of my 3 pregnancies where I went from hyper to hypo and then it regulated itself-never took meds because I never got diagnosed until it was almost back to normal. My last pregnancy was 6 1/2 yrs ago and I am fairly certain I've had some hypothyroidism going on since then with major hairloss, fatigue and weight gain to name a few symptoms. But it seems to come and go- is that even possible? Oh and I also have Reynaud's syndrome and my blood tests showed my triglycerides very high and all other cholesteral levels were borderline. I seem to have a lot of the indicators of hypothyroidism but so many of the symptoms can be caused by other things as well. I'm wondering if it might be better to just ask for a referal to an endocrinologist?

[chigirl29]

I understand and agree about each patient having their own set-point.  I provided the article because it is a controversial but relevant and coherent argument that she may want to know about.  I think I need to start putting disclaimers on things--articles may not represent my sentiments.

Sorry for misunderstanding--I am getting tired too.  Drowsy medicine setting in.

[chigirl29]

After all, few endocrine disease states appear suddenly in an "on or off" or "black or white" manner. Rather, the disordered physiology must start at a subintense level and then will have the potential to progress from mild to moderate to overt or severe. Just as we have revised downward our concept of normal range blood pressure and cholesterol, so we now should consider the evidence for doing so with TSH.

Alrighty, I see where you are coming from..this is from your link.

Actually, cardiologists still fight over whether there LDL and its range is a true factor in cardiac failure.

Observe my article on the Enhance Trials:
http://carolinamaine.blogspot.com/2008/01/enhance-trial-controversy.html

[kitty9309]

I realize there is a normal range for all things.
I am not looking for a nice neat number.
We all have our own set point for many things where we feel best.
My point is that we need to consider the patient, not just the lab results. Some of us feel better in the lower end of the range and some feel better with higher levels. It is very individual, and to say "only diagnose at this level" is short sighted.
Not looking for an argument, just trying to get my point across.

[AR-10]

GravesLady is incorrect. She only posted half of the article.

I don't know what to say to Anny526.
I'm getting tired of saying anything to GravesLady.

Kitty 9309 works in a lab and has thyroid disease.
I think I would trust her input.

[chigirl29]

Also--what I am trying to say, but I am getting drowsy--med kicking in:

There is no normal BP--there is a Normal RANGE for a BP.

Just as there is a normal RANGE for the thyroid.

Even with BP patients--some feel stress with a BP on the upper end of the spectrum.

Each person is basically a unique universe of chemical reactions based on hormones, genetics, diet, age, height, weight, and so on.

I understand you want a nice neat quantified number, but that is never going to happen.

Unless you design  a robot with a thyroid--that way you will have all the parameters set and can work from that.

[chigirl29]

Actually, many factors affect thyroid hormone levels--like estrogen, pregnancy, menopause, muscle mass, genetics--and so forth.  The heart has a structure that does not vary much among humans--it is adjusted for children and so on.  The human heart has a musculature that is pretty common among humans--and vessels and arteries have pretty common thicknesses--affects pressure.

It is easier to have a normal range of BP than a normal range of thryoid hormones.

There is no absolute to anything--

All things are variable and based on contingents.

[kitty9309]

I am on another forum with the man who wrote the article. He used to post here. He is very reasonable.
My point is that the ranges to diagnose and treat should be the same.

This article is well written on the subject:

http://jcem.endojournals.org/cgi/content/full/90/9/5483

I will pull this out as it pertains to our above discussion:

"We are also befuddled by the practice of supporters of the recommendations of the consensus panel who promote a target TSH range of 1.0–1.5 mU/liter in patients already receiving T4 therapy, whereas they refuse to accept TSH levels of 3–10 mU/liter as abnormal in patients not receiving T4 therapy"

They actually don't say diagnose and treatment levels should be the same, but they come close to saying it. I am a scientist and a medical laboratory professional and to me it makes scientific and medical sense.
For example: A normal blood pressure is the same whether you are on meds or not. The goal is the same.

[chigirl29]

I was trying to pick an article that was easier to discern for someone just now reading up on these things.

Grave's lady, you are right--it goes both ways.

[kitty9309]

There is no vice versa.  
A normal level to diagnose should be the same as the treatment level. As I said before, normal should be normal.

[GravesLady]

And visa versa.  Diagnose level should not be that of treatment level.

Subclinical:
TSH of 4.5 to 10:  No routine levothyroxine

TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable or
TSH levels between 5 and 10 ccIU/mL in conjunction with goiter or positive anti-thyroid peroxidase antibodies (or both).

PER:
AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006  -  Clinical Implications of the New TSH Reference August 15, 2006 Presentation:  "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."

US Government 2004 Guidelines
UK 2006 Guidelines,  
American Thyroid Association
The Endocrine Society -  Albert Einstein College of Medicine, New York.
September 23, 2004 .  
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician  May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004 Revised Date: April 1, 2007

GL,

January is Thyroid Awareness Month, a month when various organizations put together informational efforts to help us all learn more about thyroid disease here in the U.S.

January is National Graves Disease Awareness Month
National Graves' Disease Awareness Week 1/7 thr 1/13

[kitty9309]

Yes, my new endo says lab tests are worth 49% and a patient's well-being is worth 51% and we must take both into account.
He is willing to go as low as 0.5 TSH and add t3 in some patients, if their symptoms suggest it may help.
It makes no sense to say there is a good level for patients who are already diagnosed, but another level for those who aren't diagnosed. Normal thyroid levels should be normal levels period. For everyone.

[chigirl29]

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.


Full article with more info on the ranges at:
http://www.bellaonline.com/articles/art42377.asp

[GravesLady]

What your doctor said, is also my understanding in my 12 years.
Also, level  depends on whether a person is already diagnosed, in which levothyroxine treatment dose, the target TSH level should be between 0.3 and 3.0, whereas most medicals agree 3.0 is too low.   Then there is a diagnose level which is different than the above described.

Each Lab has its own way of testing, probably with different types of machines to test and measure on.  Some Labs use TSH  measured in
mIU/ml, mIU/l, mIU/ml , mU/l, IU/mL, µIU/l , ulU/ml,  or uU/l .  These might represent and produce different numbers TSH numbers.  The FTs are represented with these type however different,  codes as well . So what might seem a high or low range, really is not by that Labs method.
Normal test result values are expressed as a reference range, which is based on the average values in a healthy population; 95% of healthy people have values within this range. These values vary somewhat among laboratories, due to methodology and even geography. Blood tests and Blood testing methods and quality vary widely in different parts of the world and in different parts of many countries, due to characteristics in the population, both racial Blood differences and ethnic Blood characteristics, among other factors.  Free Cord Blood testing at thBloodmobile.

American Blood laboratories use a different version of the metric system than does most of the rest of the world, which uses the System International (SI). In some cases translation between the two systems is easy, but the difference between the two is most pronounced in the measurement of chemical concentration. The American system generally uses mass per unit volume, while SI uses moles per unit volume. Since mass per mole varies with the molecular weight of the substance being analyzed, conversion between American and SI units requires many different conversion factors....bloodbook

I state all the above with references, however I am not a scientist or medical Lab tec.
  
GL,

January is Thyroid Awareness Month, a month when various organizations put together informational efforts to help us all learn more about thyroid disease here in the U.S.

January is National Graves Disease Awareness Month
National Graves' Disease Awareness Week 1/7 thr 1/13

[kitty9309]

The method for the TSH test is the same no matter what lab it is tested in.

It is a 3rd generation TSH test. It uses the Immunochemiluminometric assay (ICMA) method. The references ranges are different because they are either determined by the manufacturer of the kit or determined in house by the lab by using patient or employee samples. (I have personally done this in the lab)

The reference ranges include people with occult (hidden) thyroid disease. The only way to rule out these samples would be to test for antibodies, perform a thyroid ultrasound and to exclude those people with a family or personal history of thyroid disease. Removing this population from the reference range would bring down the upper end of the range to about 2.5.

Make sure you get free t3 and free t4, not totals as these are outdated tests.

[kitty9309]

The method for the TSH test is the same no matter what lab it is tested in.

It is a 3rd generation TSH test. It uses the Immunochemiluminometric assay (ICMA) method. The references ranges are different because they are either determined by the manufacturer of the kit or determined in house by the lab by using patient or employee samples. (I have personally done this in the lab)

The reference ranges include people with occult (hidden) thyroid disease. The only way to rule out these samples would be to test for antibodies, perform a thyroid ultrasound and to exclude those people with a family or personal history of thyroid disease. Removing this population from the reference range would bring down the upper end of the range to about 2.5.

Make sure you get free t3 and free t4, not totals as these are outdated tests.