What should normal TSH levels be when yoou are without a thyroid gland

[Opal52]

My thyroid was ablated in August of 2016 due to Graves Disease.  My current TSH is 4.14.  However, I am still feeling very tired and my weight continues to gain despite my efforts to eat healthier.   My physician feels this level is normal.  I am taking 100mc of Synthroid for the past 6 weeks.

[gimel]

TSH is affected by so many variables that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones Free T4 and Free T3.  TSH is useful mainly to identify overt hypothyroidism  (TSH > 10).  When TSH is above range but less than 10 it is diagnosed as subclinical and a Free T4 test is done.  If the Free T4 is within range, the patient is told that thyroid levels are "normal" and that symptoms must be due to something else.  This is fallacious due to the inadequacy of TSH and the erroneously broad range for Free T4.  

The other use for TSH is to distinguish between primary and central hypothyroidism.  

The AACE/ATA Guidelines for Hypothyroidism did lower the upper limit of the reference range for a short while, but have backtracked on that and changed it from 3.0 to 4.3.   Apparently the intent was to avoid false positive diagnoses.  Instead the increase leads to more false negative diagnoses.  It really doesn't matter anyway, due to the shortcomings of using TSH as the primary diagnostic.  Diagnosis should be primarily based on symptoms, along with Free T4 and Free T3 levels.  

You can read all about this in the link above.

[cosmicsoul]

If my TSH was 4.14 I would be severly hypothyroid and more likely non functioning. Consdering that healthy individuals without any thyroid disease like Hashimotos have a TSH between 1-1.5 why would 4 be normal? And sadly the lab range is off in lab results misleading thusands of people....and no authority is correcting it. The American Association of Clinical Endocrinologists (AACE) recommends the TSH lab range to be: 0.3 to 3.0.

[gimel]

If TSH is the only thyroid related test your doctor is doing to assess your thyroid status, he is not diagnosing and treating you adequately. A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting the biologically active thyroid hormones, Free T4 and Free T3, as needed to relieve symptoms, without being influenced by resultant TSH levels.  For a number of reasons, when already taking thyroid hormones, TSH is basically unnecessary.  Symptom relief should be all important, not just test results.  

Many of us have found that symptom relief frequently required Free T4 at least at the mid-point of its range, and Free T3 in the upper part of its range, adjusted as needed to relieve symptoms.  So you should make sure they always test you for both Free T4 and Free T3 every time you go in for tests.  In addition, hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  If not tested for those, you should do so and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.

You can confirm what I say by reading at lest the first two pages of the following link, and also read further if you want to get into the discussion and scientific evidence supporting all the suggestions on page 2.  If your doctor has an open mind and is willing to read the paper, you could also consider giving him a copy and ask him to reconsider your treatment strategy.  If the doctor refuses to reconsider then you will need to find a good thyroid doctor that will treat clinically, as described above.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf