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TSH Levels Varying Doctors' and Medical Info Opinions

I am a Graves disease patient and 3 months post RAI.

I recently had an 11 week post RAI blood test which showed Free T4  1.76 (ref. range 0.82-1.77), Free T3  4.2 (ref. range 2.0-4.4) and TSH 0.005 (ref. range 0.450-4.500).  My endocrinologist is happy the my Free T4 and Free T3 are in range and not worried that TSH has not moved since my 3 week post RAI blood test as he said it will rise in time.

My current endocrinologist says that I should eventually go hypothyroid, need Synthroid and TSH should be between 2-3 because I am in my early 50s.

I recently went for a second opinion and that endocrinologist told me that TSH should be around 1, even at my age.

I read the AACE has suggested that the thyroid patient's TSH should be somewhere in the range of 0.3-3.0.

I then read the ATA which has suggested that thyroid patient's TSH shold be somewhere in the range of 0.5-2.5.

I read in another medical journal that TSH higher than 2.5 could cause higher cholesterol levels (LDL).

I also read that TSH should be kept no higher than 2 for patients with thyroid eye disease (TED). I was diagnosed with moderate TED.

I am getting confused at where my TSH levels should end up when they rise and once I am on Synthroid.  I have copies of past blood work from before I was having problems with Graves disease symptoms and my TSH seemed okay for me between 1.7 to 2.5.  I know at those times I felt fine; my only issue was when my TSH was 2.5 or higher that my cholesterol levels (LDL) were out of range.  TSH over 2.5 for me I always had hypothyroid symptoms in the past.

I appreciate any input on this subject as I am hearing some endocrinologists in this country are now saying TSH should not be higher that 1.

Thank you in advance for your medical input Dr. Lupo.







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Avatar universal
Thank you very much Dr. Lupo for your very helpful medical information and quick response to my question.
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
I do not think that there is a consensus regarding a TSH being less than 1.  I typically uses 0.3-3.0 for patients not on medication and a 0.5-1.5 for most patients on medication depending on the scenario.  There's no universal target range however.  In your case, the TSH may take several months to increase after radioactive iodine treatment for Graves' disease.  It is very important to follow the T4 and T3 levels and to intervene early with Synthroid therapy.  Avoiding hypothyroidism is important for avoiding problems with thyroid eye disease and other complications of untreated, unrecognized hypothyroidism that often occurs if this physician is only looking at the TSH level in the post I-131 time period.
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