TSH problematic, but flagged normal?

[Nicole1120]

Hi Dr. Lupo,

I recently had a TSH test and my level came out at 5.2. According to the lab, this level was flagged as normal since it fell between the 0.5 - 5.5 range. However, a couple of red flags come to mind:

1. Two years, ago, I was at a 3.5. Isn't it problematic that it is now at a 5.2?
2. After doing some research online, it looks like there is a new TSH normal range, with 3.0 being the upper limit. Is this correct?

I've been feeling ill for years - I've gained weight (with a lot of puffiness in the face), suffer from fatigue/depression/anxiety attacks (which is being treated with Lexapro, but to no avail), have MAJOR gastrointestinal issues (constipation is my enemy and I often feel like there is blockage), etc. Every doctor I've been to tells me to stop investment banking or take iron supplements or exercise more, but honestly, I don't think sitting in a rocking chair for the rest of my life is going to make me feel that much better. I was a picture of health up until my third year of college, and three years later, I can barely get out of bed.

I belong to an HMO where it's hard to get a referral to a specialist if the internal medicine doc doesn't seen anything "abnormal" on the blood workup. What should I do? Should I push this issue further?

[Mark Lupo, M.D.]

TSH levels of 3.5 and 5.2 two years apart -- this is almost always Hashimoto's (immune system attack on your thyroid) with early thyroid failure.  With these symptoms, you should have the diagnosis confirmed (test TPO and Tg antibodies) and a trial of levothyroxine therapy considered.  Stress is a contributor to autoimmune disease and to your symptoms in general, but the thyroid may well be a significant cause as well.

[mosesgt]

Dr Lupo is right on target as usual. I would add, stay away from iron, unless you are iron deficient that will really constipate you. Lexapro is a great drug, but anxiety attacks require higher dosages but slow titration. Once your endocrine system is normal, you will likely feel a lot better, but still may need the Lexapro. The other concern is that with one auto immune condition, you need to watch for others as well. At the minimum, I would ask for an ANA. I always recommend name brand synthroid, since I believe there is too much variance w/ levothyroxine generics, but that's my thought. A 25 OH vit D level would not hurt, since low vit D is associated w/ many of those symptoms as well & the sun is not very high yet!