TSH, what is "normal" / 4.7 for a 44 yo male w/ symptoms?

[bcloud3]

I am a 44 yo male. Have been treated for depression for about 5 yrs, and sleep apnea for 2 yrs. I still have symptoms of fatigue, difficulty waking, poor concentration/memory, lack motivation (and apathetic about everything), 30lb weight gain in last 4-5 years.  Dr. tested TSH 2 yrs ago with a level of 4.7.  He did not seem concerned with that.  Given my continuing (and seemingly worsening) symptoms he has sent me for another check of TSH (as well as other standard blood tests and testosterone check).  There seems to be alot of disagreement on what "normal" TSH range is.  Should the 4.7 result a couple years ago have been more of a concern? I feel terrible and am hoping this latest test will be enough higher that he will pursue the thyroid direction.

[gimel]

Of the two tests I mentioned, free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free t4 and TSH did not correlate.  TSH is supposed to reflect the levels of the thyroid hormones, but it cannot be shown to correlate well with either Free T3 or Free T4, much less with hypo symptoms.  

If you look through this listing of 26 typical hypo symptoms, I;m sure that you will note a number that you have.  

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  symptom relief should be all important, not just test results.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

So when you go in for your next appointment, I think it would be a good idea to give the doctor a copy of the letter and talk about the need for clinical treatment, and testing of Free T3 and Free T4.  If the doctor resists, then you should insist on it and don't take no for an answer.  Some additional tests that might be useful would be for Vitamin D and B12.

If the doctor has a problem with clinical treatment as I described, then you are going to have to provide enough scientific study data to change his mind, or you will have to find a good thyroid doctor.

[kl42]

thats high all those symtoms could be from hypothyroidism !!!

[gimel]

I am hoping that you see this before going in for the testing.  Firtst thing you should know is that the doctor is still referring to the old range for TSH.  The AACE recommended that it should be lowered to .3 - 3.0, over 8 years ago.  Second TSH is a pituitary hormone that 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 T3 and Free T4 (not the same as Total T3 and Total T4).  


More to come, but I wanted to try and catch you now.