Aa
Levels within normal range
I was wondering if a TF4 level came back as 1.1 Ref Range 0.8-1.8 and a TSH of 2.48 Ref. Range .40-4.50 might indicate hypo? My step son has some pretty strong S/S beginning lately. His father was just DX with Hasti's this past week. My advise to him was check it out further by asking his doctor to run a antibodies and TF3. I'm hoping I'm not over reacting but he battles weight, anxiety, breathing problems, gout, and always overwhelmed and tired. Just wondering what you though?
If you need some ammunition in that fight, you might get some use from this email that I sent to the ATA several times.
After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined. After removing some suspect hypo patients' data, and recalculating the range, they recommended it be lowered and narrowed to .3-3.0. Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range? Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated. Is the ATA doing anything to encourage the medical community to change this practice? If so, why is it taking so long?
My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status. Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested? Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions? From studies I have seen and much personal experience, TSH does not even correlate very well at all with hypo symptoms. The test that has been shown to correlate best with hypo symptoms is free T3. Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.
When FT3 and FT4 are tested, the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range. As a result they are also told they are "normal" and receive no treatment. Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients? If this were done, these ranges would likewise be raised and narrowed, comparable to the new range for TSH. I'm sure that some would say that the range is just a reference range, that as you approach the lower end of the range, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable. I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results within the reference range as "normal" and don't want to go any further. As a result of all this the above misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.
Is the ATA doing anything to raise the awareness of these problems among the medical community so that we hypo patients can look forward to some positive changes? If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.
After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined. After removing some suspect hypo patients' data, and recalculating the range, they recommended it be lowered and narrowed to .3-3.0. Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range? Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated. Is the ATA doing anything to encourage the medical community to change this practice? If so, why is it taking so long?
My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status. Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested? Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions? From studies I have seen and much personal experience, TSH does not even correlate very well at all with hypo symptoms. The test that has been shown to correlate best with hypo symptoms is free T3. Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.
When FT3 and FT4 are tested, the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range. As a result they are also told they are "normal" and receive no treatment. Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients? If this were done, these ranges would likewise be raised and narrowed, comparable to the new range for TSH. I'm sure that some would say that the range is just a reference range, that as you approach the lower end of the range, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable. I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results within the reference range as "normal" and don't want to go any further. As a result of all this the above misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.
Is the ATA doing anything to raise the awareness of these problems among the medical community so that we hypo patients can look forward to some positive changes? If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.
Thanks for your response! It is good to know I am advising him correctly. It's hard when we stand against the GP's interpretation of these blood levels so I appreciate the reassurance!
With those symptoms and a FT4 that is below the midpoint of the range, it would be a very good idea to test for FT3 and antibodies tests, TPO ab and TG ab. Note that the Amer. Assn. of clinical Endocrinologists recommended ove 6 years ago that the ref. range for TSH should be changed to .3 - 3.0. TSH is affected by so many variables, including the time of day when blood is drawn, that a test result of 2.48 is not conclusive of anything. Much more important is the symptoms and the levels of FT3, and also FT4.
If the FT3 test result is in the lower half of its range, this is also consistent with being hypo and indicative of needing thyroid meds to bring FT3 up into the upper part of its range and T4 at least to the midpoint of its range.
If the FT3 test result is in the lower half of its range, this is also consistent with being hypo and indicative of needing thyroid meds to bring FT3 up into the upper part of its range and T4 at least to the midpoint of its range.
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