Aa
New Range
My husband had his TSH tested in 2000 and his TSH was 4.9. I recently noticed that the range for this has changed. Can you tell me what the new range is. He also goes Monday for an ultrasound with a preference to a nodule on the right lobe. Should we be concerned?
I did not ignored you, but before I reply, AR-10 said come to this thread and discuss the issue here. so, I posted OK at that thread, and I came here (see my post here -- count 5 up from this one).
We all have the right to our opinion.
Cutting, pasting, and snipping medical information to say what you want rather than what the text says is not apropriate.
I see no apology is necessary, and I will continue to follow behind you telling people that waiting for a TSH of 10.0 to receive treatment is wrong, regardless of who you quote.
Which is what you did in another thread yesterday, and I re-directed the subject back to this thread. You really should stop doing that.
And one last thing. If you have such a low opinion of the AACE, why do you constantly quote them? Not asking, really, just an observation.
Cutting, pasting, and snipping medical information to say what you want rather than what the text says is not apropriate.
I see no apology is necessary, and I will continue to follow behind you telling people that waiting for a TSH of 10.0 to receive treatment is wrong, regardless of who you quote.
Which is what you did in another thread yesterday, and I re-directed the subject back to this thread. You really should stop doing that.
And one last thing. If you have such a low opinion of the AACE, why do you constantly quote them? Not asking, really, just an observation.
I apologize that I did not/couldn't, post each and every web sites
information on guidelines in total, which would be ludicrous to expect.
I gave the sites name so whoever felt compiled could google, read and discover for themself.
To each their own in interpretation.
Also, I asked hypogirl80 to message me so as not to carry this over onto others post, as not to take away from their importance and to avoid (others) personal (revenge) sparing. However the request was ignored, therefore this has debated on someone else's important thread.
There are a lot of thyroid medicals out there that disagrees with AACE "New" level. However not so "New" for this controversy as been around for years. In time it will be known whether these other medicals agree or disagree with AACE, which has been influenced by thyroid advocate, instead of findings through test and trials.
I thank you for the comments here and at the other thread, although I am still not quite convinced. As long as there remains controversy among medicals, I fill justified to keep posting information to the contrary controversy beliefs of others at this site. However, I am still searching, including the two sites given over my eleven (and counting).
I don't care to debate or duel this further, however, I would be inclined to check out URLs messaged me on this matter with no comments necessary, for I can read, interpretate and make judgments for myself, although I appreciate the time taken.
We all have the right to our opinion with medical references and scientific back up.
GL
If you can't get through to message me, perhaps one of your buddies can.
information on guidelines in total, which would be ludicrous to expect.
I gave the sites name so whoever felt compiled could google, read and discover for themself.
To each their own in interpretation.
Also, I asked hypogirl80 to message me so as not to carry this over onto others post, as not to take away from their importance and to avoid (others) personal (revenge) sparing. However the request was ignored, therefore this has debated on someone else's important thread.
There are a lot of thyroid medicals out there that disagrees with AACE "New" level. However not so "New" for this controversy as been around for years. In time it will be known whether these other medicals agree or disagree with AACE, which has been influenced by thyroid advocate, instead of findings through test and trials.
I thank you for the comments here and at the other thread, although I am still not quite convinced. As long as there remains controversy among medicals, I fill justified to keep posting information to the contrary controversy beliefs of others at this site. However, I am still searching, including the two sites given over my eleven (and counting).
I don't care to debate or duel this further, however, I would be inclined to check out URLs messaged me on this matter with no comments necessary, for I can read, interpretate and make judgments for myself, although I appreciate the time taken.
We all have the right to our opinion with medical references and scientific back up.
GL
If you can't get through to message me, perhaps one of your buddies can.
It is odd, isn't it Momtoteenboys.
Doctors know the average TSH is just a bit over 1.0, and they SHOULD know that being off a point one way or the other can give you symptoms, but lab ranges are usually 0.5-5.0.
If you google AACE thyroid guidelines and click on the first link, you can read their position on thyroid disease and how it should be treated. You will need Adobe Acrobat Reader.
Page two is very interesting. It talks about subclinical conditions and the need to treat them.
Grave'sLady is focussing on a very narrow definition where the AACE says IF you have a tsh between 5.0 and 10.0 and IF you don't have high antibodies and IF you don't have a goiter, (and I presume IF your T3 and T4 are within range), then no treatment is required until the TSH rises over ten.
Her contention is if your TSH is below ten, you should not be treated.
But if you read page two, and then go down to page seven and read the entire next few pages, you will see they recommend treatment under a wide variety of conditions, including initiating treatment when your TSH is normal, if you have a goiter.
She is misquoting them and misleading people. She thinks the AACE is God of Thyroids, but they are in bed with the drug companies. She needs to come by and correct me if I am wrong. I don't even see half of her quotes in the guidelines. I am willing to learn.
I'll even apologize if I am wrong.
Hashimoto's Thyroiditis is the most common form of hypothyroidism. If your TSH is above normal lab range, you should be tested for anti-bodies. The likelyhood of having anti-bodies is very high, which would give you a diagnosis of Hashimoto's with a TSH of 5.1(?) and that should be treated, according to the AACE.
And the target range under treatment? Half way between 0.3 and 3.0
So why aren't normal lab ranges 0.3-3.0?
Doctors know the average TSH is just a bit over 1.0, and they SHOULD know that being off a point one way or the other can give you symptoms, but lab ranges are usually 0.5-5.0.
If you google AACE thyroid guidelines and click on the first link, you can read their position on thyroid disease and how it should be treated. You will need Adobe Acrobat Reader.
Page two is very interesting. It talks about subclinical conditions and the need to treat them.
Grave'sLady is focussing on a very narrow definition where the AACE says IF you have a tsh between 5.0 and 10.0 and IF you don't have high antibodies and IF you don't have a goiter, (and I presume IF your T3 and T4 are within range), then no treatment is required until the TSH rises over ten.
Her contention is if your TSH is below ten, you should not be treated.
But if you read page two, and then go down to page seven and read the entire next few pages, you will see they recommend treatment under a wide variety of conditions, including initiating treatment when your TSH is normal, if you have a goiter.
She is misquoting them and misleading people. She thinks the AACE is God of Thyroids, but they are in bed with the drug companies. She needs to come by and correct me if I am wrong. I don't even see half of her quotes in the guidelines. I am willing to learn.
I'll even apologize if I am wrong.
Hashimoto's Thyroiditis is the most common form of hypothyroidism. If your TSH is above normal lab range, you should be tested for anti-bodies. The likelyhood of having anti-bodies is very high, which would give you a diagnosis of Hashimoto's with a TSH of 5.1(?) and that should be treated, according to the AACE.
And the target range under treatment? Half way between 0.3 and 3.0
So why aren't normal lab ranges 0.3-3.0?
Its interesting that some would even consider a TSH of 5 to be normal when therapeautically doctors aim to keep someone on meds at around a TSH of 1 to keep symptoms under control.
I did not know so much has been posted here already. Anyway, my information was from National Academyof Clinical Biochemistry (AACB) which is a prt of N.A. of Clinical Chemistry (AACC). They issued a new range in late 2002 of range 0.4 to 2.5. then, I asked my doctor, he told me at their annual Endocrinologists conference, 0.3 to 3.0 was generally recommended.
When you cut through all the mumbo jumbo, it works like this;
The AACE has seen enough recent studies to conclude the average TSH is 1.5, and the have lowered the range for diagnosed patients to 0.3-3.0.
They also state that 5.0 is the threshold where they should be looking at further testing and forming a diagnosis. If T3 and T4 look good and anti-body tests look good, no treatment is warranted. Follow up testing is warranted.
If you have high antibodies and low T's and a TSH of 5.5, the AACE is recommending treatment.
The patient needs to considered in the whole equation, too. Do they present as a probable thyroid patient? Add that question into the process of deciding a course of treatment or a battery of tests.
The AACE has seen enough recent studies to conclude the average TSH is 1.5, and the have lowered the range for diagnosed patients to 0.3-3.0.
They also state that 5.0 is the threshold where they should be looking at further testing and forming a diagnosis. If T3 and T4 look good and anti-body tests look good, no treatment is warranted. Follow up testing is warranted.
If you have high antibodies and low T's and a TSH of 5.5, the AACE is recommending treatment.
The patient needs to considered in the whole equation, too. Do they present as a probable thyroid patient? Add that question into the process of deciding a course of treatment or a battery of tests.
From The Journal of Clinical Endocrinology and Metabolism 2005
"Although many of the earlier studies indicating little benefit of T4 therapy were of patients who achieved TSH reductions down to only the range of 3–3.5 mU/liter, it is remarkable that some did show benefit with minimal TSH reductions in this range (20). Other studies employing appropriate dosage titration to TSH levels under 3.0 are more uniformly associated with improvement in symptoms, lipid abnormalities, and cardiovascular function (33, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46). "
AND
"Clinicians should appreciate that a presumed normal range given on a laboratory report is actually only a reference range for an ostensibly normal population. Such reference ranges were derived from cross-sectional studies of populations uncorrected for any underlying or occult disease, and for TSH have ranged from 0.5 up to 7.0 mU/liter. Indeed, the earlier first generation TSH RIAs often described the upper limit of normal at 10 mU/liter. With minor refinements in the past decade, the reference range has dropped to 0.5–5.5 mU/liter, reflecting the mean of all samples ± 2 SD. A symmetrical Gaussian distribution would place the midpoint or mean value of such a population at 3.0 mU/liter. This would appear to be inconsistent with recently published data indicating a population mean value of 1.5 mU/liter for an iodine-sufficient population (6, 7, 8, 9, 10). The discrepancy arises because the raw value reference interval for TSH is a skewed curve with a long tail toward the higher TSH values and is not a bell-shaped curve typical of a true Gaussian distribution curve. Thus, to create a normally distributed curve of the values, the reference interval for TSH is calculated by log transformation of the arithmetic TSH values."
You need to have some knowledge of statistics to understand some of the above paragraph. Basically, the upper end of the range- the skewed curve with a long tail- are outliers and don't belong.
These upper range numbers probably represent occult thyroid disease.
Kitty
"Although many of the earlier studies indicating little benefit of T4 therapy were of patients who achieved TSH reductions down to only the range of 3–3.5 mU/liter, it is remarkable that some did show benefit with minimal TSH reductions in this range (20). Other studies employing appropriate dosage titration to TSH levels under 3.0 are more uniformly associated with improvement in symptoms, lipid abnormalities, and cardiovascular function (33, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46). "
AND
"Clinicians should appreciate that a presumed normal range given on a laboratory report is actually only a reference range for an ostensibly normal population. Such reference ranges were derived from cross-sectional studies of populations uncorrected for any underlying or occult disease, and for TSH have ranged from 0.5 up to 7.0 mU/liter. Indeed, the earlier first generation TSH RIAs often described the upper limit of normal at 10 mU/liter. With minor refinements in the past decade, the reference range has dropped to 0.5–5.5 mU/liter, reflecting the mean of all samples ± 2 SD. A symmetrical Gaussian distribution would place the midpoint or mean value of such a population at 3.0 mU/liter. This would appear to be inconsistent with recently published data indicating a population mean value of 1.5 mU/liter for an iodine-sufficient population (6, 7, 8, 9, 10). The discrepancy arises because the raw value reference interval for TSH is a skewed curve with a long tail toward the higher TSH values and is not a bell-shaped curve typical of a true Gaussian distribution curve. Thus, to create a normally distributed curve of the values, the reference interval for TSH is calculated by log transformation of the arithmetic TSH values."
You need to have some knowledge of statistics to understand some of the above paragraph. Basically, the upper end of the range- the skewed curve with a long tail- are outliers and don't belong.
These upper range numbers probably represent occult thyroid disease.
Kitty
Also, why do doctors treat mild high blood pressure, pre-diabetes and mildly elevated cholseterol levels but it's not ok to treat a mildly failing thyroid? The cut-off levels for these diseases used to be much higher. For example, total cholesterol of up to 300 was considered normal not so long ago.
It seems that studies have proved this to be too high for good health.
Seems a bit strange, huh?
As a laboratory proffessional for 20 years now, I have seen many changes in reference ranges and what is considered a normal test result. I'm sure there will continue to be changes in diagnostic testing that are in the best interest of the patient.
Kitty
It seems that studies have proved this to be too high for good health.
Seems a bit strange, huh?
As a laboratory proffessional for 20 years now, I have seen many changes in reference ranges and what is considered a normal test result. I'm sure there will continue to be changes in diagnostic testing that are in the best interest of the patient.
Kitty
Sorry to do this in your thread.
It seems the AACE says the new guidelines are 0.3-3.0
But my lab is still using 0.5-5.0
I don't know what my Endo thinks.
It seems the AACE says the new guidelines are 0.3-3.0
But my lab is still using 0.5-5.0
I don't know what my Endo thinks.
See that part tht says "We believe that treatment is indicated in patients with TSH levels>10blah blah or in patients with TSH levels between 5 and 10blah blah in conjunction with goiter or posetive anti-thyroid peroxidase antibodies (or both)."?
That is in direct conflict with the way you quoted the same paragraph up above in your first post.
That is in direct conflict with the way you quoted the same paragraph up above in your first post.
You are (in your first post) quoting two different sources, and picking and choosing your quotes.
Here is a fiew more paragraphs from the AACE site, just where you left off.
Although subclinical hypothyroidism is often asymptomatic,
potential risks associated with the condition
include progression to overt hypothyroidism, cardiovascular
effects, hyperlipidemia, and neuropsychiatric effects
(16,19). Recent studies have suggested that treatment of
subclinical hypothyroidism will reduce cardiovascular risk
factors, improve the lipid profile, and minimize neurobehavioral
abnormalities (19,20). Some of these data, however,
were derived from studies that included patients with
TSH levels well above 10 μIU/mL; for patients with mildly
increased TSH levels (5 to 10 μIU/mL), the data are
controversial.
Treatment of subclinical hypothyroidism remains
controversial, and recent arguments for and against treatment
have been proposed (19,21). We believe that treatment
is indicated in patients with TSH levels >10 μIU/mL
or in patients with TSH levels between 5 and 10 μIU/mL
in conjunction with goiter or positive anti-thyroid peroxidase
antibodies (or both). These patients have the highest
rates of progression to overt hypothyroidism. An initial
dosage of levothyroxine of 25 to 50 μg/day can be used,
the serum TSH level should be measured in 6 to 8 weeks,
and the levothyroxine dose should be adjusted as necessary.
The target TSH level should be between 0.3 and 3.0
μIU/mL. Once a stable TSH level
Here is a fiew more paragraphs from the AACE site, just where you left off.
Although subclinical hypothyroidism is often asymptomatic,
potential risks associated with the condition
include progression to overt hypothyroidism, cardiovascular
effects, hyperlipidemia, and neuropsychiatric effects
(16,19). Recent studies have suggested that treatment of
subclinical hypothyroidism will reduce cardiovascular risk
factors, improve the lipid profile, and minimize neurobehavioral
abnormalities (19,20). Some of these data, however,
were derived from studies that included patients with
TSH levels well above 10 μIU/mL; for patients with mildly
increased TSH levels (5 to 10 μIU/mL), the data are
controversial.
Treatment of subclinical hypothyroidism remains
controversial, and recent arguments for and against treatment
have been proposed (19,21). We believe that treatment
is indicated in patients with TSH levels >10 μIU/mL
or in patients with TSH levels between 5 and 10 μIU/mL
in conjunction with goiter or positive anti-thyroid peroxidase
antibodies (or both). These patients have the highest
rates of progression to overt hypothyroidism. An initial
dosage of levothyroxine of 25 to 50 μg/day can be used,
the serum TSH level should be measured in 6 to 8 weeks,
and the levothyroxine dose should be adjusted as necessary.
The target TSH level should be between 0.3 and 3.0
μIU/mL. Once a stable TSH level
Give it a rest!
That is conspiracy theory ravings.
We've had this discussion before and you were shown the truth then. We shouldn't have to go over it again. Just go to page two or whatever and read the other thread.
That is conspiracy theory ravings.
We've had this discussion before and you were shown the truth then. We shouldn't have to go over it again. Just go to page two or whatever and read the other thread.
November 8, 2005:
"For two years, endocrinologists have been arguing about where to set the bar for the diagnosis and treatment of a failing thyroid...."
The below is a good reason they want to set TSH to 0.3 and 3.0 and you can help make them rich!
"American Association of Clinical Endocrinologists which, like the American Thyroid Association and the Endocrine Society, accepts substantial financing from companies that make levothyroxine, like Abbott Laboratories and King Pharmaceuticals.
National Academy of Clinical Biochemistry found that 95 percent of Americans have a T.S.H. of less than 2.5 milliunits per liter. The academy also accepts financing from manufacturers of levothyroxine." nytimes.com
"For two years, endocrinologists have been arguing about where to set the bar for the diagnosis and treatment of a failing thyroid...."
The below is a good reason they want to set TSH to 0.3 and 3.0 and you can help make them rich!
"American Association of Clinical Endocrinologists which, like the American Thyroid Association and the Endocrine Society, accepts substantial financing from companies that make levothyroxine, like Abbott Laboratories and King Pharmaceuticals.
National Academy of Clinical Biochemistry found that 95 percent of Americans have a T.S.H. of less than 2.5 milliunits per liter. The academy also accepts financing from manufacturers of levothyroxine." nytimes.com
No new range as yet that reflects in any thyroid guidelines from legit thyroid sources as listed below. The above is for already diagnosed and treated patients.
PER:
AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006 - Clinical Implications of the New TSH Reference August 15, 2006 Presentation: "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."
US Government 2004 Guidelines
UK 2006 Guidelines,
American Thyroid Association
The Endocrine Society - Albert Einstein College of Medicine, New York. September 23, 2004 .
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004
Revised Date: April 1, 2007
All the above can be googled and confirmed.
quote - TSH 2.5 - 4.5: May be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations in this range would be misidentified as having hypothyroidism
TSH of 4.5 to 10: No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.........
or patients with TSH levels between 5 and 10 ccIU/mL in conjunction with goiter or positive anti-thyroid peroxidase antibodies (or both). These patients have the highest rates of progression to overt hypothyroidism.
TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable.
Data do not confirm clear-cut benefits for early therapy compared with treatment when symptoms or overt hypothyroidism develop. - unquote
Overt hypothyroidism is defined as TSH higher than 10 and both FTs lower than Labs range, comes with the symptoms and is very rare.
Good Luck and Happy Holidays
GL,
The above information is based from many extensive test done on thyroid patients.
To the rest of you, sorry for sounding like a broken record.
PER:
AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006 - Clinical Implications of the New TSH Reference August 15, 2006 Presentation: "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."
US Government 2004 Guidelines
UK 2006 Guidelines,
American Thyroid Association
The Endocrine Society - Albert Einstein College of Medicine, New York. September 23, 2004 .
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004
Revised Date: April 1, 2007
All the above can be googled and confirmed.
quote - TSH 2.5 - 4.5: May be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations in this range would be misidentified as having hypothyroidism
TSH of 4.5 to 10: No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.........
or patients with TSH levels between 5 and 10 ccIU/mL in conjunction with goiter or positive anti-thyroid peroxidase antibodies (or both). These patients have the highest rates of progression to overt hypothyroidism.
TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable.
Data do not confirm clear-cut benefits for early therapy compared with treatment when symptoms or overt hypothyroidism develop. - unquote
Overt hypothyroidism is defined as TSH higher than 10 and both FTs lower than Labs range, comes with the symptoms and is very rare.
Good Luck and Happy Holidays
GL,
The above information is based from many extensive test done on thyroid patients.
To the rest of you, sorry for sounding like a broken record.
Some are saying 0.3-3.0
Some are saying 0.3-3.5
Some are saying nothing has changed. 0.5-5.0
My lab is still using 0.5-5.0, and I think the official word is nothing has changed.
I personally feel 0.3-3.0 makes more sense when you read the current studies and published papers, but I don't think the Big Boys have budged on the issue.
Some are saying 0.3-3.5
Some are saying nothing has changed. 0.5-5.0
My lab is still using 0.5-5.0, and I think the official word is nothing has changed.
I personally feel 0.3-3.0 makes more sense when you read the current studies and published papers, but I don't think the Big Boys have budged on the issue.
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