The Thyroid Normal Range Change: A Report From the Field About Changes to The TSH Test Normal Range
Thyroid expert Richard Shames, MD, author of ThyroidPower and Feeling Fat, Fuzzy, Frazzled?, shares this important news from the trenches of thyroid treatment!
It's a red letter day for the thyroid-challenged!Richard Shames MD is a Harvard/University of Penn graduate, in private practice for 30 years in northern CA. He is currently also providing telephone consultation for thyroid, adrenal, and sex gland imbalances. Karilee Shames provides counseling, and is co-author of the couple's thyroid books. More information is available at their website.It all started this week when I was reviewing my patients' lab reports. I noticed there was one from Hunter Laboratory, not far from us here in Northern California. Their lab report showed a patient's TSH level as 3.4, and this was flagged as being outside the normal range!
It turns out that their new 'range of normal' is now .25 to 2.5, which is narrower than the revised range proposed by the American Association of Clinical Endocrinologists several years ago.
It's the first time we've seen this, and it bodes well for those millions who have yet to be diagnosed.
Now, thyroid patients may be in a better position to convince your doctors that your thyroid is not normal, that you do have a thyroid problem, even based on the "gold standard" TSH test.
Why is this happening now? Why didn't it happen more quickly when AACE changed their standards for the normal range in TSH testing? We suspect some of this may have to do with the growing vocal consumer movement, patients who follow Mary Shomon's work, or those in the Canary Club who are becoming more aware of their potential to change the way medicine is practiced.
Is change in medicine quick? Hardly ever, except for those rare occasions when pharmaceuticals are rapidly removed due to related deaths and/or very negative results in highly publicized research studies. Change seems to happen very slowly in medicine, due to vested interests on the part of practitioners, insurance companies, some laboratories, and mostly pharmaceutical interests.
Remember that standards for medical practice are evaluated by how things are done in your community. So it obviously behooves health consumers to become louder, join forces, and demand that those who are struggling with underactive thyroid glands receive the care and support you need.
We called the good folks over at Hunter Labs to inquire as to how they made this decision to narrow TSH range of normal. Basically, they say they were responding to pressure from practitioners to narrow this range appropriately. We suspect there's more to this story, and will keep you posted as we learn more.
What's good news is that at least ONE lab is listening to its practitioner base and responding appropriately. This means that as you discuss your views with your practitioners, eventually your thoughts reach those who make decisions, and eventually change happens.
Be aware that all the labs are not yet using these new range of normal values. Some are still be using the old ones, established prior to the new AACE standards. You have to ask your doctor to specifically identify which standards are being applied to you.
We are among a growing group of practitioners and consumers who believe that testing inadequately for thyroid problems could at times be construed as malpractice. Just as overtreating can lead to physician-caused (known in medical lingo as "iatrogenic") conditions, so can undertreating contribute to other more serious conditions, such as high blood pressure and high cholesterol, worsening diabetes and other autoimmune conditions.
YOU ARE THE AGENT FOR CHANGE. There's never been a better time to advocate for those in your family, your friends, and others who -- despite having multiple thyroid symptoms -- have been undiagnosed and undertreated. You can begin to lobby other labs to consider narrowing their range of normal for TSH, following the lead of the innovative Hunter Labs.
Remember to always ask for your numbers, not just whether you fall into the "normal range" or not. Be sure to then ask for the numbers for their normal range. If it's too broad (more than 0.3 - 3.0 and especially if it's above the older top range number of 5.0) question them on why they continue to use outdated values for TSH and encourage them to consider re-evaluating their normal range so that millions more won't have to suffer needlessly. Together, we can make a difference."
Comments
Are changes in the works for T3 and T4 (free) ranges, as well? My TSH is always within the “normal” range, but I have to argue with my doc to not change my meds because my T4 is always right on the upper borderline of the normal range.
Hi,
I have had an underactive thyroid since I was 18, recently I had to have my medication inreased as it was low. However in the test results it showed my TSH was 0. Is this worrying My Dr. told me this had to be kept an eye on several years down the line and might be a problem if any more of an increase was made to my medication. Any info would help as I had never really had the differnt elements of my condition explained to me. Thanks
Hallelujah! FINALLY, a medical professional who is PRO-patient rights instead of against them! I applaud Dr. Sharnes for his efforts in informing patients, and keeping abreast of changes and updates in medical testing.
Shouldn’t it be required, if it is not already, that not only physicians, but also medical testing facilities, be re-certified and checked periodically to ensure compliance with a STANDARD range for testing? Patients that move, or change primary care practitioners, are at highest risk for frustration, misdiagnosis, and erroneous recommendations for treatment.
I am an ‘undiagnosed’ thyroid patient who has encountered reluctance on the part of my own physician, who is STILL going by the ancient standards of 0.50 to 5.50 for the ‘normal’ range. When my TSH came back at 2.84, she told me I’m ‘perfectly normal’ in spite of over a dozen symptoms. I am tired of being treated as if I’m imagining illness. Thank you Dr. Starnes!
I’ve was diagnosed as hypothyroid when I was 11 years old (36 years ago). I reacted wonderfullyto medds until I was in my mid 20’s and everthing went down hill after that. When I was in the hospital about to have a hysterectomy, my labs came back weird, so my DR put me on a high dose of levothyroxin for a couple of weeks. Soon after, I felt terrific. I lost weight. Within 3 months I went from a size 20 to 12 without dieting or trying. Once my thyroid was back to its “normal” pre-surgery level, I gained all the weightback and then some.
Since then I’ve been extremely foggy, swollen, tired, no sex drive, etc. I also don’t sleep well.
My doctors tell me my thyroid levels are fine. Also, my GP said my thyroid felt enlarged.
Any ideas? I’m at my wit’s end.
I have been undiagnosed hypothyroid for 18 years despite symptoms, enlarged thyroid & a jump in TSH from 1.8 to 4.3 in one year! But the 4.3 was still considered normal range. I hope I will get help soon with the guideline changes. Mary Shomon you have kept me going (& hoping) for years now. God Bless you
Your research over the past few years has been so helpful to me. It has taught me to advocate for myself. No one knows their body better than themself. When one goes from being a non-stop on the go person who fits in exercise and is at goal weight to needing naps several times a week, inability to exercse, excessive weight gain and the need to drink a few cups of coffee from 4 PM on to stay awake until 10:30 PM, and then easily fall asleep, something is wrong. Just 2 weeks ago, I had my 3 month bloodwork done. My TSH was 3.25. The lab had this in the normal range. My past 3 endocrinologists all accepted this and told me there was nothing they could do for me because I was normal. Then why am I sleeping, gaining a lot of weight, feeling depressed and finding it an effort to run more than one or two errands, let alone work? Sure enough my new doctor saw me this past week and told me it was time to increase my dosage. She stated that my TSH was too high and that she’d like to see me at about a 1. I’m thrilled to think I might start to get my old self back. I look forward to continued research from both of you. Thank you.
Geez, I have been to a “respected” endocrinologist twice now over the course of almost a year, after not being able to see a dr. for over 3 years. I have been feeling worse to the point I can’t get much done during the day, can’t sleep well at night and wake up feeling like I’ve been hit by a truck and then had it back up and run over me AGAIN, my TSH is 5.321, my free T4 is .93, and my dr. just keeps saying I’m “borderline low, come back in 3 months for another test”. I eat right, take vites, exercise, my BMI is 24, and yet some days over the last month or two just climbing the stairs makes me feel like I have to lie down. I went to see another dr. because this one is telling me it’s all in my head, and he looked at my records, said there is definitely something wrong and it has been for some time, and that other tests should have been done, so he took blood a week and a half ago, and I can’t get him to call me back with results! I’m 50, am perimenopausal, and I’m pretty much disgusted with the medical profession. I am going to start taking the raw thyroid glandular complex I got from the health food store that I was taking a year ago, that made me feel like a human being again, that the first dr. took me off of because she didn’t want it to interfere with my test results. And here now I read that the new normal is half what my TSH reading is, no wonder I have had problems for 20 years! Now I test “moderate severe” for depression; heck yeah, I feel like CRAP! All the money we pay for health insurance to dr.s who don’t do diddly, it is pretty frustrating. Give me a naturopath over an MD any day, they have more common sense at least than most in western medicine. I am going off to check into the reseach by these dr.s and see if I can find something to show a dr. near me, IF I can find one who can take his head out of his rear long enough to listen to a patient instead of playing God.
Just wanted to note to the frustrated — Mary provides a nice list of (relatively) patient-friendly endocrinologists, here: http://thyroid.about.com/cs/doctors/a/topdocs.htm.
Personally my take is yes, we just have to advocate for ourselves. If this means seeing multiple doctors and paying out-of-pocket for the privilege, well, that’s what it means…
How does have heels spurs and other feet problems relate to thyroid problems. I have hypo and my feet seem to be getting worse as i havebones that have like droped and need to have surgery to put them back in line. I have to wear steel toed shoes and walk on concert. Is there any way to get disablitily beacuse of my feet.
This article is outdated; as of April 29,2007 Hunter Labs CHANGED the TSH range to .34 - 4.00. I spoke with the lab today to ask about the discrepancy between the Hunter Lab TSH range listed on a lab test from last week and the range listed in this article; they indicated that doctors felt the lowered range was TOO low so Hunter felt the need to raise it somewhat. I understand why they did it but this is crazy.
Several things are very important to remember:
1. Thyroid status is a Diagnosis, NOT a lab value. You can have any numbers you like on a lab slip while you are Hypothyroid, Hyperthyroid, or Euthyroid!
2. Lab values are just the lab’s ESTIMATE of the amount of a given chemical in your blood (or other sample). As such, it can only comment on that chemical; NOT health or disease. That decision needs to be made by a Health Care Provider.
3. About 85% of any Diagnosis information comes from the History (What has been happening to the patient before coming to the office?); 10% from the Examination (How does this patient look to the, hopefully, well trained observer?) and the Laboratory is worth about 5%. This has always been the shibboleth of Clinical Medicine.
4. “Normal” does NOT mean “Healthy.” It means (according to the Pathologists responsible for the accuracy of the Thyroid Function tests at one major Clinical Laboratory in Indiana and the Laboratory that took care of University of Michigan Medical Center) a score within “2 Standard Deviations of the Mean” at their particular laboratory. That means the middle 95.5% of all the scores of(sick) people who we send to the lab to get their blood tested because we suspect a Thyroid problem.
So, essentially it means that your score, on a test that may have little to do with thyroid status, fits right in with all those other sick people’s scores. NOT especially reassuring, is it?
5. Basically, NO Clinical Lab is a substitute for Clinical Acumen. Lab work gets done a lot because it make money for the labs; and docs, too often, prefer to dealing with lab slips, instead of listening to patients. Also, a lab slip seems to carry more weight in court than intelligence or opinion.
D. Michael, MD, PC
Mishawaka, IN