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Mary Shomon

When Your Doctor Says Your Thyroid is Normal, Is It...Really?

By February 25, 2010

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If you've been told by your doctor that your thyroid is "normal," you may think there's nothing else to investigate. But let's take a look at what it really means when a doctor says "normal."

Most conventional doctors rely solely on the Thyroid Stimulating Hormone (TSH) test to diagnose and manage thyroid disease. The test measures a pituitary hormone, and is considered by many conventional physicians to be the best test -- they call it the "gold standard" -- for diagnosing and managing thyroid problems. For those doctors, if your TSH test result falls within the reference range, then your thyroid is "normal."

The challenge? Since 2002, various groups within the endocrinology community have disagreed about the TSH test's reference range. One group favors a range of 0.5 to 4/5-5.0, while another group believes that the narrower recommended range of 0.3 to 3.0 should be adopted. TSH levels above the top of the range are considered evidence of hypothyroidism, an underactive thyroid.

The number of Americans whose TSH levels fall in that limbo between 3.0 and 4.5/5.0 -- which is "normal" to some doctors, and hypothyroid to others -- is estimated to be in the millions. That means some people with a TSH of, for example 4.0, will have doctors who treat them for hypothyroidism. Other doctors will tell a patient with a TSH of 4.0: "your thyroid is normal."

The solution? Always ask for the numbers. If you are told that your thyroid is normal, ask for the specific test names and results, and the reference range being used to make that decision. And, if you are experiencing symptoms, your TSH falls into that 3.0 to 4.5/5.0 limbo, and you have a doctor who believes that is normal and won't diagnose or treat you, it's time for a new doctor.

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February 26, 2010 at 11:43 am
(1) Cindy DePaulo says:

I have Graves Disease and Hashimoto’s too. I am trying to lose weight because I have two heart Diseases also. I am on am on medication and they want me to have surgery for toxic nodular Goiter mass. I have decided to try some other homeopathic products to balance my immune system. Have any ideas to help me lose weight? Thank You Cindy

February 26, 2010 at 12:16 pm
(2) K. Christensen says:

Cindy~Mary has many thyroid weight loss stories if you do a search.

About this article: many docs consider 2.0 TSH to be optimal and perhaps the tipping point should be SYMPTOMS. If you are experiencing hypo symptoms, you should do more research and also get your FREE T3 and FREE T4 tested.

February 26, 2010 at 12:46 pm
(3) pat says:

That’s it Mary? The TSH. Your not going to mention a doctor that doesn’t check for Antibodies, (Hashimoto’s?) My antibodies were 820 with a TSH of 4.8. Even after 7 years on thryroid med’s IF you don’t test for Reverse T3, you will not find out if your body is getting that medication. Until I was tested COMPLETELY for my thyroid, I was not able to lose weight. Once I got on T3 with T4 I have lost 40 lbs. Yes, I do have to diet, like everyone else, BUT this time I had results. I can’t believe after interviewing Dr. Holtorf you didn’t mention all the other tests you need to have.

February 26, 2010 at 1:02 pm
(4) Francesca says:

My spouse has all the symptons of Hypo and his TSH is “normal”. We know the lab uses the 0-5 range.

The doctor absolutely refuses to test his T3 & T4 despite us asking several times – purely because the TSH is normal. My spouse is very obese, very tired, very sluggish, and has memory problems.

BUT because this is Canada we cannot change doctors easily due to a major shortage of doctors.

I am so angry that our doctor sits there and does NOTHING. I call this malpractice!!!!

February 26, 2010 at 4:08 pm
(5) Lauren Piscopo says:

Thanks sharing your story with Natural Solutions readers, Mary. And thanks for posting here. I’m also a thyroid disease sufferer who recently discovered a benign thyroid nodule. I’m now trying to tune up my thyroid by cutting out gluten and soy, taking herbs, and easing stress through exercise.

February 26, 2010 at 4:22 pm
(6) Victoria says:

I was told over and over that my TSH of 3.87 was “midrange” and “normal.” I was finally dx’ed when I found a doctor willing to dig a little deeper and do Free T4 and Free T3 along with TSH. My Free T3 came back WAY below range.

I now take 150mg natural thyroid with 50mcg levothyroxine and I am feeling good. My leg bruising has gone away and my periods are starting to come back.

February 26, 2010 at 4:27 pm
(7) Mary says:

Five years ago, my gyno doctor suggested that my thyroid be tested. She did the lab, said I was low and to see my family doctor. He did the lab and said that I was fine. For five years, I suffered – slowly getting stiffer in my joints, depressed, gaining weight, overwhelmed, etc. Last May I went to a wonder Nurse Practitioner who tested me – found that my thyroid was way low and that I had Hashimoto’s. Thank you Family Doctor for those five years of h _ _ _. Thanks to the NP, I feel wonderful – am happy and exercising at the gym!!! No more joint pain.

February 26, 2010 at 7:11 pm
(8) c. gordon says:

I have been on thyroid medication for over 20 years and have been feeling pretty good. My regular thyroid test just came back at .o4 almost nothing. The doctor cut my meds to .150 but I still feel lousy. – very tired, off balance all the time and very sluggish. Help – what shoud I do. Ask for the T3 test – I do not know.

February 27, 2010 at 11:13 am
(9) Dianne says:

My test results just came in 0.264 which was told
to me via the doctors nurse. She said it was very
low & because I’m already taking the highest dose
of thyroid medication there’s nothing they can do for me. What! My doctor won’t call. How bad is this?

February 27, 2010 at 12:32 pm
(10) Elizabeth says:

I’ve not heard of taking natural thyroid AND levothyroxine. What is the reason for that? I’ve been taking desiccated thyroid and am up to 90mg a day, but my doctor doesn’t want to increase it, as he says my numbers are “normal.” I keep trying to tell him it’s not thyroid NUMBERS but thyroid FUNCTION that is at play here.

February 27, 2010 at 4:50 pm
(11) Judy Friedlund says:

Will someone please say something about a TSH of .02
My T3 and T4 is ni normal range.
Thank you.

February 28, 2010 at 8:49 am
(12) Bethann says:

I’ve been hypothyroid for about 10 years now. I’ve been taking a generic form of levoxyl .175mg. I’ve NEVER felt “normal” after being diagnosed even though my “numbers” have been normal. In the last few months I feel as if my medication isn’t working at all so I was tested again. My TSH came back completely normal at 1.70 mIU/L but my Free T4 Index came back high at 4.4 and my T4(thyroxine), Total came back high at 12.8, my T3 Uptake came back in range at 34. I’ve now been 3 weeks on name brand Levoxyl .175mg I’m feeling no change whatsoever, I am completely exhausted. What can I do? I’m soooo tired of being tired! So tired of NOT being able to lose weight even through diet and exercise. I can’t take it anymore. Help!

February 28, 2010 at 6:44 pm
(13) frances a. says:

judy, you might want to have a complete metabolic panel done. my tsh was .02 with my t3/t4 levels pretty much where they ought to be, but my calcium was low. my endocrinologist explained that when your tsh is low it leeches calcium from your bones which can lead to osteoporosis. he lowered my levothyroxine dose from 125mcg to 100mcg, and told me not to take ANY thyroid meds for a week to bring my tsh back up. i was skeptical at first, but after a few days off of levothyroxine, i actually felt an improvement in my mental faculties and general outlook. not anywhere near the improvement when i went back onto 100mcg, but i definitely felt like less of a thyroid zombie than the first two days, and now that i’m on 100mcg, i’m “back”! for the last year i thought i’d been UNDERmedicated, but it turns out i’ve been OVERmedicated. i’m not saying that’s the case with you, but i think it’s worth your calcium etc levels being checked out.

March 1, 2010 at 2:00 am
(14) suba says:

hello i m suba frm malaysia…in a 2 -3 years i m not feel good many say look like ur condition tyroid batter u go n check it so i m going to check it but doctor say i m normal but why until now i feel like very tired, very sluggish, and has memory problems…plz help me!!!! wat i do

March 1, 2010 at 2:22 am
(15) Mary Jane says:

I recently received a test result on the TSH of .58. I have chronic lyme and have been on many meds for this. I am fatigued, my skin is dry, my eyes are dry and I itch like crazy. I cannot gain weight – which to some may seem ok – but at 92 pounds, I have nothing if I would get seriously ill and look like a bag of bones. I hate it. Not only that but I am afraid for my life because I eat and eat (healthy foods) and take natural supps and nothing seems to work. I know part of this is lyme – but my docs office will not tell me anything more than – you are in normal range, don’t worry. I cannot afford to go to another doc yet, but I would like to know if this is right in the middle and I am completely absolutely normal like they say.

Thank you.

March 1, 2010 at 11:48 am
(16) Susan says:

One thing that may be a solution to your issues of feeling bad would be to get your Dr. to add Cytamel to yor Levoxyl. That would give you some T3 to your T4 and will help your weight and sluggish feeling.

March 3, 2010 at 11:04 am
(17) Heather Wooten says:

I am in limbo. My TSH is 4.8 and one time it was in the 7′s. My Free T4 is .92 and I have some symptoms except weight gain (I am also a year postpartum). I do not want to be on lifelong meds if I do not have to but I also want to do what is best for body. I feel like I fall in the maybe category. What would you do?

March 4, 2010 at 11:45 am
(18) Beverly says:

My TSH is 28.524. Very high My T3,T4,T7 is very low. I am not feeling very well. I am now going to see a specialist at the end of march. My doctor does nothing except change my pill from one to another. My thyroid goes from one end to the other lately. It causes alot of problems. Time for a new doctor. Always ask for the numbers. It use to be that a normal range on TSH was 0.47 to 6.20. Now it is 0.47 to 3.20. That is bull. When you don’t feel good. Get a second opinion!!

March 4, 2010 at 4:08 pm
(19) WillieM says:

I asked my general Dr for a Thyriod test becuase I have all the classic symptoms and when it came back he told me that it was perfect 1.37 out of 0.40-4.5 range. All he did was a TSH 3rd Generation w/Reflex to FT4. Should I be asking for a more define test? Should I be going to a specialist? Or maybe I,m going thru Manopause (andropause). What should I do? Thanks.

March 7, 2010 at 6:47 am
(20) Theresa says:

Frances A., I too have a very low tsh (0.03). My doctor at first worried that having such suppressed tsh would put me at risk for osteoporosis ( I have been on a fairly high dose of desiccated thyroid for a couple of years now). He ordered a bone mineral density scan, which showed my bones to be equivalent to a 20 year old (I was just turning 50).

Tsh does not have any effect on the body, other than to try to spur your thyroid gland into producing more thyroid hormones. A suppressed tsh result (a very useless test when on full thyroid replacement, IMO) simply means that you have enough thyroid hormones for your body’s needs. It is the parathyroid glands’ job to try to regulate calcium metabolism by leaching calcium from the bones, in concert with the thyroid (calcitonin secreted by the thyroid keeps this leaching action in check). If you are not feeling fine with suppressed tsh, then you should investigate other factors, such as iron (including ferritin, storage iron), and adrenal issues. Both have a major impact on how well our bodies use our thyroid hormones.

April 15, 2010 at 4:08 am
(21) suzanna moyle says:

have been feeling more worse sence dec 2oo8, when I had a full hyromy….Ive always been on 100mg levothroxine…ths levels say normal,but inner sence still tells me Im not quite right, still gane weight, where my question has always been, if my Im on the right amount of levothroxine that my body needs, then why do I still have problems with my weight, up and down, which at times does make me feel depressed as I dont like feeling or looking like this….sence my major opp have developed a nodule on the left side of my throat,why have I develped this I have asked several doctors, but just get sometimes this happens like I have to except this answer…I have looked on the net and have learnt more on site than from G P`s…its not living well,I do understand how you all feel, so why is it a problem for doctors to be more empathic to are needs,I feel they need to treat us instead of our throyid problem,as we all have different needs,this does stress me out!!…..does anybody know why I have develped this nodule,could you tell me why???

April 20, 2010 at 3:36 pm
(22) valerie says:

Hi Mary, if you are reading this message today 20th april, you can post a message and get a reply from the 3 party leaders but we need to bombard them and ask which one of them is going to help us stop this madness that is going on with non treatment of thyroid conditions.

August 5, 2010 at 11:47 am
(23) Nancy says:

My TSH numbers have been all over the map for four years and my well-meaning doctor would only check for TSH. Nothing he prescribed worked for me. I finally went to an MD who specializes in bio-identical hormones who had me do a full hormone panel. The reason for this is that if other hormones are out of whack they can inhibit the thyroid’s ability to do its job. Our hormones work in very close syncronisity with each other. In fact, he explained that depending on the results we might correct other hormone problems and not even have to do thyroid replacement therapy as once the other hormones are corrected my thyroid might begin working properly on its own. This test was very expensive. I live in Canada and it isn’t covered by our medical system here. But it tests for pretty well every hormone function you can think of. I’m now awaiting the results but am feeling very confident that this is a good way to go for me. Bio-identical hormones, by the way, are hormones that are taken from natural sources rather than synthetic and are compounded by a pharmacist who is trained to work with them. An advantage of this is they can work with very tiny amounts rather than having to rely on pre-set doses that the synthetic ones come in. So your hormones are more “tailor-made”. Wish me luck!

February 16, 2011 at 3:30 pm
(24) The Mrs says:

Well, I’ve gotten my thyroid tested 1) becuase my mother had it and during her pregnancies with us (I’m the oldest) 2) I’m exhausted all the time, cranky, horrid mood swings, and cannot lose the weight (30 lbs over). My level came to a 0.647 (TSH) and she said I was “normal.” During my pregnancy, I swore I was going to become diabetic or something. I cannot maintain full alertness now becuase I’m so exhausted. My child is now 4 and I’m still feeling just as horrible as I did during the pregnancy. I don’t know who to see anymore, becuase even the endocrinologist said I was normal.

May 1, 2011 at 4:01 am
(25) Alternative Medicine says:

I really impressed by reading your blog you provide nice information and its very helpful for me

March 4, 2012 at 3:14 pm
(26) Chris says:

I’m so confused. My gyno noticed that my thyroid looked full and was sticking out of my neck so she ordered test. My TSH reflex was normal but the ultrasound showed my thyroid to be enlarged with two nodules one on each side. One mesuring 6mm and the other 3mm. I was then sent to see a surgeon, who’s pa said I do not need surgery unless the nodules increase to 1cm and I don’t have thyroid disease, so my thyroid is not what’s making me sick. I have been so sick for about the past year. Extreme fatigue, weight gain, memory problems, moodyness, insomnia, I started expirencing heavy periods and clotting about 6 months ago. At times I feel as if there’s something in the back of my throat, I also have developed hoarsness. Over all I feel sick. I have all they symptoms but The tsh reflex says it’s normal. Shouldn’t my doctor check my t3 and t4 to be sure? What else could this be. My CBC W DIFF just showed my RDW was a little low. My TSH with Free T4 was 0.58.

June 27, 2012 at 1:18 am
(27) Martha says:

So…. I have had 1/2 a thyroid since 2/2008 and apparently 2.81 with hypo symptoms is just fine.

March 27, 2014 at 9:21 pm
(28) shadowgirl1976 says:

i’m taking 200mg of levothyroxine. i’m still tired and having weight gain issues. my tsh is 0.410 i wake up some mornings with major headache. but my dr just says everything is normal. even tells me to exercise more to lose weight. i have been diagnosed with hyshimotos disease. is there anything anyone can sugguest to me?

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