Seven Questions to Ask Your Doctor About Hypothyroidism

by Mary J. Shomon

When hypothyroidism sets in after RAI or thyroidectomy, or you're diagnosed due to Hashimoto's Thyroiditis, here are some critical questions you should ask your doctor, and some information on how to understand the results!

What is the normal TSH range at the lab you work with?

Different labs have different values for what is normal. The endocrinology community says that normal range is actually .3 to 3.0. But at the lab my doctor uses, the normal range is .5 to 5.5. A TSH of less than .5 is considered hyPERthyroid, and a TSH of more than 5.5 is considered hyPOthyroid. Other labs might use .35 to 5, or .6 to 5.2, etc., but it's important for you to know the values at YOUR lab.

What TSH level will you target for me?

This is a very loaded, but VERY important question. Your doctor's answer will tell you her or his philosophy about "normal" TSH. Some doctors believe that getting you into the very top of the normal range is their sole objective, and then the job is done. So, for example, using the 5.5 TSH level from my lab, that sort of doctor believes that getting me to somewhere around there constitutes full treatment.

Other doctors believe that certain TSH levels within the normal range are more appropriate targets. My endocrinologist, for example, believes that women don't feel well (and can't lose weight or get rid of other hypothyroidism symptoms) unless TSH is down between 1 and 2, far below the higher end of "normal." (There are some research reports that have shown that the average TSH of a women without thyroid disease is 1 to 2, so that may be why some women don't feel well at 4 or 5.) She aims to make sure you feel as well as possible within normal range, but finds that on average, women don't feel well at the higher end, so she aims to take it lower.

Some doctors are up on the latest news, and know that the American Academy of Clinical Endocrinologists, as of March 2003, have determined that the old .5 to 5 normal range is obsolete, and that the new normal range is .3 to 3.0, meaning that more people are considered to have a thyroid condition. Many labs and practitioners are, however, not aware of these new guidelines. (see Endos Say Normal TSH Range Now .3 to 3: Millions More at Thyroid Risk)

And finally, there are doctors who believe that managing your thyroid is a combination of TSH AND how you feel. These are doctors who treat you like a patient, not a lab value! These doctors might say "well, let's get you into the normal range, see how you feel, and adjust the dosage from there."