In the Fall of 2002, the American Association of Clinical Endocrinologists (AACE) announced that what was normal the year before, thyroid-wise, would now be considered abnormal.
According to the AACE, doctors had typically been basing their diagnoses on the "normal" range for
the TSH test. The typical normal reference range levels at most laboratories ran in the 0.5 to 5.0 range.
The new guidelines narrowed the range for acceptable thyroid function, and the AACE was encouraging
doctors to consider thyroid treatment for patients who test outside the target TSH reference range of 0.3 to 3.0, a far
narrower range. AACE believed that use of the new range would result in proper diagnosis for millions of Americans
who suffer from a mild thyroid disorder, but have gone untreated.
At a press conference, Hossein Gharib, MD, FACE, and president of AACE, said: "This means that
there are more people with minor thyroid abnormalities than previously perceived."
AACE estimates that the new guidelines actually double the number of people who have abnormal
thyroid function, bringing the total to as many as 27 million, up from 13 million thought to have the
condition under the old guidelines. These new estimates would make thyroid disease the most common
endocrine disorder in North America, far outpacing diabetes.
AACE made the decision to narrow the range because of data suggesting many people may have low-level
thyroid problems that could be improved with treatment and a narrower TSH range will give doctors
reason to more carefully consider those patients.
"The prevalence of undiagnosed thyroid disease in the United States is shockingly high - particularly since
it is a condition that is easy to diagnose and treat," said Dr. Gharib. "The new TSH range from the
AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it
can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease,
osteoporosis, infertility, and depression."
Commentary from Mary Shomon
This announcement from AACE represented a long-overdue and much-needed improvement in the level
of awareness of endocrinologists. After decades of denying that patients within the normal range of TSH
could in fact have a thyroid condition, they were acknowledging what patients and advocates
had been saying quite vocally for years: that the high and low end of the normal range is not, in fact,
normal for most people.
It is, however, also clear that the endocrinology community has a long way to go in terms of true
understanding of the patient condition, when you read the words of Dr. Gharib, an endocrinologist and
president of AACE. Dr. Gharib parrots the official endocrinologist party line when he states that thyroid
disease, "is a condition that is easy to diagnose and treat."
Dr. Gharib's pronouncement contradicts the AACE's own statement on many levels.
First, many family doctors, general practitioners and even endocrinologists have absolutely no idea about
these new guidelines from the AACE, and as of this week, are still routinely denying diagnosis and
treatment to patients who have TSH levels that fall in the level between 3.0 and 6.0, or between .1 and
.3. So, until the word it out, and accepted, thyroid disease continues to be a condition that is not
easy to diagnose.
Second, until this announcement, people who had clear symptoms of thyroid disease, but were in the .1
to .3, or 3 to 6 range on the TSH scale were considered "euthyroid" (normal) by almost all
endocrinologists and practitioners. They were not diagnosed as having a thyroid condition, and a total
lack of diagnosis cannot be in any way said to be easy, particularly for the unfortunate patients on
the receiving end of such sub-standard care. People who had family histories of thyroid disease,
symptoms (including enlarged thyroid, goiter, nodules, etc.) but whose TSH tests were in the low or high
end of normal were routinely denied treatment, and sent away with no diagnosis and no treatment. This
narrow-minded means of diagnosis has been the "standard of care" for conventional doctors and
endocrinologists for decades, based on a near- slavish reliance on the TSH test -- often to the exclusion
of clinical evidence, symptoms and medical observation.
Third, and equally of concern, many people with symptoms, whose TSH levels fell into the high or
low-normal, were told that their problems were actually the result of depression, and given
antidepressants. This means that a percentage of the population was misdiagnosed, sometimes stigmatized
by the diagnosis of mental illness, and unnecessarily given drugs.