Endocrinologists Say TSH Normal Range is Now 0.3 to 3

New Guidelines Say Millions More Are at Thyroid Risk

I would not consider any of these situations that have gone on for decades as evidence that thyroid disease is "easy to diagnose" -- particularly from the perspective of the millions of patients who have sufferered with undiagnosed thyroid disease, misdiagnosis, and who have been condemned to decades of chronic illness due to this myopic reliance on TSH tests.

As for thyroid disease being "easy to treat," this is a myth that is promulgated by endocrinologists, and frequently, by the levothyroxine manufacturers. There is plenty of evidence, anecdotal and empirical, to the contrary.

First, a survey of nearly 1,000 thyroid patients that I recently conducted -- the first large-scale quality-of-life survey ever conducted among thyroid patients -- found that more than 50% of respondents reported that they are not satisfied with their thyroid treatment.

Second, a Thyroid Foundation of America survey found that more than two-thirds of Graves' disease patients continued to suffer debilitating symptoms after treatment and while "euthyroid."

Third, a study published in the February, 2002 issue of the Journal of Clinical Endocrinology and Metabolism found that nearly five percent of Americans suffer from often undiagnosed thyroid disease. And those projections were based on the earlier TSH "normal range" of .5 to 5.0 -6.0, not on these new, narrower guidelines that say as many as 10 percent of the population are affected. If thyroid disease is so easy to diagnose, why are so many millions of people undiagnosed?

Fourth, and equally telling, were the results of the groundbreaking [link url=http://thyroid.about.com/library/weekly/aa022800a.htm]Colorado Thyroid Prevalence Study[/link]. Reported on in the February 2000 issue of the Archives of Internal Medicine, the study found that among patients taking thyroid medication, only 60% were within the normal range of TSH (and again, that was according to the .1 to 5.0-6.0 TSH range). The fact that forty percent of patients, a number that translates to millions of Americans, are already taking thyroid hormone and being treated by a doctor but are still not in TSH range indicates that proper treatment is not as easy as Dr. Gharib suggests.

Fifth, the inadequacy of treatment's ability to relieve symptoms was also addressed in February of 1999 when the February 11, 1999 New England Journal of Medicine published a [link url=http://thyroid.about.com/library/weekly/aa021199.htm]landmark T3 thyroid drug study[/link] that found that the majority of patients studied felt better on a combination of two drugs, including levothyroxine (T4) and T3, and NOT solely levothyroxine/T4 (i.e., Synthroid, Unithroid, or Levoxyl) alone. Yet levothyroxine alone has been, and continues to be, the "standard-of-care" treatment offered by endocrinologists, and is the AACE's standard treatment for hypothyroidism in their guidelines. The majority of patients who don't feel well on what is considered the best possible treatment by endocrinologists would not agree that thyroid disease is quite as "easy to treat" as Dr. Gharib asserts.

The AACE has finally moved into the 21st century in terms of its awareness that the outdated TSH reference range needed revisiting. But this acknowledgement of what patients and some enlightened practitioners have known for years is just a first step toward a far greater awareness that is needed.

There are many much-needed revisions that need to be made in the process of diagnosing and treating thyroid disease, and we can only hope that it doesn't take decades for AACE to catch up with patients and the more innovative practitioners who are making real breakthroughs in understanding, treating, living with and even overcoming thyroid disease.