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The TSH Reference Range Wars: What's "Normal?", Who is Wrong, Who is Right...

And What Does It All Mean For You and Your Health?


Updated June 10, 2014

The TSH Reference Range Wars: What's "Normal?", Who is Wrong, Who is Right...
What this all means for you is that--

1. Your doctor probably is still using the old reference range of 0.5 to 5.0 for diagnosis and management of your thyroid disease

2. You should not accept the answers "normal," "high" or "low" as a report of your blood tests. Instead, ask for the actual numbers and ask for the lab's normal range. Better yet, ask that a copy of your blood test report be faxed or mailed or given to you.

3. If your TSH test levels come in below 0.5, or above 2.5-3.0, and your doctor is saying these levels are normal, make him or her aware of the AACE and American Association for Clinical Chemistry Laboratory Medicine Practice Guidelines and their 0.3 to 3.0 new reference range. Ask the doctor if he or she will consider a different diagnosis and treatment based on this new information.

4. If your doctor refuses to consider your results according to the new range, you may want to look for a new doctor who is more accepting of change and new evidence, and who will in fact be practicing according to the American Association of Clinical Endocrinologists new guidelines.

Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," "Living Well With Chronic Fatigue Syndrome and Fibromyalgia," and the "Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success." Click here for more information on Mary Shomon.


American Association of Clinical Endocrinologists. "January is Thyroid Awareness Month~ 2003 Campaign Encourages Awareness of Mild Thyroid Failure, Importance of Routine Testing." January 2003. Web

Anderson et. al., "Narrow Individual Variations in the Serum T4 and T3 in Normal Subjects: A Clue to the Understanding of Subclinical Thyroid Disease," Journal of Clinical Endocrinology and Metabolism, 87(3): 1068-1072

Casey et. al. "Subclinical hypothyroidism and pregnancy outcomes." Obstetrics & Gynecology. 2005 Feb 105(2):239-45.

Fatourechi V, Klee GG, Grebe SK, et al. Effects of reducing the upper limit of normal TSH values. Journal of the American Medical Association. 2003;290:3195-3196.

NACB Laboratory Medicine Practice Guidelines, Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease, 2002. Web

Nyrnes et. al. "Serum TSH is positively associated with BMI." International Journal of Obesity. 2005 Sep 27

Surks, et. al. "Controversy in Clinical Endocrinology: The Thyrotropin Reference Range Should Remain Unchanged," Journal of Clinical Endocrinology and Metabolism 90(9)/5489-5496

Wartofsky & Dickey, "Controversy in Clinical Endocrinology: The Evidence for a Narrower Thyrotropin Reference Range is Compelling," Journal of Clinical Endocrinology and Metabolism 90(9)/5483-5488

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