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Old 08-03-2005, 08:07 PM   #1
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Unhappy TSH of 4.1? Please help!

Well I did go and have my thyroid scan done. This is what I got...

TSH 4.139 (.35 - 5.50)
T4 6.1 (4.5 - 12.0)
T3 Uptake 31 (24 - 39)
Free Thyroxine 1.9 (1.2 - 4.9)

Any thoughts? Does the 'normal' range on the TSH seem kind of high, given what I've been hearing? I had these run myself and will make a appointment to take them to my dr. What is the likelihood that he's be willing to treat this? Any advice on how to approach him?

Thanks!

Sharon

 
Old 08-03-2005, 08:30 PM   #2
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KCThy HB User
Re: TSH of 4.1? Please help!

I guess my first response to the labs' values would be: are these in line with the reliable websources of 2003, where the labs' say 3.0 is the high?

Mine, when first diagnosed was 5.9 and my doc says, it's "normal" borderline. That was Feb, I've since had a Total Thyroidectomy and been on Levoxyl since April 1.....

I'm going to post, a new question, why do associations change their "guidelines" - maybe because we feel like "shi." above 3.0 (or even above 1-2)....... AND why is it that doctor's don't stay on top of the changes from 2 (count EM - TWO years ago?????????)

Nola, hang in there, trust yourself and if you feel terrible and your doctor says your "just fine"..... find another doctor. Oh, I get soooo tired of saying that, but you deserve better advice honey.

 
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Old 08-04-2005, 03:05 AM   #3
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Re: TSH of 4.1? Please help!

Ignorant doctors are starting to really **** me off!

If you have to self-medicate. My TSH was 4.565 and I feel SO much better on 75mcg of Levoxyl.

 
Old 08-04-2005, 04:56 AM   #4
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Re: TSH of 4.1? Please help!

Sharon, find a new doctor. You're primary hypothyroid. Your TSH is well above where it should be, your Total T4 is below the mid point and your calculated FT4 is very low. These are not normal numbers, and they are certainly not normal for you.
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Old 08-04-2005, 08:26 AM   #5
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Re: TSH of 4.1? Please help!

My doctor lets me have my TSH at 0.013 with the flag showing Low. It depends on your doctor and how much knowledge he has. You need someone that doesn't always look at lab ranges and asks "How do you feel?"

 
Old 08-04-2005, 09:00 AM   #6
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Re: TSH of 4.1? Please help!

I got a call back from my dr's office. I have an appointment for Monday but his assistant said that he said he probably won't treat it. I have seen the release for the American Association of Clinical Endocrinologies saying that the normal range should be adjusted to .3 to 3.04, but, I can't seem to find the actual references. The clinical treatment guidelines document on their page still refers to the old numbers?

Does anyone know where I can find this? I'd like to be able to bring it with me.

Also, loaded question but do any of you self medicate?

Thanks

 
Old 08-04-2005, 09:44 AM   #7
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Re: TSH of 4.1? Please help!

Yes, some of us do, or did selfmedicate, before we found a good doctor. You'll get many opinions on it, if you do go that route do your homework - there's information out there that you can find that can help.

As for the new range, AACE offers a TSH fact sheet that states:

Until recently, physicians accepted the normal TSH range of 0.5 to 5.0 mIU/L. Recent data suggest that normal serum TSH levels may have a narrower range. For example, the National Academy of Clinical Biochemistry (NACB) guidelines believes that a sustained TSH level above 2.5 mIU/L might not be normal and that current TSH upper limits of >4 mIU/L are likely skewed by the inclusion of individuals with occult thyroid deficiency. The NACB guidelines were published in their entirety in the January issue of the Thyroid.

The following info is available for the NACB's Laboratory Medicine Practice Guidelines: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease:

"It is likely that the current upper limit of the population reference range is skewed by the inclusion of persons with occult thyroid dysfunction."

"In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L."

"A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism."

"Thyroxine requirements increase during pregnancy. Thyroid status should be checked with TSH + FT4 during each trimester of pregnancy. The L-T4 dose should be increased (usually by 50 micrograms/day) to maintain a serum TSH between 0.5 and 2.0 mIU/L and a serum FT4 in the upper third of the normal reference interval."

"A serum FT4 level in the upper third of the reference interval is the therapeutic target for the L-T4 replacement dose used to treat central hypothyroidism due to pituitary or hypothalamic dysfunction."

"It is now well documented that hypothyroid patients have serum FT4 values in the upper third of the reference interval when the L-T4 replacement dose is titered to bring the serum TSH into the therapeutic target range (0.5-2.0 mIU/L) (219,220)."


Good luck.
Nat
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Old 08-04-2005, 12:28 PM   #8
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Re: TSH of 4.1? Please help!

Here are the two URLs that explain what the AACE now says:
http://www.aace.com/pub/tam2003/press.php
http://www.aace.com/pub/tam2003/explanation.php

 
Old 08-04-2005, 02:53 PM   #9
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Re: TSH of 4.1? Please help!

NOLA,

Your other option would be to start talking to friends in your locale and see if they can recommend a doc who might go by the current AACE guidelines. When I had to find a new doc I wasn't expecting him to find me hypothyroid because even though I have all the symptoms (and have for years), my labs have been normal for 3 years. But, I needed to find someone who would take time to talk to me, not just push me in and then shove me out. He was going by the lab values given (.5 to 5.5), but when I talked to him about the "new"er guildelines he was more than willing to treat me (since I'd already been hypothyroid with a goiter back in 1997 and have a strong family history). It really depends so much on the doctor. But, you can change docs! And you may just find someone who's a better doc anyway.

Kali
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Old 08-05-2005, 06:48 AM   #10
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Re: TSH of 4.1? Please help!

Quote:
Originally Posted by midwest1
Here are the two URLs that explain what the AACE now says:
http://www.aace.com/pub/tam2003/press.php
http://www.aace.com/pub/tam2003/explanation.php

Thanks, Midwest, I didn't know we could post those links. Good to know.
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