Re: Elaine: TSH - New Reference Range

[Guest guest]

Hi ,

A large study on nutrition showed that normal people do not have TSH levels

higher than 2.0. This prompted the Institute of Medicine to question the TSH

range and ask that it be modified.

The National Academy of Clinical Biochemistry studied this and in October

2002 recommended that the range be changed. You should find a link to this

on the clinical chem site, which I believe is www.aacc.com or .org

Better yet, the American Association of Clinical Endocrinologists sent out a

press release in Jan 03 recommending these changes, with TSH reference range

changed to 0.3-3.04 mu/L. After I showed them the info and badgered the

pathologists a bit, the lab where I work changed their range in March and

sent info regarding the change in our hospital newsletter. I can see where

not all labs are going to be quick in changing their ranges until the endos

demand it. And not all endos read the press releases. You should be able to

find it on the www.aace site, which i think is .org but again may be .com

I'm working on a new project and my thyroid files are currently unaccessible.

But I have the link at work. if you can't find it, email me at

elaine.moore@... and I'll give it to you. Take care, Elaine

[Guest guest]

In a message dated 5/15/2003 4:38:16 PM Central Daylight Time,

daisyelaine@... writes:

> A large study on nutrition showed that normal people do not have TSH levels

> higher than 2.0. This prompted the Institute of Medicine to question the

> TSH

> range and ask that it be modified.

> The National Academy of Clinical Biochemistry studied this and in October

> 2002 recommended that the range be changed

I just got back my latest TSH level which was 4.5 uU/ml. The endo said that

was " technically a normal result, but is on the underactive side of normal " .

My February result was " abnormal " . She has therefore increased my unithroid

and is trying to get my result " in the ballpark of 1 uU/ml " . I'm not sure

exactly what this means, except I'm tired all the time with weight gain.

Terri

Graves disease 1979; treated with RAI; exothalmia 1982, treated with IV

steroids; since then on unithroid. New flare up of TED with severe double

vision, swelling in intraocular muscles and inflammation in August of 2002.

Currently hypoactive. Treating TED with prednisone. If doesn't work,

considering other options (surgical).

[Guest guest]

Hi Terri,

Being hypothyroid can make your eye symptoms worse. And the TSH test can be

falsely decreased in people with TSH receptor antibodies. Since you have TED

you likely have these antibodies.

While keeping TSH somewhere between 0.3-1.0 is a common goal in treating

hypothyroidism, it's more important that your FT4 and FT3 levels are within

range. TSH is a pituitary hormone and roughly reflects thyroid function,

whereas FT4 and FT3 measure the amount of available thyroid hormone in your

blood. It's high or low levels of these hormones, not TSH, that cause

symptoms of hypoT or hyperT. TSH is a good test for screening newly diagnosed

patients or stable patients but it can be very misleading in autoimmune

thyroid disease. Take care, Elaine

[Guest guest]

thanks, ,

I'll save it too and hopefully I'll remember where I saved it.

[Guest guest]

Thanks Elaine,

I think this was the press release you were referring to, I'll attach

the link in case anyone else needs it.

http://www.aace.com/pub/press/releases/index.php?r=20030118

[Guest guest]

In a message dated 5/16/2003 11:23:18 AM Central Daylight Time,

daisyelaine@... writes:

> <<While keeping TSH somewhere between 0.3-1.0 is a common goal in treating

> hypothyroidism, it's more important that your FT4 and FT3 levels are within

>

> range. TSH is a pituitary hormone and roughly reflects thyroid function,

> whereas FT4 and FT3 measure the amount of available thyroid hormone in

> your

> blood. It's high or low levels of these hormones, not TSH, that cause

> symptoms of hypoT or hyperT. TSH is a good test for screening newly

> diagnosed

> patients or stable patients but it can be very misleading in autoimmune

> thyroid disease. >>

>

According to my endo, my FT3 and FT4 are reading normal in the two tests

since February, but the TSH in both tests is reading low. Coupled with the

pretty severe eye problems and other symptoms of hypo (fatigue, unexplained

weight gain, etc.) she has increased my unithroid to .075 and then wants

tests again July to re-test with the goal of TSH of 1 uU/ml. They have never

done a TSI test. Should I ask for one in July?

Terri

Graves disease 1979; treated with RAI; exothalmia 1982, treated with IV

steroids; since then on unithroid. New flare up of TED with severe double

vision, swelling in intraocular muscles and inflammation in August of 2002.

Currently hypoactive. Treating TED with prednisone. If doesn't work,

considering other options (surgical).

[Guest guest]

Hi Terri,

Yes, because this is a good way to monitor active GO and your response to

therapy for it. Because you are now hypo and have had RAI, you should have

tests for both blocking and stimulating TSH receptor antibodies, since both

contribute to: the eye disease, your thyroid status, and both cause a falsely

decreased TSH.

Well the goal of reaching a TSH seems to be a good intention and would work

in people without autoimmune thyroid disease, in GD TSH does not accurately

reflect thyroid status. Only your FT4 and FT3 do. You no longer have an

intact thyroid-hypothalamic-pituitary axis controlling these hormones. Best,

Elaine