Hypothyroidism and TSH Levels: Other Websites

Purpose of this compilation

To show that the TSH (thyroid stimulating hormone) test is often not an accurate measurement of thyroid hormone function, and that if this test is used, the current reference range is to be questioned.

A. Medical clinics
B. Medical writers
C. Other

A. Medical clinics

1. Mary Medical Clinic: "Thyroid Dysfunction"

...physicians are not willing to trust their clinical judgement, and would rather place it in the hands of the laboratory technician....The gold standard has become the thyroid stimulating hormone (TSH). We have had many patients who presented to the Clinic, reporting that the other doctor did not lay a hand on them. He did, however do a lab test and determine that their function was normal and therefore so were they....

The problem with all this is the fact that the lab studies can be normal (and usually are most of the time), while the patient can truly be clinically hypothyroid.

Online at <www.maryclinic.com/thyroid.html> (accessed 2003/09/18).

2. The Regent Clinic: "Thyroid Insufficiency"

TSH is an indirect measurement, which reflects T4 activity rather than T3 (T3 is the more relevant to symptoms and well-being) and which depends on an intact feedback control system in the hypothalamus and the pituitary gland. We cannot assume that this system is always in perfect working order....we have been seduced by the precision of our tests into believing that borderline cases no longer exist and that there is a binary state — normal or abnormal. Human beings, of course, are not binary creatures!

Online at <www.regentclinic.co.uk/our_methods.htm> (accessed 2003/09/18).

B. Medical writers

1. Elaine A. Moore, author of Autoimmune Diseases & Their Environmental Triggers (2002) and Graves' Disease, A Practical Guide (2001): "Laboratory Tests for Thyroid Function"

...TSH [is] normally released in a pulsatile fashion, peaking during the night, and the changes in response are subtle, with TSH gradually responding to excess or diminished thyroid hormone. In patients undergoing medication changes or who are undergoing treatment for hyperthyroidism, TSH levels may take many weeks to many months to reflect thyroid hormone changes.

Thus, patients with abnormal thyroid function or abnormal thyroid hormone levels may have normal TSH levels in the early stages of thyroid dysfunction and after medication and treatment changes.

Online at <www.ithyroid.com/thyroid_test_interpretation.htm> (accessed 2003/09/18).

2. Mary J. Shomon, author of Living Well With Autoimmune Disease (2002) and Living Well With Hypothyroidism (2000), and About.com Guide to Thyroid Disease: "HELP! My TSH Is 'Normal' But I Think I'm Hypothyroid"

In my own experience, I feel downright awful at anything above 4, and I feel great between 1 and 2, which is where my endocrinologist keeps my TSH. But some doctors would have no problem keeping me between a TSH of 4 and 5.5, still in the "normal" range, despite the fact that I still have the full range of hypothyroid symptoms — fatigue, weight gain, irregular menstrual periods, dry skin, hair falling out — at those levels.

Online at <www.thyroid.about.com/cs/hypothyroidism/a/normaltsh.htm> (accessed 2004/09/02).

C. Other

1. About.com Thyroid Disease Weblinks and News: "What is Normal TSH? Probably Somewhere Around 1.0!"

I work in a hospital lab and have done thousands of thyroid profiles. I've discovered that, while normal range for TSH is 0.5-5.0, the AVERAGE TSH for patients with no thyroid disease, is around 1.0!

Online at <www.thyroid.about.com/blnwslnk.htm#normaltsh> (accessed 2003/09/18).

2. Breast Iodine Thyroid Effectiveness Society (BITES): "Hypothyroidism"

When patients have symptoms of hypothyroidism but their TSH lab results are within the lab ranges, most doctors either try to treat the symptoms individually or dismiss the symptoms and not treat them. This happens with patients who are undertreated and with those who are undiagnosed. Treating each symptom is like constantly repairing a car engine and all its parts because the car is too low on oil instead of keeping the oil at an optimal level. The result of denying hypothyroid patients that oil, or thyroid hormone, is numerous visits to doctors' offices to treat the individual ailments, which cost the medical system huge amounts of money. It also costs the economy in time that employees miss from work due to health problems. The loss of the ability to function properly is immeasurable.

Last online in January 2005.

3. Thyroid Australia: "'Normal' TSH"

The centre of the Reference Range is clearly not a good target point because very few of the healthy population have TSH readings around this point. A much better target point would be around 1.0 to 1.5.

[A chart showing the distribution of TSH levels of people without indication of thyroid illness is on the Thyroid Australia page.]

Online at <www.thyroid.org.au/Information/NormalTSH.html> (accessed 2003/09/18).

4. This site: A long compilation of patients' descriptions of where they need their TSH levels to be for them to feel well

Suchman: In order to feel well my TSH needs to be below .1 in a "normal" range of .4-5.5. When my TSH is suppressed like this my Free T3 and Free T4 are in the upper half of the "normal" ranges. If my TSH gets over .5 I get symptomatic.

Mike T: ...the TSH is not nearly as good as the free t4/t3. If my TSH was a 2, my t4/t3 levels would be way off and I'd feel just awful. My TSH is currently .5, but the free t4/t3 are balanced in the upper third of normal, t3 uptake is about median. So I ignore the TSH and I am currently sinus-trouble free.
Online at <www.altsupportthyroid.org/tsh/tshexp1pr.php> (accessed 2003/09/11).

SH: I barely have enough energy to go to get out of bed if my TSH is over 1.5.

Paula: I had hypothyroid symptoms at a TSH of 1.8, last spring, and for years before — my TSH tests were always "normal" — but apparently that is not normal for *me*. I had a TRH stimulation test which was resoundingly positive for hypothyroidism, when my baseline TSH was only 2.4 to 2.8.
Online at <www.altsupportthyroid.org/tsh/tshexp2pr.php> (accessed 2003/09/11).