[Bobbi]

#1066605

I read an essay written by an endocrinologist long ago, which stated that there was a very wide range of "normal" for TSH, and that, as a result, he believed that it would be possible to tinker with someone’s dose of replacement to enhance how they feel, without sending them into either hyper or hypo territory. But in recent years, doctors decided that more of the population becomes hypo as they age than originally thought (and the ranges of normal are based on averages for the population at large), so they adjusted the normal range of TSH accordingly — ie they narrowed it. So I don’t know if the author of the article i read long ago would still consider the range of normal to be wide enough to tinker much.

I have read articles in which a doctor argued that since there are dangers associated with being even slightly hyperthyroid (i.e. bone loss and muscle loss) it makes it more appropriate to find the middle of the range, if possible. Apparently, minor levels of hypothyroid do not carry similar dangers.

[James]

#1066606

I was just back from the Dr. recently and had him comment on my recent labs (TSH). The reference range and units of measurement can vary depending on your geographical region. Here in Canada (.2-6.00) mU/L is the standard. Regardless, it is a fairly wide reference range. My experience with Dr’s. is that as long as you are in the reference range, they typically don’t fuss too much. With that being said, some patients seem to be very sensitive to even minor changes in hormone, and other patients less so. For many years I insisted on testing FT4, FT3 and TSH. Together they can assist you and your Dr. in determining what is happening with your Thyroid and where you should be. The TSH as I understand it is typically an average over time. Whereas your FT3 has the most significant impact on your metabolic rate which greatly impacts how you are feeling.

Depending where you are at in your treatment, your Dr. and you will have to decide which labs are the most important to provide you with pertinent information.

In my stage of treatment, I have been stable (in remission) for the last 6 years, so I only test TSH at this point in time, but ONLY because my levels have been stable for a sustained period of time. My normal TSH (running average) is in the bottom 1/3 of the reference range. My FT3’s are usually in the top 1/3 of the reference range. So if there is a “sweet spot”, that is where it is for me. You and your Dr. need to study all of your labs over time to determine that sweet spot that is appropriate to you. Best thing to do is keep records of all of your lab reports and make notes or keep a journal.

Take care!

James

[genuinruby]

#1018707

I know that there is a refernce range for TSH, how does the doctor determine what your "personal" level should be after treatment? Does the doctor give you a number and say that most people feel best here…or do they just shoot for somewhere in the reference range. I have a fear of being "borderline hypo" again just because the lab test says I am in the "normal range".

[cathycnm]

#1066607

Ruby – I had a situation last year when I first went on replacement that I started feeling a little hyper after 4 months or so. My TSH was normal – but lower than my normal before Graves. I convinced my endo that the irritability and muscle aches were real and I needed a slightly reduced dose. I have been on this dose since that time and felt much better within 3-4 weeks. Interesting that when they rechecked my TSH 6 weeks after the change, it was almost unchanged. I believe it went from 1.7 to 1.86. So, I am a believer that it sometimes only takes a small change.

[Ski]

#1066608

Hi Ruby,

The real question is ~ will your doctor work with you to help you feel the best you can, or will they brush you off when you ask for help? The fact is that opinions among doctors are as numerous as the doctors themselves ~ in other words, everyone seems to have their own philosophy on this point. I’ve heard doctors say they target some particular, narrow range of TSH for GD patients following RAI or surgery, and everyone "seems to do okay." I’ve heard doctors say they’ll discuss symptoms and levels with their patients, and adjust doses in order to find that patient’s particular "sweet spot" for TSH. I’ve heard some say, "normal range, check, go away." You need to find a doctor that will work with you to make sure that you feel as well as you possibly can. Luckily, since replacement hormone takes time to adjust successfully, you have some time to find that doctor, if need be. Remember that once you’ve been treated by removing your thyroid (either through RAI or surgery), you can usually choose to adjust your replacement hormone through your general practitioner, ob/gyn, or internal med doctor, whichever works best for you ~ they often have more time to devote to you, which is definitely an improvement over the eternally busy endocrinologists.

[genuinruby]

#1066609

Thank YOU…I feel really special with so many INFORMATIVE replies. After more than 2 years of trying to achieve remission, as I see my TSH dropping into the hyper zone again, I am seriously considering surgery. Thanks again for your answers.

Ruby in Reno

[Author]

Posts