thyroid question

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thyroid question

Postby tlotoxl on June 2nd, 2003, 3:18 am

I finally convinced the doctor here in Japan to give me a blood test two weeks ago, and had my electrolytes and thyroid levels checked. He talked me through the test results and said that they were normal and that though the TSH level was slightly high (at 5.31), it was within error of normal and nothing to worry about.

A quick search online (and would I even belong on aboutbfs.com if I didn't research these things independently? ;) ) suggests that a value greater than 3.0 is now considered suspect:

http://thyroid.about.com/library/weekly ... values.htm

Under .4 can indicate possible hyperthyroidism. Over 6 is considered indicative of hypothyroidism. *Note:* the American Association of Clinical Endocrinologists has revised these guidelines as of early 2003, narrowing the range to .3 to 3.0. Many labs and practitioners are not, however, aware of these revised guidelines.


My doctor doesn't really seem concerned, but 5.31 is definitely greater than 3.0, so what should I do? Is it second opinion time? Anyone here have insights into hypothyroidism?
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Postby dwl on June 2nd, 2003, 4:26 am

An upper level of 3 for tsh would include many normal people. You could always get the test repeated in a few weeks. Nothing bad will happen by leaving it for a while! Sounds like a job creation scheme for endocrinologists :-) Do these recommendations say what the evidence is for their suggestions or was it just a bunch of guys getting round a table?

A low tsh would point towards hyperthyroidism which might cause fascics so I guess there's not any link between your blood results and twitching.
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Postby dave YY on June 2nd, 2003, 6:59 am

You're definitely hypothyroid, at least by what the endochrinologists I have seen have said. And hypothyroid can also cause twitching, not just hyper. There are lots of people with thyroid problems and twitching.

My first endochrinologist in California kept my TSH between 0.5 and 1.1, saying the official levels are just wrong. I moved to Italy, and my Italian endo says anything over 2.0 becomes suspect.

You can ask for a stimulation test that involves in injection and blood drawing half an hour later... forgot the name of it... but you ought to see an endo if you're not feeling well.
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Postby tlotoxl on June 2nd, 2003, 7:11 am

Thanks for the posts. I guess I'll be looking into it with a second doctor soon.
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Thyroid

Postby jcavan4125 on June 2nd, 2003, 5:05 pm

Hi,
The information you have been getting is not accurate with regard to thyroid and TSH levels. Each lab has it's own range of normal (but anywhere from 0.35 to 5.5 will include most laboratories) and I have never heard of anyone calling 3.0 abnormal. In fact, 5.8 or 5.9 would probably only call for a repeat test in 6 weeks or so. I feel sure that it is not the cause of your symptoms.
Joe... "That which does not kill us makes us stronger"! - Nietzsche
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Postby dave YY on June 2nd, 2003, 6:19 pm

My endocrinologists have been unambiguous about the TSH labs (which don't differ that much from lab to lab). My first endo told me "yes yours are technically considered normal, but they're not what they SHOULD be."
I moved to Italy a couple years ago, and the one I see here at a university hospital told me on my last visit that "when someone's TSH is over 2.0 we start to get suspicious." I don't know if they are refering to everyone or just people who are symptomatic--but I do know at the time I was suffering from CFS and I magically improved by say 80 percent a few weeks after starting Synthroid. I now believe it was mostly, but not all, thyroid related illness. Now whenever my TSH goes over about 1.5 I know it well in advance from the symtpoms. Lots of symptoms.

Also, I think it was in Great Britain that the TSH levels have recently dropped officially to 3.0.

My last neuro in Indiana believed my hypothyroid was very possibly behind my twitching too.

Don't take my word for it, do the research (just from looking at the Healthboards thyroid board it looks to me like there's lots of supporting info out there) and ask an endo who specializes in thyroid. I might note, though, that I think this philosophy is more new-school than old.
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Postby Craig on June 2nd, 2003, 6:34 pm

I agree with Dave. The endocrinologist I saw at the Mayo Clinic in AZ said that she sees many patients whose symptoms don't go away until their TSH is at or below 2.0. I would think a borderline TSH is definitely worth treating.

The American Association of Clinical Endocrinologists (AACE) issued new guidelines this year to what a normal TSH is. Their new TSH range is 0.3 to 3.04. See below URL for article.

http://thyroid.about.com/library/weekly ... Hrange.htm
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Postby jcavan4125 on June 3rd, 2003, 4:56 pm

Craig your post intrigued me so I went to your hyperlink and read the article from AACE. I then went to the AACE web site and downloaded the thirteen page article on the AACE Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. It turns out the 0.3-3.0 figures are the new guidelines for treatment of hypothyroidism not for the diagnosis of hypothyroidism. In other words, if a patient is on medication (such as synthroid) for hypothroidism, the TSH should be kept between 0.3 and 3.0. The criteria for the diagnosis of hypothyroidism however, has not changed. A TSH greater than 10 is definitive of Hypothyroidsm and between 5 and 10 is suggestive but not diagnostic of hypothyroidism.
This brings me back to my original point that a TSH of 3.0 would not be suggestive of hypothyroidism. Hope this helps.
Joe... "That which does not kill us makes us stronger"! - Nietzsche
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Postby tlotoxl on June 3rd, 2003, 9:02 pm

jcavan4125 --

thanks for bring that up. i checked out the full guidelines for clinical practice and while i didn't read the full thing, it suggested that for subclinical hypothyroid (ie, raised TSH levels but normal FT4, which i have) treatment is controversial for TSH levels below 10 in the absence of goiter or positive anti-thyroid peroxidase antibodies.

so i guess i'll listen to the doctors here, for now (after being tested once more in a few weeks, perhaps).
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Postby tlotoxl on July 25th, 2003, 1:49 pm

well, i just had my blood taken again for another thyroid test. the doctor said that generally my cholestrol would be raised if i was hypothyroid, but my cholestrol levels are actually quite low. my resting pulse, however, is only 51 beats per minute, which is obviously slow considering that i'm not a triathelete or anything.

anyone else here have ridiculously slow pulses?
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Postby SusanSid on July 25th, 2003, 6:29 pm

I found the conversation about thyroid levels interesting. Having been worked up for thyroid disease I read a lot on it. I went to an endocrinologist at who's specialty is sublinical thyroid disease (meaning borderline levels) at the University of Denver and she said that the levels are lower now (for diagnosing and treating) for hypothyroid. She said you have too look at the TSH, T3 T4 and antibody tests, other lab levels as well as symptoms the patient is having before making a decision. She stressed how individual it is. She said you can be very borderline with symptoms, and with other blood levels that are abnormal and she would treat it.
My point is that is if you have a thyroid problem, borderline, or with symptoms of thyroid disease go to an endorcrinologist.....they are the experts. This field changes a lot and a GP cannot always keep up on the lastest info.
Also, if you have family members with hypothyroid, hyperthyroid or hashimoto's disease (antibodies attack the thyroid) you are at risk for thyroid disease and your levels and symptoms can change slowly or quickly. Just get it checked out if you are in an at risk group or have a family history...with a an endocrinologist is possible.
That's my 2 cents worth.
Sue :-)
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Postby tlotoxl on July 29th, 2003, 4:33 am

well, i just got my second test back (done two months after the first), and it lists my TSH at 1.96 (with lab norms 0.35-4.94). arghghg. so what does that mean? is it normal for TSH to fluctuate all over the place? could it be seasonal?
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Postby jcavan4125 on July 29th, 2003, 4:29 pm

Yes, TSH levels can fluctuate. Stress and illness are two factors that can cause variance. Medications can do it also. Remember that the actual result of any test can vary by the degree of lab error for that test (example If a test result is 3.0 but has a variance of 0.5 then the actual result may be 2.5, 3.0, or 3.5). Secondly, the so called normal range for any test is a bell shaped curve which encompasses 95% of the population. This means that 2.5% of the population will fall outside the low end of the range and 2.5% of the population will fall outside the high end of the range and they are still normal! So whenever a physician gets test results, he or she must weigh the results against the clinical picture and ask themselves "What does this mean?..and "What does it mean in this case?" In your paticular case, it seems that your first test result was likely a lab error or there was some other confounding factor that skewed the result.
Joe... "That which does not kill us makes us stronger"! - Nietzsche
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Postby tlotoxl on September 3rd, 2003, 3:29 am

just an update:

I had one more thyroid test, including thyroid antibodies this time. My results were a highish TSH (5.6) but also high-normal FT3 and FT4 (around 1.7 or something like that). Antibody test came out negative for Hashimoto's disease.

Anyway, my doctor - a Dutch guy running a practice in downtown *beep*, a relief for me to speak English to the doctor - seemed quite puzzled by my case but saw no reason for alarm or any special course of action.

...and so ends my thyroid investigation, for now.
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