Has Your Thyroid Been Properly Checked? There are many patients writing in with questions about their thyroid test results and it’s no wonder they have questions. Doctors, many times, are not up-to-date with the research and recommendations on thyroid treatment, and patients who rely on their doctor’s interpretation of their thyroid test results could actually have an undiagnosed thyroid condition. Why is there so much confusion regarding thyroid test results?

proper-thyroid-testingReasons for Confusion among patients and doctors regarding Thyroid Testing and Results
There are numerous reasons why patients have such a hard time getting help with a thyroid issue, but a main issue is the problem determining the correct reference range, and organizations are now acknowledging what patients have known for years, that the TSH reference values for “normal” were too high. (Note: It can also be confusing because if your TSH values are too high, this means that you have too little thyroid hormone in your body.)

1. Confusion among professionals regarding exactly what reference ranges in terms of lab results is normal. Let me explain, there are many different types of thyroid testing, but one of the main tests that family practice doctors may order is called the TSH test. Although it’s not the most conclusive thyroid test, it is the one that most doctors are familiar with, so generally, this is the first test that a patient may have ordered if there is a question about the thyroid. Normal Thyroid Reference Ranges may vary depending upon the laboratory used! What, you may say? Isn’t there one “standard” for thyroid testing? No, and that’s part of the problem. For example, some labs may still report TSH levels that fall between 0.5 and 5.0 to be “normal”. But you may not feel “normal” if your levels are within those ranges, and you may struggle with many symptoms of having a low thyroid level including weight gain or difficulty in losing weight even with appropriate diet and exercise. Even though there are now new guidelines that are being published in journals and discussed in the endocrinology community, many family doctors are not aware of the guidelines, or are simply relying on what the reference ranges of the particular lab that is used, to determine if treatment for their patients is necessary.

Back in January of 2003 the American Association of Clinical Endocrinologists (AACE) released a press release stating “Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrow margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now.”
If you have been told by your doctor that your thyroid results are “normal” and you fall outside the ranges of 0.3 to 3.04 you may want to Get your copy of the press release from the AACE now, print it out, and show your doctor the highlighted areas.

2. A 2nd organization, which is called The National Academy of Clinical Biochemistry and is part of the the Academy of the American Association for Clinical Chemistry (AACC), published the following Laboratory Medicine Practice Guidelines: Labor oratory Support for the Diagnosis and Monitoring of Thyroid Disease. This is also a document on Thyroid Laboratory Testing that you may want to Get Your Own Copy Right Now and Print it out and take to your doctor.

In this material which discusses laboratory testing and analysis it says “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.”

We’ll have many more updates about thyroid testing, and how to talk with your doctor about this very important issue. Maybe the most important thing is to learn to “trust” your body and to become your own best health care advocate if you are not feeling as well as you used to in the past. Before “accepting” that getting older means feeling worse, or that menopause means less energy and weight gain, or being told by your physician that you are simply depressed, you owe it to yourself to get your thyroid checked and to make certain that you are working with a physician who understands how to interpret the results properly.