Endo - TSH levels?

[Iggy123]

I had a pt whos TSH level came back at 3.5, other labs normal...now according to the newer reccommendations regarding hypothyroidism thats technically a high TSH level. Well I was told by the resident that they don't consider this a high level until it hits 5 or 6, etc...but from what I have looked up online for the new rsch, some websites say anything over 2 is high and then some say anything over 3 is high and that the pt should be treated for hypothyroidism

What does the lab at your hospital say re: TSH levels? I find this very confusing as there is so many "recommendations" about what an acceptable TSH level is. Was wondering what other labs/MD's do or what you have experienced on your unit

I never knew there was so much controversy over TSH results before!

[Iggy123]

Anyone?

[TransplantRN3]

I'm not at work, so cannot check with our lab to see what is considered normal.. Found this online, though... "As of May 2009, at most laboratories in the U.S., the official "normal" reference range for the Thyroid Stimulating Hormone (TSH) blood test runs from approximately .5 to 5.0." Looks like what the resident told you was correct?

[mondkmondk]

I have hypothryroidism. My last level was a 4. Our lab considers anything above a 3 abnormal. Now, for a different perspective, I am also bipolar and the psych hospital I am sent to every so often for med changes, regards anything above a 1 to be abnormal for bipolar people. Allegedly, (this was their reasoning) the higher the TSH, the more prone to depression and suicidal thoughts/ideation especially in those with mental illness. They put me on a high dose of Synthroid (100mcg daily) and told me I'd have to watch it. My psychiatrist however, does not take care of this...my PCP now, used to be my RE, takes care of it. My RE also got fanatical if my TSH went too much above a 1.

Interesting huh?

Blessings, Michelle

[morte, LPN, LVN]

enough years ago, that i cant remember how many, i read about the national org. of endos congress agreeing on lowering the upper number (and i think the lower end as well) i think the upper went to 3.5 maybe it was 3.....anyway i would say you are on the cutting edge and the resident needs a brushup, which of course means his med school/mentoring doc does as well....good luck with that!

[OncallRN]

not all doctors are as up on new "normal levels"

is the pt having hypothryoid symptoms?

does she have antibodies?

even some endocrinlogists are not as up on new recommendatins as they should be.

[Iggy123]

no from what I recall the pt denied having any classic hypothyroid symptoms. I have been researching this on the side a big as I wasn't too familiar with all the thyroid issues before and from what I have read people have said it depends on the person some people feel awful at a TSH of 4 and others can be like 10 and not really feel anything

Do you think it may just be a cause of only treating when the person is symptomatic? I have been told that before too...

[Meraki]

The range has changed often and is extremely varied across doctors and geographic locations. The majority of healthy people have a TSH of below 2.5 however a TSH above that is not an indication that they have a thyroid problem. Traditionally in the absence of symptoms they would only treat as hypothyroidism if the TSH was above 10.

The problem is that in the western world the primary cause of hypothyroidism is an autimmune condition called hashimotos thyroiditis. (In other parts of the world it is an iodine deficiency) TSH is quite unreliable when Thyroid antibodies are present. It is very important if symptoms are present to test the FT4 and FT3 and antibodies, as you can not rely on TSH alone and decisions about treatment should be made based on the other tests.

There are also other things that can cause a TSH to rise (stress, pituitary, other hormone shifts, adrenal function, illness) that do not necessarily indicate hypothyroidism.

People can be perfectly healthy at very different TSH levels making it difficult to establish a true normal. Typically someone with a TSH of 3.5 and no symptoms and no other abnormal labs would be considered to be fine, although there may be a benefit to test every 6 months to ensure that it is not the very beginning of a thyroid that is going out of whack.

TSH can also shift very quickly, depending on the time of day and other variables like illness and stress so one slightly high reading of TSH alone really tells you nothing!

Many less traditional physicians are now treating primarily based on symptoms and more or less ignoring the numbers. I agree with this, while numbers can add to the story, the patient knows their body best.

[MJB2010]

My personal endo likes to keep my level between 0.5 and1.5, but she said up to 3 is "normal" . Last time I was checked, I went in due to feeling symptoms, it was around 4 and she upped my meds. I still do not feel better, but I am giving it a few more weeks.