Thyroid meds/ target levels

Medicines
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My last thyroid test was much higher than what it has averaged the last 10 years. But was still within “normal” limits. My previous endo was aggressive with keeping at lower end of range. But current one doesn’t agree. (I have been on T-meds synthroid, levoxyl, etc for over 30 years).

So i agreed to wait and get another test, which is coming up. I did have, and still have symptoms related to low thyroid, but until i saw previous results, had attributed that to other factors.

Any suggestions regarding thyroid ranges that work for you ? (TSH)

For example i found this, supporting lower ranges.

What should your TSH level be?

Normal TSH levels for the average adult range from 0.4 ‑ 4.0 mIU/L (milli-international units per liter) (3).

However, many organizations agree that a reading of 2.5 or less is truly ideal for normal thyroid levels, with anything 2.5 – 4.0 mIU/L considered “at risk”.

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I’ve never taken thyroid meds (yet). My last TSH was around 11. When confronted with this test result, I asked my Dr to run a free T3 test, which was normal. I’m asymptomatic, near as I can tell, so he agreed that drug therapy isn’t warranted at this time.

I’m under the impression that TSH is an indicator that doesn’t tell the full story - T3 and T4 tests are what’s needed. Correct?

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Sounds right. But my endo didnt agree to order tests, since my tsh was in range.

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My opinion is the reference range on thyroid tests is very fuzzy.

We have had lots of thyroid lab work. So rather than use lab reference range, we watched trend over many tests. Typically it was a panel and not just the one test.

In addition to lab work, just as important was symptoms that were likely thyroid related. Can’t only use symptoms IMHO as some of the symptoms are so general that pretty much anybody could say they have them.

But symptoms in conjunction with trending lab work is (IMHO again) a good approach.

And at the end of the day, what would the treatment be? For some thyroid issues, the treatment may not necessarily have significant side effects so potentially if borderline, it might be worth it to try the treatment, see if the symptoms resolve, run some more labwork while on treatment and see what that looks like. Then decide. Continue treatment, increase treatment, decrease treatment or stop treatment.

It is not always so easy to be exact. With some stuff, a good approach can be to feel your way through.

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Thanks. Unfortunately current endo believes in the reference range. Maybe he will order the full suite. Hopefully i will be armed with information to have a constructive conversation with him.

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Yep, that is correct. For my cat, too!

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In the years before I developed thyroid problems, my TSH was checked yearly and was almost always between 1.5 to 2.5.

Based on that evidence, I would say I do feel best when my TSH is between 1.5 and 2.5. However, my endocrinologist considers anything within the lab’s range (which for my lab is up to 5.0) to be normal.

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I have been athyroid for about 40 years after papillary carcinoma/ hashimotos destroyed my thyroid. For all that time I was on 150mcg daily.

My last idiot endo who I weat to after my endo passed away told me I had to cut down to 135mcg daily.

I tild him that I had tried that about 15 years ago and I ended up with triglycerides over 1000 and in near thyroid crises. I told him thank you but I’ll just stay on 150mcg. He unceremoniously dismissed me from his practice. I told him the feeling is mutual.

Needless to say I’m still taking 150mcg/day.

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Hi @Jen, I know this is an old thread, but Thyroid levels at/sub 1 but > than .4 are ok? Should these levels be concerning if they are consistent over last decade, or no?

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There’s a lot to say about this question.

First of all, this is a question for your physician, isn’t it? They’re the one who is supposed to have the comprehensive view of your condition and well being.

tsh is an indirect indication. It is a signal of how hard the control system is calling for the release of thyroxine into the blood stream.

The point of a “reference range” for a lab test such as tsh is to indicate that any value within the range is unremarkable in and of itself. Contrarywise, if the tsh value is outside the range, that’s interesting, it is a sufficient reason to look a little further. A low tsh is the body saying to the thyroid gland “I’m absolutely stuffed. Will you please back off and quit jamming so much thyroxine into this body! C’mon now…” Similarly, a high tsh says “Please, I’m begging you, can’t you give me some more thyroxine? Pretty please???”

So a value inside the reference range, by itself, says there’s no reason to look further. There is no “optimal” value. And anyway, the tsh is not a stable measurement, it fluctuates during the day as conditions change. But when combined with a collection of other imprecise observations, it may provide a clue. For instance, if I visit my physician and complain “I’m always tired, and cold, and constipated” and my tsh is in the normal range but towards the high end, that constellation of observations may suggest that the doctor order a test of t3 levels to see if I am somewhat hypothyroid, and my well being could be enhanced by adding thyroxine via a pill. It’s the constellation of symptoms and signs that becomes interesting, and it takes knowledge and experience to evaluate this well. In that respect it’s different from dosing insulin, where any yahoo can learn to add insulin if the BG is too high, and reduce insulin if the BG is too low, because of a direct cause and effect relationship.

So a tsh lab result isn’t a figure of wellness to be optimized, it is just a hazy, partial, and indirect indication. Kind of like the heart’s pulse rate. Normal is 70. If Eric goes to the doctor and his pulse is 55, the doctor may say “Excellent, I see you are keeping your fitness up to a superior level.” If granny goes to the doctor and her pulse is 55, the physician may send her directly to hospital for observation. It depends on the whole picture.

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Thanks for the perspective @bkh !