New Thyroid Ranges for Hypo

iVillage Member
Registered: 11-09-2001
New Thyroid Ranges for Hypo
4
Sat, 07-17-2004 - 9:48am
Copy this article and bring it to your doctor if you need to educate him or her about your thyroid so that you can be properly treated!!

ENDOCRINOLOGISTS SAY TSH NORMAL RANGE IS NOW 0.3 TO 3

MILLIONS MORE HAVE THYROID PROBLEMS UNDER NEW GUIDELINES

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According to the American Association of Clinical Endocrinologists (AACE), 1 in 10 Americans - more than the number of Americans with diabetes and cancer combined - suffer from thyroid disease, yet as many as half remain undiagnosed. In order to counteract this lack of awareness and educate the public about the prevalence of thyroid disease, diagnosis, and treatment, in January, AACE continued its annual thyroid awareness campaign. The 2003 campaign, Hiding in Plain Sight: Thyroid Undercover, launched as part of the January 2003 Thyroid Awareness Month.

According to the AACE, 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. The new guidelines narrow the range for acceptable thyroid function, and AACE is now encouraging doctors to consider treatment for patients who test outside the boundaries of a narrower 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. AACE estimates that the new guidelines double the number of people who have abnormal thyroid function, bringing the total to 27 million.

AACE made the decision to narrow the range because of data suggesting many people may have low-level thyroid problems that could be improved with treatment and a narrower TSH range will give doctors reason to more carefully consider those patients.

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high - particularly since it is a condition that is easy to diagnose and treat," said Hossein Gharib, MD, FACE, and president of AACE. "The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

COMMENTARY FROM MARY

While it is a dramatic improvement in the awareness of endocrinologists that they are now realizing that the high end of the normal range was not, in fact, normal for most of the population, it's clear they still have a way to go when you read the words of Dr. Gharib, an endocrinologist and president of AACE. Dr. Gharib parrots the official endocrinologist party line when he states that thyroid disease, "is a condition that is easy to diagnose and treat."



This pronouncement contradicts Dr. Gharib's own statement. Until November of 2002, people who had clear symptoms of thyroid disease, but were in the .1 to .3, or 3 to 6 range on the TSH scale, were considered "euthyroid" or normal by almost all endocrinologists and practitioners, and were NOT diagnosed at all, much less easily diagnosed. People who had family histories of thyroid disease, symptoms (including enlarged thyroid, goiter, nodules, etc.) but whose TSH tests were in the low or high end of normal who were testing in these levels were routinely denied treatment, or told that their problems were the result of depression and given antidepressants. This has gone on for decades, as conventional medicine has relied on the TSH test -- often to the exclusion of clinical evidence, symptoms and medical observation -- to make a diagnosis. I would not consider this evidence of "easy to diagnose" -- particularly from the perspective of the millions of patients who have suffered with undiagnosed thyroid disease, not to mention the suffering that resulted from being misdiagnosed with a host of mental or physical ailments by their doctors, and prescribed various drugs, hormones, and other inappropriate treatments.

As for the "easy to treat" component, a survey I just conducted, reported on in this issue, found that more than 50% of respondents reported that they are not satisfied with their thyroid treatment. A Thyroid Foundation of America survey found that more than two-thirds of Graves' disease patients continued to suffer debilitating symptoms after treatment and while "euthyroid." A study published in the February, 2002 issue of the Journal of Clinical Endocrinology and Metabolism found that nearly five percent of Americans suffer from often undiagnosed thyroid disease. And those projections were based on the earlier .5 to 5-6 TSH "normal range." If thyroid disease is so easy to diagnose, why are millions of people undiagnosed?

Perhaps more telling were the results of the groundbreaking Colorado Thyroid Prevalence Study, reported on in the February 2000 issue of the Archives of Internal Medicine, the study found that among patients taking thyroid medication, only 60% were within the normal range of TSH (and again, that was according to the .1 to 5-6 TSH range). The fact that forty percent of patients, a number that translates to millions of Americans, are already taking thyroid hormone and being treated by a doctor but are still not in TSH range indicates that proper treatment is not as easy as Dr. Gharib suggests.

The inadequacy of treatment's ability to relieve symptoms was also addressed in February of 1999 when the February 11, 1999 New England Journal of Medicine published a landmark T3 thyroid drug study that found that the majority of patients studied felt better on a combination of two drugs, including levothyroxine (T4) and T3, and NOT solely levothyroxine/T4 (i.e., Synthroid, Unithroid, or Levoxyl) alone. Levothyroxine alone is the standard treatment.

The AACE has finally moved into the 21st century in terms of its awareness that the outdated TSH reference range needed revisiting, but it's just a first step among many much-needed revisions to the diagnosis and treatment of thyroid disease.

(Source: Canaris, et. al. Vol. 160 No. 4, February 28, 2000, "The Colorado Thyroid Disease Prevalence Study," Archives of Internal Medicine.)

iVillage Member
Registered: 06-22-2004
Sat, 07-17-2004 - 5:03pm
Just what I needed!!

Thanks Cathy for putting this up. I need it for my Wed. Endo appt. I was on the phone with my HMO today trying to piece together a history and it was really interesting because the advice nurse on the phone said, offhandedly, "but your last TSH test was normal, it was 5.5" and I told her about the new guidelines and she revealed that SHE has been battling with her provider (my HMO) because she is symptomatic with TSH of 5 and her MD won't diagnose/treat her!! So I decided to check back here and see about some hard evidence to bring along with me... just in case the Endo doesn't know, and here it is! So, thanks much.

ps. I also found out today that I was never screened for Thyroid before, during or after my pregnancy... until I asked them to because of family history (I was afraid to get pregnant again without some answers after 2 miscarriages: one before, and one after, my daughter: it also took me 2 years to conceive my daughter; internet research revealed thyroid as a poss. which rang a bell because of my mother, grandmother and aunts). Incidently, I am the only person in my family to have preeclampsia and I just learned last night on the AACE website that there's a link with hypo, so I suspect I was hypo during my pregnancy... I'll never know without the tests, though. I'll try not to dwell on any of it, I'm simply hoping to get enough info to be able to say with confidence what's 'normal' for ME. ...But first I need a nap :)
iVillage Member
Registered: 11-09-2001
Sat, 07-17-2004 - 6:29pm
I'm so glad this helps!! I think one of the most interesting parts of all this is piecing everything together and realizing what symptoms you had when and what your thyroid may have influenced without you knowing it. When I think of all the work I did around our house 4 years ago while I was feeling that overwhelming fatigue, I could just shudder. We had just moved and I packed our old house, unpacked here, painted rooms, cleared the back yard, planted gardens, put in a slate walk way, etc!! Oh well, like you said! :) Cathy
iVillage Member
Registered: 04-21-2004
Sun, 07-18-2004 - 8:36am
Thanks! I have printed this out and will take this to my Endo appt. next week. Appreciate this information! Makes sense- there is certainly a strong family history of thyroid problems in my family plus everything else!

Sherry

iVillage Member
Registered: 11-09-2001
Mon, 07-19-2004 - 8:43am
Hi Sherry - I'm glad this will help you! Cathy :)