Hi Dr. Lupo,
I have Hashimoto's, however my labs are normal. My TSH is 4.33 and my free t4 .9, free t3 230 TPO antibodies over 1000. I also am in premature menopause as of age 32, I'm 41 now. Doctors have gone back and forth trying me on thyroid meds. I can't tolerate even the smallest amount 12.5 levothyroid makes me feel hyper.
to put me on armour, and WOW it was like somebody turned on a light switch.. my thyroid panel levels all normal, feel like a million bucks.... So these new guidelines.. are they saying a Dr will not be allowed to prescribe anything but a syhthroid drug?.. some people cannot tolerate synthroid, in fact I know some who are allergic to some of the compounds in synthroid.. no way do I want to go back to a drug that made me miserable...
Every voice of dissent against their guidelines adds to the momentum for better care for all thyroid patients. I really appreciate you taking the time.
Dear MedHelp members, if you have not added your voice to patient discontent and concern over the AACE focus on TSH as the only appropriate diagnostic tool and T4 as the appropriate treatment for hypothyroidism, please consider doing it if you have a Facebook account.
In November 2002, AACE published revised guidelines that provided a new range for normal thyroid function. Until this time, 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. AACE encouraged 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.
For the purposes of their guidelines, the task force defined overt hypothyroidism as a Thyroid Stimulating Hormone (TSH) level above 10 mIU/L, and subclinical hypothyroidism as a TSH less than 10 mIU/L, with lower Free Thyroxine (Free T4) levels.)
The following are highlights of some of the Guidelines' key recommendations. The full list of guidelines can be read online at in the journal Thyroid.
I would take the synthroid for 4 months to shrink the thyroid nodule and i will take another thyroid function test and thyroid level test and we will go from there the last thryoid function and level test suggested i get a biopsy in the first place ......should i be seeing an endocrinoligist...because my primary care doctor refered me to an ENT docter and he is the one who put me on the synthroid......my original complaint to my dr.
Still, according to the American Thyroid Association guidelines, thyroid nodules that grow should be re-biopsied to be sure that a cancer hasn't been missed. There is disagreement as to how much growth warrants re-biopsy. The American Thyroid Association guidelines suggest that it is reasonable to re-biopsy a nodule if the diameter grows by 20% with a minimum increase in two or more dimensions of at least two mm (0.2 cm).
I will be getting my thyroid removed in a few weeks...I've been doing a lot of reading on it of course but have one worry and concern...I work for a freight transportion co. and on a daily basis lift over 50lbs and pull and push on containers weighing up to 5000lbs....doing work of this nature is it at all safe to go back to work in as soon as 2 to 3 weeks after surgery...
Continuing with the case of thyroid, TSH is a measure of thyroid function, and as the thyroid fails the TSH gets bigger, We know from studies in the heart as well as bench analysis that if the TSH is above 1, the thyroid function – its effects on different body tissues, is abnormal. Cardiac output, the ability of the heart to pump blood diminishes with a TSH above 1. Yet our lab range of “normal” continues to be 0.4 to 4.5 – a range so broad as to include a lot of sick people.
The scientific evidence is coming in to support using Free T3 and Free T4 along with symptom relief as the better scenario for many (most?) hypothyroid patients. Guidelines from the thyroid associations (or any association) are slow to change until the evidence is overwhelming. Patients demanding a better quality of life can drive change too!
One cannot overlook the underlying reasons for this slowness to change. Some might be that:
1. they will be admitting they have been wrong,
2.
With the ranges as they are currently, they should be considered as guidelines within which to adjust thyroid hormone levels as necessary to relieve symptoms. Unfortunately many doctors interpret results anywhere within the range as "normal" and want to do nothing further, unless pressured by patients to help get symptom relief.
If your doctor is willing to listen and discuss, then you might benefit from reading the article in this link and giving a copy to the doctor.
//www.aace.com/pub/guidelines/
Hope this helps some. I would start doing alot of research before her appointment with the endo!
Got diagnosed with an underactive thyroid 12 week ago with a level of 93 which should be 0.5 - 4.5. After unable to get pregnant for a year. My thyroid was down to 30 last month & I got pregnant but miscarried shortly after finding out. My thyroid is now down to 12 & iv been upped on medication again 100mg levothyroxine. I'm due to ovulate again any time soon. Do you think ill be ok to try again with it still being not quite right.
//www.medhelp.org/posts/Thyroid-Disorders/Major-Changes--AACE-Guidelines-for-Hypothyroidism-in-Adults-----------------/show/1810133#post_8339341
This is a huge change in guidelines, IMHO.
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•TSH (thyroid stimulating hormone) – Though the reference range according to the lab I work with is 0.5 – 5.5 mIU/L, I consider anything over 3.0 mIU/L suspect for low thyroid. (Important Note: The recommended reference range for TSH is now .3 to 3.0, according to National Academy of Clinical Biochemistry's revised testing guidelines issued in late 2002).
My doctor made me wait until I was 7.9 - ugh. In the meantime I got fatter and fatter, couldn't breathe (had to yawn like a weirdo a million zillion times a day and all through the night), had panic attacks, and lots of other classic symptoms. She doesn't believe in the new lower TSH guidelines that say we should be 1.5
I saw three other doctors before her who sent me home with a pat on the head and a doggie bag of anti-anxiety meds.
(Per Endo he follows current American Thyroid Assoc. guidelines for thyroid panel. This February I requested transfer to a different primary provider and she agreed to order TSH, FT4, FT3 but I just accessed my lab results and they only tested TSH which was 4.67 (per their report the reference range being .45-4.68) with no FT4 warranted. She did retest my Vit D which was now 21.5 and I did see she ordered me an prescription for Vit D 50,000 iu (twice weekly) which I am waiting for in mail.
The problem is that the ATA/AACE Guidelines for hypothyroidism say that thyroid medication dosage should be adjusted as needed to keep TSH in range. They don't acknowledge that taking thyroid med changes the relationship among TSH, FT4 and FT3. They also haven't yet acknowedged that a TSH in range does not always mean the patient is symptom free.
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