# TSH is creeping up over the years



## momofzaf (Mar 27, 2008)

TSH 
May 2000 was .435-Low (bouts of diarrhea)
Aug 2000 was 1.4 (bouts of diarrhea)
June 2001 was 2.8
July 2006 was 3.11
March 2008 is 2.95

I have read anything above 2 can be considered hypo. My father has hypo, my aunt on mom's side has hypo. This winter, I suffered with excessive dry flaky skin, feeling cold, depressed for now good reason. Anti-dep has helped anxiety, and obsessive worrying, but not depression, in fact, I feel more tired now than ever, dry eyes, muscles aches and pains, and constipation. Some liver enzymes have been showing up low lately, and my cholesterol is high despite good diet, and that other cholesterol test is bad. When they do the T3 and T4-and they don't always, they are always within range. My oral temp is always low. I had a baby in winter of 1999. I think my thyroid was hyper initially, then burned out. Trying to get doctor to work with me is impossible. Can a person's TSH fluctuate within the "normal" limits and still be "normal"? I ask because a nurse friend of mine told me, "normal" lab ranges are just that ranges, but sometimes a reading that is within range, but not typical for a patient, can indicate an abnormal for that particular person. Also, Where to go from here?


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## GD Women (Mar 5, 2007)

I would not consider you as being hypothyroid with a TSH under 7 and in
most cases, under 10. TSH 2.95 is well within most Labs reference range for already treated patients.

What you hear from others, is from wishful people/want-ta-be's and not from medicals.

""normal" lab ranges are just that ranges, but sometimes a reading that is within range, but not typical for a patient, can indicate an abnormal for that particular person." Is pertaining to already diagnosed and treated patients and not meant for a diagnose level(s).

If it were me with TSH level as yours, I would not want to be treated and take pills. There are too many variables, some which are as follows: 
Data do not confirm clear-cut benefits for early therapy.
Early levothyroxine therapy does not alter the natural history of the disease, if there is disease. 
Levels can go back to normal or change for the better. Plus levels fluctuate for various reasons and you might take the chance of over dosing yourself with over medication, when you actually don't need the meds. with such a good TSH level in the first place. 
Treatment is not a 100% guarantee a cure-all for all symptoms.

Treatment of subclinical hypothyroidism remains controversial, and recent arguments for and against treatment have been proposed. Most medicals believe that treatment is indicated in patients with TSH levels above 
10 ccIU/mL.......

"The symptoms of both hyperthyroidism and hypothyroidism are non-specific and can be mimicked by other conditions. Thus the practice of prescribing thyroid treatment on a clinical basis alone without biochemical confirmation carries potential risks". Per new england journal of medicine.

Symptoms that seem like thyroid actually be a result of another low-energy disease and need to be corrected first before thyroid. Other illness or health conditions can worsen thyroid levels. To achieve lasting improvement you may have to treat more than one condition at a time. It is important that you obtain a full and complete diagnosis and treat in the appropriate order all conditions that may be contributing to your health issue(s)".

Subclinical thyroid disease: scientific review and guidelines for ... - guideline.gov/summary/
GUIDELINE TITLE. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. ...
Subclinical hyperthyroidism is defined as a serum TSH concentration below the statistically defined lower limit of the reference range when serum FT4 and T3 concentrations are within their reference ranges. ...subnormal serum TSH concentrations are common in a variety of severe nonthyroidal illnesses,.... Other causes of a low serum TSH must be excluded.

Subclinical Hypothyroidism With Serum TSH Higher Than 10 mIU/L. Levothyroxine therapy is reasonable for patients with subclinical hypothyroidism and serum TSH higher than 10 mIU/L.

Subclinical thyroid disease is, by its very nature, a laboratory diagnosis. Patients with subclinical disease have few or no definitive clinical signs or symptoms of thyroid dysfunction.

The Endocrine Society : Current Issues in Thyroid Disease Management 
NACB guidelines

Evaluating subclinical hypothyroidism. When serum TSH is between 4.5 and 10 mIU/L and confirmed by repeat determination, treatment should prevent overt disease. For these patients the panel does not recommend routine levothyroxine treatment, but it does recommend periodic clinical and laboratory monitoring.
For serum TSH greater than 10 mIu/L, levothyroxine is recommended to stop progression to overt disease.
Clinical context-such as actual or possible pregnancy, lipid elevation, and the presence of thyroid antibodies-should be considered. 
An elevated TSH alerts the physician to the need for follow-up and periodic monitoring to detect progression. Depending on the clinical circumstances, a TPOAb test might be ordered to further define the risk of progression. The point at which levothyroxine replacement should be considered is a matter of clinical judgment based on patient-specific factors.

View as HTML - aace.com
AACE positition statement on hypo treatment
AACE clinical practice. guidelines for the evaluation and treatment 
Subclinical hypothyriodism treatment is indicated with TSH 10
In conjunction with a goiter or positive anti-thyroid peroxidase antibodies or both TSH between 5 and 10.
Levothyroxine treatment: The target TSH level between 0.3 and 3.0

AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006 - Clinical Implications of the New TSH Reference August 15, 2006 Presentation: "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."

US Government 2004 Guidelines 
UK 2006 Guidelines, 
American Thyroid Association 
The Endocrine Society - Albert Einstein College of Medicine, New York. September 23, 2004 . 
The Johns Hopkins University School of Medicine and 
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004 
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today 
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005 
American Family Physician May 1, 2005 
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines 
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004 Revised Date: April 1, 2007


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## SBLU (Mar 28, 2008)

You might consider getting your estradiol (estrogen) level checked. My experience was that I had symptoms that could have been from Hashimotos (I have high antibodies but normal TSH and mostly normal T3 T4) but actually turned out to be from really low estrogen. I felt worse on the thyroid medicine and had to stop it... but much better when I was put on estrogen replacement therapy. I was only 41 when that happened but it made me realize that I had probably been suffering from too little estrogen for several years.

The other areas that I was deficient in were vitamin D and protein. Increasing my protein intake (meat protein - whey protein didn't seem to help) really helped in many areas. I also had a coq10 deficiency and taking that helped alot.

So there are many things that can mimic hypo thyroid but I can tell you from experience that if you take thyroid medicine and you don't actually need it is will make you feel worse.

I found a book entitled "Screaming to be heard" by Dr. Vliet very helpful. She discusses all areas of hormone replacement


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