# article on new normals from American Association of Clinical Endocrinologists



## mccreel (Apr 13, 2010)

I don't know if anyone has seen this but I was doing a lot of searching and run upon this article. Just thought it was interesting and didn't know if anyone had seen that the American Association of Clinical Endocrinologists (AACE) had changed the standard for what was normal and a lot of Dr. 's had not followed. the web page I found this on is http://thyroid.about.com/cs/testsforthyroid/a/newrange_2.htm
"In the Fall of 2002, the American Association of Clinical Endocrinologists (AACE) announced that what was normal the year before, thyroid-wise, would now be considered abnormal. According to the AACE, doctors had typically been basing their diagnoses on the "normal" range for the TSH test. The typical normal reference range levels at most laboratories ran in the 0.5 to 5.0 range. The new guidelines narrowed the range for acceptable thyroid function, and the AACE was encouraging doctors to consider thyroid treatment for patients who test outside the target TSH reference range of 0.3 to 3.0, a far narrower range. AACE believed that use of the new range would result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated. At a press conference, Hossein Gharib, MD, FACE, and president of AACE, said: "This means that there are more people with minor thyroid abnormalities than previously perceived."

The target TSH level should be between 0.3 and 3.0
μIU/mL. Once a stable TSH level is achieved, annual
examination is appropriate.

http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf


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## GD Women (Mar 5, 2007)

Nothing new, this has been around for years. American Association of Clinical Endocrinologists January 18, 2001 recommendation that TSH range be lowered to 0.3 to 3.0 is just a recommendation, not that the range should be changed. AACE recommends TSH level between 0.3 and 3.0 as target levels for treatment once diagnosed with a thyroid issue.

I lost the link to the below with my computer crash, I am going to post anyway. The below are quote:

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*Quote*:
A reference range is a set of values used by a health professional to interpret a set of medical test results. The range is usually defined as the set of values 95% of the normal population falls within. Reference range will vary, depending on the age, sex and race of a population, and even the machines the laboratory uses to do the tests, as well as the different types of thyroid conditions. Also remember that by definition 5% of the normal population will fall outside the reference range.

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*Quote:*
Levels have not changed per se or they have not changed much for most Labs, and they probably won't for a long time.

There has been a lot of controversy on TSH levels among medicals and thyroid organizations/org. Therefore leading to misconception of TSH levels by the thyroid communities, which are saying TSH 0.5 and 2.5-3.0 mIU/L is for diagnosing.

As well as, there are Links with pharmaceutical companies which leads to suspicion of the TSH levels 2.5-3.0 so more people will fall into the hypothyroid category thereby pharmaceutical companies can sell more drugs.

TSH between 0.5 and 2.5-3.0 mIU/L 
is the recommended target for L-T4 replacement dose adjustment which is still a controversy among medicals. So there is a diagnose and target level controversy among medicals and thyroid communities.

".......recent arguments for and against treatment have been proposed......
We believe that treatment is indicated in patients with TSH levels >10 uIU/mL or in patients with TSH levels between 5 and 10 uIU/mL in conjunction with goiter or positive anti-thyroid peroxi-das antibodies (or both). These patients have the highest rate of progression to overt hypothyroidism. The target TSH level should be between 0.3 and 3.0 uIU/mL."

Some medicals believe that TSH assays is only a problem if are trying to establish a rigid TSH reference range that covers all groups. Some medicals and thyroid origination/Orgs. believe that its better to abandon the concept of a fixed TSH range, because it cannot be rationalized on either a methodology, biologic or practical basis.

The US Government panel guidelines set forth by U.S. Preventive Services Task Force (USPSTF) Jan 14, 2004 as follows; Individuals with TSH levels between 4.5 and 10 mIU/L have symptoms compatible with hypothyroidism and Physicians and patients must understand that there is insufficient evidence to expect therapeutic benefit in patients in this group.

The available data do not confirm clear-cut benefits for early therapy compared with treatment when symptoms or overt hypothyroidism develop.
Therefore, the panel does not recommend routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level.

American Thyroid Association, the American Association of Clinical Endocrinologists and the Endocrine Society convened a panel of experts to evaluate existing research and create practice guidelines. In hopes that the panel would confirm the TSH 0.03 to 3.0.

It back fired on them and instead the group/panel found no compelling evidence to treat patients, even those with symptoms, who have subclinical hypothyroidism, defined primarily as having slightly elevated (4.5 to 10 milliunits per liter) blood levels of thyroid stimulating hormone.

"It provoked a huge ruckus," in other words, it P.O.d the American Thyroid Association, the American Association of Clinical Endocrinologists and the Endocrine Society who were the medical groups that sponsored the review panel, strenuously disagreed and published a rebuttal in the January 2005 Journal of Clinical Endocrinology & Metabolism.

As much as I like and quote from American Thyroid Association, the American Association of Clinical Endocrinologists and the Endocrine Society, I personally think they don't want to be the bad guy, so they are letting certain thyroid advocates influence them over their own panels findings and other medicals.


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## GD Women (Mar 5, 2007)

*Con't*

*Quote:*
US Government panel guidelines set forth by U.S. Preventive Services Task Force (USPSTF) Jan 14, 2004 as follows:
TSH below 0.1 mU/L are considered low and values above 6.5 mU/L are considered elevated. http://www.ahrq.gov/clinic/3rduspstf/thyroid/thyrrs.htm

TSH of 4.5 to 10:
Subclinical Hypothyroidism With Serum TSH of 4.5 to 10 mIU/L
early levothyroxine therapy does not alter the natural history of the disease, it may prevent symptoms and signs of overt disease in those who do progress.

Individuals with TSH levels between 4.5 and 10 mIU/L have symptoms compatible with hypothyroidism and Physicians and patients must understand that there is insufficient evidence to expect therapeutic benefit in patients in this group

The available data do not confirm clear-cut benefits for early therapy compared with treatment when symptoms or overt hypothyroidism develop.

Therefore, the panel does not recommend routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level.

TSH Higher Than 10: (Overt (With normal or low normal F/T-4))
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.

The rate of progression is 5% in comparison with patients with lower levels of TSH, and treatment may potentially prevent the manifestations and consequences of hypothyroidism in those patients who do progress. Still, the evidence that therapy will reduce total and LDL cholesterol levels and improve symptoms in these patients is inconclusive.


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## GD Women (Mar 5, 2007)

I stayed up until 2:00 am trying to find sites that back up my *Quotes*, mostly to no avail. Lot of sites are Adobe. Windows 7 didn't come with Adobe and it takes 7 hours and 20 min. to download. I gave up after 20 min. The most recient information date I could find was 2004.

*Below is ACCES guidelines this is long and takes adobe.*
http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf
Try the Quick View

*U.S. Preventive Services Task Force (USPSTF)*
http://www.ahrq.gov/clinic/3rduspstf/thyroid/thyrrs.htm

*American Thyroid Association - ATA *
http://www.thyroidguidelines.org/

*Medscape*
http://www.medscape.com/viewarticle/473518


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## Lovlkn (Dec 20, 2009)

GD Women said:


> *Below is ACCES guidelines this is long and takes adobe.*
> http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf
> Try the Quick View


This is fantastic and needs to be sticky noted as a good review of all testing and options for treatment.

It took me a second or 2 to open so I am wondering if there is something going on with your computer.


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## GD Women (Mar 5, 2007)

I think the U.S. Preventive Services Task Force (USPSTF)
http://www.ahrq.gov/clinic/3rduspstf/thyroid/thyrrs.htm
should be listed as a sticky as well.

I don't know if something is wrong with my computer or not, it new. Windows 7 does not come downloaded with Adobe in which a lot of sites are doing now. With this particular ACCE site I was able to use *the Quick View*.

I have a lot of stickies:winking0051:


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