Here's a scenario that I see daily in my clinic: A patient comes in complaining of various thyroid related symptoms. She may have fatigue, thinning hair, depression, inability to lose weight, or some other hypothyroid symptom. After reviewing the patient's case, I discover that the patient has had her thyroid tested and her TSH is within the "normal" laboratory range of .35 - 5.0. Without fail, this patient is frustrated and confused. If they TSH is normal, why do the symptoms persist?
Well, there are several reasons for this. The first reason that I want to discuss is "laboratory ranges" versus "functional ranges".
Let's first discuss the laboratory ranges: Whenever you have a lab test done, the clinician will compare your results to a "normal" range. The common laboratory range is figured by taking a bell curve analysis of the results of all the people that came through a lab during a particular time period. The problem with this is that many of the people analyzed are sick and even already taking medication. So, the ranges are very broad to account for these patients. This means your results are actually being scrutinized and compared to a sick population. This does not give us a good idea of how you are functioning compared what the optimum level is for your body. We call this broad range the "laboratory range" or "pathological range".
Now, compare that to the Functional Range: Fortunately, several groups have done significant research and worked to come up with an ideal "functional range" that tells us what lab values would be normal for a body that is functioning optimally. (Some of these groups are The Endocrine Society, Dr. Harry Eidenier, and Balancing Body Chemistry) These ranges are based only on a study of healthy individuals without disease/pathology and who are not taking medication. Functional medicine practitioners like myself utilize this functional range so that we can detect "subclinical" dysfunctions and help support these problems before they progress into pathological processes. Functional ranges are much narrower compared to the laboratory ranges.
By comparison, the laboratory range for Thyroid Stimulating Hormone (TSH) is .35 - 5.0. The optimum functional range is 1.8 - 3.0.
Again, the laboratory ranges that most doctor's compare your lab markers to are far too broad. It's likely that a patient's family practitioner only ordered one thyroid test, which is TSH. If you are "lucky", maybe he has ordered a couple more, like a T4 marker. From your Doctor's perspective, if your TSH level is within that very wide lab range of .35 -5.0, you're normal. There's nothing wrong with you! But - and this is a HUGE "but" - the OPTIMAL LEVEL (or "functional level) for TSH is 1.8 to 3.0. So you could still be "normal" in the medical doctor's eyes but abnormal when we consider what the optimum thyroid function is.
It's only when the TSH range is above 5.0 that the medical doctor will put you on a thyroid hormone such as Synthroid or the generic, levothyroxine. And really, that's all the intervention that is normally offered.
So, if you're TSH level is , say 3.8, your doctor will say that you are in the normal range and you don't even need medication. Even though you may still have all the thyroid symptoms: extreme fatigue, hair falling out, weight gain, etc....you're NORMAL!
Well, you and I both know you are not "normal". If you were, you wouldn't still be suffering from these symptoms. The problem is that if you are outside of the optimum range of 1.8 - 3.0., you to have a whole host of thyroid symptoms.
In summary, one reason that you may have normal labs but still have thyroid symptoms is that most doctors compare your values to a "normal" range that is far too broad. Often times by taking a more critical look at your labs, we are able to see why you have the symptoms you are experiencing.
In the next segment, I will explain why you can still have symptoms even though you are taking medication and your TSH is in the optimum range.
Dr. Daniel Boggs
Beckley, WV
For questions, or to schedule a consultation, call (304)255-4325 or email drb@drdanboggs.com
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