Push for additional testing, or consider finding a doctor who will order the tests for you. Without those additional numbers, however, a normal or borderline TSH will not reveal the underlying problem.

The problem is that some people who have a borderline TSH level may have changes to free T4 and free T3 that point to a diagnosable thyroid problem. Some doctors believe that only the TSH test is necessary and refuse to order free T4 or free T3 tests. The course of treatment to see 11 your symptoms improve, li your doctor is so number obsessed that it's like talking to an accountant instead of a health care practitioner, start looking for a new doctor. Ask for the actual number, and ask for the normal range for the lab where your blood was tested. Don't accept a response of wait-and-see.

In that situation, despite your symptoms, your doctor may refuse to treat you. Your TSH level may be borderline. Many doctors are still operating according to the old "normal" range and therefore will inaccurately rule out thyroid conditions. This also means that people who are receiving treatment but who have TSH levels in the "high-normal range" - above 2.5 - may in fact exhibit hypothyroid symptoms.

This would mean that millions more people would be considered hypothyroid, and qualify for treatment. What this means is that, while the so-called "normal" range at many labs may be listed as .5 to 5.5, and the endocrinologists now recommend narrowing the normal range to .3 to 3.0, there are experts who believe that the range should be lowered even further, to 2.5.

A serum TSH result between 0.5 and 2.0 mlU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism. Of specific interest are the following findings from the guidelines: In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mlU/L because >95°/o of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mlU/L. In late 2002, the National Academy of; Clinical Biochemistry, which is part of the Academy of the American Association for Clinical Chemistry , issued new Laboratory Medicine Practice Guidelines for thyroid testing. Your doctor may not be up on the latest thyroid recommendations regarding revised lab standards for the thyroid-stimulating hormone (TSH) test, which is considered by most conventional doctors to be the primary diagnostic tool. It may seem ridiculous that you have to struggle to get standard medical tests and treatment, but it's your health that is at stake, so keep fighting. In today's lawsuit-laden environment, doctors are especially concerned about officially documenting controversial medical decisions, so you'll probably get the tests you need. (You can then use this copy with the HMO to argue for a referral to another doctor if needed.)