What is Normal TSH?

Question

I was having a difficult time becoming pregnant. I finally got pregnant, but then miscarried. This was unusual for me because I quickly became pregnant with my previous four children. However, after my miscarriage I found out I am hypothyroid. My TSH was only at 5.1, but I was having many symptoms such as bladder trouble, strong PMS cramps, depression, foggy thinking, hair loss, cold etc…. After three months of being on 25 mcg. of Levothyroxine, my TSH is now 2.98. Most of my symptoms are completely gone. However, I am having muscle and joint pains in my arms, elbows, legs, knees, neck and back. These pains strike me all day long about every 20 minutes. I also still have extra fat on my thighs even though I am not overweight.
Do you think that my TSH is still not low enough? Can I be at 2.98 and still be suffering from hypothyroid symptoms? My doc does not want to increase my dose and thinks my level is now good. This confuses me because I am having these symptoms.

I am also hoping my ovulation has been corrected. I don’t know yet. As of last month, it was not. I only had about nine days between ovulation and starting my next cycle.

We are still hoping to have more children. I read that ovulation is often not corrected until the TSH gets down to about 1. I would appreciate any advice you have on this issue. It would be easier to get to the bottom of this, if I weren’t living overseas in an underdeveloped country. I got so frustrated with these symptoms this morning that I went ahead and took an extra half a pill. That brought my 25 mcg. dose up to 37 mcg. Can you believe I had no pains all day?! Could this have helped that fast?

Thank you for your help.

Margaret

Answer

Dear Margaret,

You have waded into controversial TSH waters. There is debate as to what a “normal” TSH (thyroid stimulating hormone) is.

First of all, a word about TSH; the higher the TSH, the lower the thyroid function. That is, the TSH has an inverse relationship to thyroid function.

Most laboratories report a normal range of about 0.4 to 4. However with regards to fertility, many experts feel the TSH should be 0.4 to 1 or 2.

In your case, since you still have symptoms, have fertility concerns and the TSH is greater than 2, it certainly would make sense to carefully increase your levothyroxine dose. The TSH should be monitored to avoid pushing below 0.5.

You may reason with your doctor that if he or she is comfortable with a TSH of 0.5 to 3, then why not try to titrate the dose upwards as long as the TSH is kept above 0.5.

In health,

George Delgado, M.D.

Answered By:

George Delgado, M.D., F.A.A.F.P.
President and Founder of Steno Institute and Medical Director of Culture of Life Family Services (COLFS), San Diego, is a Professional Member / Supporter of CANFP. Board certified in both family medicine and hospice and palliative medicine, Dr. Delgado received his medical degree from the University of California, Davis, and completed his residency at Santa Monica Hospital/UCLA. Dr. Delgado is a Natural Family Planning Medical Consultant, trained in NaProTechnology.

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