Note: The text below is a transcription from the video above. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
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what is the optimal TSH level? I don’t think anybody knows. I really don’t, but here’s the back story on that. When I got into this, so there’s a medical lab range and it’s better known as a pathological lab range. So most of the medical ranges that you see on your lab test in Labcorp or wherever you go are medical, pathological ranges. Meaning by the time those ranges really become positive on your test, and positive means it’s not a good thing, there’s a lot of damage that’s already taken done. Now we’re at the end point and it’s showing up on that range. Now it’s let’s take his medicine or something like that.
But when we first started out in chronic conditions, and chronic pain, and chronic gut problems and realized that Hashimoto’s was an issue and autoimmunity was an issue, and that the ranges, everybody was told that their lab tests were normal for everything, not just thyroids but everything. Then there were biochemists who started to shrink the ranges down. So back then the optimal range in the functional world. So the functional world was we wanted to know about dysfunction. The patient would come in, they’d have all of the symptoms of a disease, of a condition, whether it was insulin resistance or whether it was SIBO or whether it was Hashimoto’s or whatever it was, but yet all their lab tests were normal.
So we wanted to know what was going on with the organs that caused those symptoms because dysfunction precedes going into pathology. Eventually you’re going to get into the pathological ones. So the biochemist that we followed made… The pathological range for Hashimoto’s was 0.45, 0.45 to 4.5 and that’s the range for thyroid stimulating hormone. I just said Hashimoto’s, but I meant to say thyroid stimulating hormone. So that’s still the range for them.
Now in the functional world, we’ve used ranges that started from 1.8 to three, which is a very narrow range for your TSH. This was 20 years ago. As time has gone on, that range has changed from by observing different research projects, by just observing hundreds, thousands of physicians observing that range went to one to three. So currently I am using the range one to three. 1.8 seemed a little tight and I thought that when we were using it and then it was suggested we use one to three and I feel like I’m getting a better grip on what’s going on with that thyroid patient using that range.
As I say, the real backstory on this is that ranges have changed forever. I could go into cholesterol. When I was in school, high cholesterol was 275 and it keeps coming down and coming down. There are some people who are irrationally now saying it should be under 100, in my opinion. Some people will tell you it’s 150 and other people will still stick to it should be under 200 and so on and so forth. So it depends on the doctor that you go to. But these ranges keep changing and changing. Ranges will change from lab to lab. You’ll go into one lab and the range will be one thing and you go into another lab because they use the average of the patients who come into that lab. So the ranges, they have always been ballpark figures.
That’s when you’ve heard me say, it’s really important that you take a really, really good history and if possible, do a good exam and try to do all of that type of procedure, diagnostic procedures. It’s important because you should have a pretty good idea what’s going on with people by the time you get to the point where you have to look at their TSH lab ranges. Because one doctor’s going to be going 1.8 to three, the other one’s going to be going one to three. The other one’s going to be going 0.45 to 4.5. So that’s the point. The point is when I said nobody knows is nobody probably still knows.
I was just talking to a colleague the other day where the ranges for free T3, which is a thyroid hormone that actually goes into the cell and creates the metabolic response in your mitochondria, that your energy making organelles in there, that we’re raising it. We being the functional medicine world. We’re raising that to four to 4.5 at the top range and we had it down to one to three. Well, four to 4.5 is the pathological medical range. So I’m going to try that out for a while and see what happens. I don’t know if we’re going to be getting to the point where a person gets to 4.5 and they start getting symptoms of having too much T3 because I’ve been working with a different range.
So when you go to your doc… That’s the problem with the ranges. It’s more not what is the ideal TSH range? It’s more, how’s your doctor working you up and are they looking at the labs? I have had patients, and one last thing before I stop. I had one patient, this is a perfect example. She came in here and she was in her eighties and she was taking thyroid medication and it was not working and so on and so forth. So she ended up having an autoimmune thyroid disease. So when you have that, you treat the autoimmunity first. You pull all of these dietary triggers and chemical triggers and that’s what we did with her. All of her symptoms that she had when she walked in the door went away, everything. So then we retested her and her TSH was 8.2, which is high in anybody’s range. So we sent her to the doctor and he gave her 25 micrograms of a thyroid hormone. Let’s say it was levothyroxine, but 25 micrograms is the lowest dose. She immediately got massive hyperthyroid symptoms.
So for her eight point whatever I said it was, 8.2, or 8.3 or 8.5 it was somewhere in there, whatever that was, that’s her TSH, that’s her normal number. So it’s really all over the place. I would probably use the two ranges of a medical doctor 0.45 to 4.5, but I would probably use the range. Right now I’m kind of comfortable with the range of one to three. That seems to be the most accurate one I’ve been working at, working with and I’ve been doing thyroid for quite a while now, pretty steadily since about 2008. So I wish I could give you a better answer on that, but that’s the reality that we deal with every day in the practice. That’s why we do the extensive histories and occasionally have to get into doing good exams and stuff like that. Hope that does answer your question. So I hope that helps.