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Thread: Thyroid Reference Range in the UK (United Kingdom)

  
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    Thyroid Reference Range in the UK (United Kingdom)

    Though this guide and reference is for the patients in the UK, other people suffering from thyroid issues could also use it. All you have to look for is the units of the test and the reference range.

    Most doctors in the UK usually refer to TSH (Thyroid Stimulating Hormone) as the base point from which they observe if a person is suffering from thyroid related illness. As a patient myself, I donít think this is the right approach hence I usually end up arguing with my GPs and doctors. Usually I end up winning as even most of the doctors donít have essential knowledge (I am no one to judge their competency but perhaps they have too much on to absorb) on how thyroid function works.

    Having said that provided your all other glands and systems are working find, you could use TSH to identify the potential problems with your thyroid hence this article and the reference range.




    Case 1 - TSH <0.03 and <0.1 mU/L
    (When TSH is between 0.3 and 0.1)


    ON THYROXINE REPLACEMENT

    Check for specified conditions where a suppressed TSH value is maintained namely;
    • Thyroid cancer
    • Informed patient preference
      Then make no adjustment to dosage unless clinically thought essential
    Hypopituitarism replaced with thyroxine often exhibit TSH <0.1mU/L and such is NOT an indication to reduce the thyroxine dosage Ė in such situations rely on FT4 (free Thyroxine) and TT3 (total tri-iodothyronine) maintained within the usual reference intervals.

    If there is NO specified reason for suppressed TSH (thyroid stimulating hormone) then;

    If on thyroxine 200mcg/day or more, reduce dosage by 50mcg/day
    Reassess in 3 months; clinical and TSH level

    If on thyroxine 50 to 175mcg/day then reduce by 25mcg/day
    Reassess in 3 months; clinical and TSH level

    If on thyroxine 25mcg/day then cease thyroxine
    Reassess in 3 months; if then TSH still suppressed refer to Specialist Thyroid Clinic

    NOT ON THYROXINE REPLACEMENT

    Refer to Specialist Thyroid Clinic
    Hypopituitarism may have TSH<0.1 mU/L



    Case 2 - TSH 0.1 to 3.9 mU/L
    (When TSH is between 0.13 and 3.9)

    ON THYROXINE REPLACEMENT
    No adjustment advised

    With dysthyroid eye disease it is essential that TSH does not become elevated above normal reference range at any time and so our advice is to provide sufficient thyroxine to maintain the TSH at less than 2.0 mU/L, so providing a margin of safety.

    NOT ON THYROXINE REPLACEMENT

    If TSH 0.1 to 0.3 mU/L
    This might be due to non-thyroidal illness so confirm low TSH after 2-3 months
    Refer to Specialist Hospital Clinic for assessment
    Take specialist advice if unsure for some clinical reason

    If TSH >0.3 to 3.9 mU/L
    Continue yearly monitoring




    Case 3 - TSH >=4.0 mU/L
    (Where TSH is more than 4.0)

    NOT ON THYROXINE REPLACEMENT

    If TSH >=4.0 up to 9.9 mU/L
    There is some difference in specialist opinion in UK with some advocating replacement whereas others will not do so unless thyroid antibodies are positive

    Specialists are advice replacement in all with TSH 6.0 mU/L or above and in those 4.0 to 5.9 mu/L where there are symptoms of hypothyroidism and/or thyroid antibodies.

    Begin thyroxine replacement
    Thyroxine 50mcg/day for 1 month
    (NB start at 25mcg/day in very elderly and cardiac disease)

    Then 75mcg/day
    Reassess at 3 months out from start of therapy; clinical and TSH level

    If TSH 10.0 mU/L or greater

    Begin thyroxine 50mcg/day for 1 month
    (NB start at 25mcg/day in very elderly and cardiac disease)

    Then thyroxine 100mcg/day
    Reassess at 3 months out from start of therapy; clinical and TSH level

    ON THYROXINE REPLACEMENT

    Check for compliance with therapy.

    Suspicion of lack of compliance with therapy is suggested by;

    Variable TSH values within and outside reference ranges over years despite adequate replacement dosages

    • High dosages of thyroxine (i.e. >=150mcg/day) and yet have raised TSH values
    • High TSH level with high FT4 value
    • Take advice from specialist if required
    If compliance satisfactory
    • Increase thyroxine dosage by 25mcg/day
    • Reassess in 3 months; clinical and TSH level


    SPECIFIED CONDITIONS AS DESCRIBED ABOVE




    Thyroid Cancer

    To prevent recurrence of the cancer TSH is maintained suppressed i.e. <0.03 or <0.1 mU/L by adequate thyroxine replacement. Follow up is complex requiring knowledge of thyroglobulin, anti-thyroid antibody level and clinical state and all such patients should be followed up by the Hospital Specialist Thyroid Service

    Informed Patient Preference
    Some patients have made an informed decision to take a higher dosage of thyroid replacement than is required to maintain the TSH level within the reference range. This usually results in a TSH level of <0.1 or <0.03 mU/L. This is a risk especially in those with dysrythmias such as atrial fibrillation and those with osteoporosis. In such circumstances the informed patientís decision is recorded and followed.

    Dysthyroid Eye Disease
    In those patients on thyroxine with dysthyroid eye disease it is essential that TSH does not become elevated above normal reference range at any time and so our advice is to provide sufficient thyroxine to maintain the TSH at less than 2.0 mU/L, so providing a margin of safety.

    Pregnancy
    Any woman on thyroxine replacement who becomes pregnant should increase their dosage by 25mcg/day immediately. Further adjustments may be required depending on monitoring TSH every 6-8 weeks during pregnancy.

    Hypopituitarism
    Hypopituitarism replaced with thyroxine often exhibit TSH <0.1mU/L and such is NOT an indication to reduce the thyroxine dosage Ė in such situations rely on FT4 and TT3 (FT3) maintaining these within the usual reference intervals

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    Please feel free to leave a feedback or you had somehow difference experience.

    Cheers

 

 

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