Borderline thyroid tests: When should you take thyroid medication?

January 27, 2011 28 Comments by Scott Isaacs MD

A recent study found that many people have untreated thyroid disease. The study, published in the Journal of Medical Screening assessed over 4000 people between the ages of 50 and 65 and found about 8% have low thyroid levels. When weight goes up, many people suspect a low thyroid. But when they go to the doctor, they get the routine “TSH” test and are told “it is borderline” and probably not the problem. As an endocrinologist, I see this frequently. There are so many cases with borderline thyroid testing where the thyroid really was to blame. Once treated, thyroid patients lose a lot of weight without a major change in their diet or exercise routine.

Thyroid experts recognize the TSH test as the test of choice when thyroid disease is suspected. An elevated TSH test diagnoses hypothyroidism. TSH is more sensitive than other thyroid tests because it begins to rise before thyroid hormones drop. As such, it’s a better indicator of early thyroid dysfunction.

When the TSH test is “high normal,” in the range of 2.5-4.5, deciding to take thyroid medication can be a difficult decision. I’ve seen many patients with this situation. Frequently, thyroid tests in this range will normalize within a few months, other times, they progress to overt hypothyroidism. The first step is to repeat the test. I never make a treatment decision based on a single blood test. Experts recommend waiting 3 months to repeat a borderline abnormal TSH test, but if you have a lot of symptoms it is better to do it sooner.

In my opinion, many doctors take the easy way out and prescribe a low dose of thyroid medication when the thyroid is really normal. If you take low dose thyroid hormone and your thyroid is normal, it will make fewer hormones to maintain normal levels. So taking a low dose of thyroid hormone, even if you don’t need it may not do much. I’ve seen so many patients who have tried this approach and then come to me still complaining of symptoms. Some of these patients stopped thyroid hormone replacement and felt better. Others do feel better, but I have always wondered how much of this was placebo effect? A study was done to determine if treatment with thyroid hormone could improve the symptoms of hypothyroidism in people with normal thyroid function tests. The results, published in the British Medical Journal, showed that thyroid hormone was no more effective than placebo for relieving symptoms.

On the other hand, some people with borderline tests have early thyroid disease that is certain to progress. Diagnosing hypothyroidism in the early stages can be tricky. That’s because when the thyroid starts to fail, tests can remain in the normal range for a period of time. The first thing that indicates low thyroid is an elevated TSH level. A change from a low normal TSH to a high normal TSH over a period of a few months may mean early thyroid failure. If thyroid antibodies are positive or if the thyroid gland is enlarged the risk for thyroid failure is extremely high. If the thyroid antibodies are normal and the thyroid is not enlarged, the risk is much lower.

The bottom line is that many times there is no easy answer. If the thyroid is truly to blame, tests will become more clearly defined as time goes on. There is usually no harm in waiting a few months to make a decision about treatment.

Is Your Doctor Missing a Thyroid Problem? (outsmarthormones.com)
When should one take a thyroid test? (zocdoc.com)
Stress, Your Thyroid and Your Weight (outsmarthormones.com)

Buffer

28 Comments

Cynthia Woodson says:
Sunday, July 22, 2012 at 8:36pm

I am so thankful I found this article. I have been dealing with all the symptoms listed above and then some but to only get an elevated but NORMAL “TSH” levels. I exist on 1200 calories a day andphysical work after 5 months, lost 0 pounds. My endocrinologist has no empathy, nor does she has no empathy but not look at symptoms at all. I would like guidance on how to get help so I can get my life back!
Scott Isaacs, MD says:
Monday, July 23, 2012 at 8:15am

I hope my book can help you.
Scott Isaacs, MD says:
Monday, July 23, 2012 at 8:17am

http://www.amazon.com/gp/product/1936693224/ref=as_li_tf_tl?ie=UTF8&tag=intelligenthe-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1936693224
sylvia says:
Saturday, September 15, 2012 at 7:07am

I had tsh done in 2009,it was 5.5. Then skipped 2010 and 2012 my tsh was 5.8 should I take the thyrozine meds Im 60 and am hesitant on taking another pill. I m on bp pills,HTCZ,Lisniopril,40mg,generic coreg,12.5 twice a day,81mg aspirin.I feel good,am overweight,276 lbs. Thank You for your advice,oh another question,do I stay on the meds for the rest of my life?
Scott Isaacs, MD says:
Tuesday, September 18, 2012 at 3:07pm

Sylvia, Your TSH is borderline elevated (which means thyroid levels are slightly low). I recommend seeing an endocrinologist who can adjust the dose of your thyroid medication to get your hormone levels into the normal range. http://www.hormone.org/FindAnEndo/
Eva says:
Saturday, September 29, 2012 at 9:40pm

Over 10 years ago, I was disagnosed with hypothyroidism. In early Sept. of this year, I began showing symptoms of hypothyroidism again (weight gain, fatigue, brittle nails, hair loss, hives, feeling of a lump when swallowing, etc.). My doctor said that my TSH range is 2.93, T4 Free 1.1 and T3 Free is 3.0. I was diagnosed as being vitamin D deficient and was told that my thryoid is fine. The vitamin D seems to have given me more energy but my hives have gotten worse and the fatigue is creeping back along with other symptoms. Are my levels considered borderline for hypothyroidism? I’m not sure how long I should wait to see an endocrinologist.Any advice?
Eva says:
Saturday, September 29, 2012 at 9:55pm

I forgot to mention that I took medication for hypothryroidism years ago but was taken off of it because my levels were fine at that time, I gave that information to my doctor before my TSH levels were checked, My doctor seemed to appreciate the informatiion but seemed to be steered more towards a vitamin deficiency.
Scott Isaacs, MD says:
Sunday, September 30, 2012 at 8:54am

Making a diagnosis can be a challenge. Your levels seem OK, but there is a lot more to making a diagnosis than those numbers. I would see an endocrinologist now.
Eva says:
Wednesday, October 3, 2012 at 10:57pm

Thank you for answering my questions. I wasn’t sure what I should do. I trust my doctor but I also know that some of my symptoms seem to be getting worse so I’m curious to see what the endocrinoligist will find. I’ll be making an appointment to see one very soon.
Elena says:
Saturday, October 6, 2012 at 10:52am

This article was indeed a lifesaver. I am ordering the book now and plan to recommend it to many others I know with this problem! I am frustrated because my TSH is normal, but My free T4 (.56) and Free T3 (1.7) continue to be low. I am about to start nature-throid, but would like your opinion, Dr Isaacs. Thank you so much.
Scott Isaacs, MD says:
Monday, October 8, 2012 at 9:26am

Thanks for your kind words. Nature-throid is an option, if you want to take desiccated porcine thyroid. Here is a link to my article about alternative thyroid medications.
http://www.outsmarthormones.com/2012/09/28/finding-the-perfect-thyroid-medication-part-2/
Sakura says:
Friday, December 21, 2012 at 1:51pm

Hi

I was having frequent throat infections and i was under medication frequently because of the tonsils that i had. since i was becoming a bit pulpy the ENT asked me to take thyroid test.

I was first diagnoised with TSH level 5.67 and my scan showed bilateral thyroid. then we went to a endocrynologist he said lets wait for 2 more months, but unfortunately my mom forced me to meet another doc since the enlargment in the neck was obviously out a little bit. then tey took the tests and said the levels are normal in blood need to take FNAC. we did tat and found tat it was hashimotos thyroidites. then i was under medication with does of 37.5 mg. by chance i cheked the BP and found tat it was fluctuationg like anything. my cardio asked me to stop the pills and gave me BP tablets. then my bp came to stable as 130/80.they asked me to take general tests. in that everything is normal and the TSH level is now 2.68 and T4 is .1 more than the normal level. Could you please advise me on this. I feel i should have waited for 2 more months that my first doc asked me to. now i am feeling why i started with the pills and i dont know which doc should i trust. Please guide me on the same.
Scott Isaacs, MD says:
Friday, December 21, 2012 at 1:54pm

Sakura, definately work with your physicians to make sure your thyroid levels are in the normal range. I wish you the best.
Sakura says:
Saturday, December 22, 2012 at 4:10am

Thank u. i will defantely meet a good physician to get my health bak in good condition.

i have a doubt regarding the thyroid medication i heard that once i start the medication i can never stop it even if norma level is maintained. is it really true that we cant stop taking medications and once we start taking the medication the body will stop producing the harmones on its own??
Becky says:
Wednesday, February 13, 2013 at 11:41pm

My TSH test last year was 4.29. I just got the result of this year’s test and it is now 7.227. I revisit my doctor next month. My mother has hypothyroidism and she takes medication (that the dosage was recently raised again). I’ve been trying to lose weight these last 2 years – unsuccessfully -and have actually gained 30 pounds in this past year. Is it safe to assume when I see the doctor next month that I will be put on medication? Or should I request further testing?
Kathy Kealey says:
Saturday, February 23, 2013 at 3:19pm

My TSH is 6.66 and my Free T4 is 12 – I have been prescribed a low dose 25mcg synthroid medication with retesting in 3 months. I had wright gain and fatigue with some mild depression but I don’t understand the statistics – is a TSH of 6.66 borderline and whst dioes the Free T4 number mean ? Many thanks for your informative comments
krishna says:
Thursday, February 28, 2013 at 4:23am

i m 2 months pregnent n my TSH test was 4.75 .. so my gynecologys doctor told me that you have to take thyroid medicine 25gm half tablet in morning then after 10 day you have to take 1 tablet. So i want to know that should i take the medicine or not?
Lakshmi says:
Friday, March 29, 2013 at 9:54pm

Hi, i read your articles online and would like your opinion. My mother is a diabetic but under good control with HBA1C around 8 and has her TSH levels at 3.7. The doctor has prescribed medication but she is reluctant to take medication when it is not required. Kindly advise at what levels should she start taking pills?
Lakshmi says:
Friday, March 29, 2013 at 10:06pm

My mother’s age is 56 and she has been a diabetic for the past 13yrs. She has recently done a master check up and all other values are in the normal range except hemoglobin level and RBC which are slightly below normal. So should she take the pills for throid?
Rocio says:
Sunday, March 31, 2013 at 9:30pm

I have low thyroid and started to gain weight I’m starting to get depressed because I see no results with medication. I would like to know if anyone has got results with anything else or if I should expect the Worst.
Chiara says:
Friday, April 12, 2013 at 10:56am

Hi, I’m italian girl, 24 years old who is 41 kgs weight. My Ths is 4..35 on 4.5 of max range and my end told me is a rather normal bprderline TSH. Can hyphptyroidusm create a situation of a underweight? Or always TSH make a weight gain? Thank you and sorry for my english ^^`
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:31pm

Complicated situation. A lot of variables, I advise working closely with an endocrinologist who can address the big picture. I wish you the best.
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:33pm

When you say no results, do you mean your thyroid levels are still low even though you are taking medication? Or do you have symptoms despite normal thyroid levels?
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:33pm

Thyroid testing is necessary to diagnose a thyroid problem.
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:34pm

I would not say that A1c is “good” control. The American Diabetes Association considers A1c of 7% controlled. Above that number is considered uncontrolled.
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:36pm

Thyroid disease in pregnancy can be complicated. It is a good idea to work closely with an endocrinologist.
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:37pm

My book Hormonal Balance has a detailed decription of the various tests used to diagnose thyroid disease. The free T4 is used in combination with the TSH test to make a diagnosis and to assess the severity of thyroid disease.
Scott Isaacs, MD says:
Friday, April 12, 2013 at 12:54pm

Further testing is needed, I discuss the details in my book Hormonal Balance. Some people with your numbers end up having normal tests a few months later, but most people progress and need medications. I wish you the best.