I've been on a trial of Armour and due for review by Endo. I expect my TSH will be suppressed (it was last time) but Endo has warned me that he'll be cutting my dose if it is. He doses by TSH, even if FT4 and FT3 are well within normal range, as he says they fluctuate too much throughout the day to be of value in this instance.
But I'm sure I've read somewhere that TSH is useless as a dosing guide when on any type of NDT as TSH will always be suppressed. Can anyone fill me in? I'll be getting blood test results from Endo today/tomorrow and he'll be deciding my new dose there and then.
Although he's an Endocrinologist (and open-minded one at that), he specialises in diabetes and usually needs nudges in the right direction. I'm worried that he'll cut dose, especially just as Winter is coming as I was very unwell last year as soon as it got cold.
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CathyT
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There is a site called TiredThyroid.com, I have just discovered and there is a section on the uselessness of the TSH blood test, with references to studies, which may help you. Lots of other info too that you may find useful. Hope you keep the same dose. xx
I am on 50 mcg T3 and my TSH is always below 0.1 for me to feel well. My doctor says he bases my dose on my symptoms not on TSH as, while it is easy to measure, it is not an accurate guide to what level of T3 a patient needs. If you feel well and do not have high pulse rate, high blood pressure or palpitations you should not decrease your dose. Take a copy of eg paper referred to by Hennerton above to support your request. I take doses at 6.45am, 12 and 5.30pm, so I arrange blood test for 5pm and delay my tablet. A test not long after a tablet gives false result! Good luck.
You are lucky your Endo has prescribed Armour and I suppose he is a little nervous due to the British Thyroid Association's false statement in their guidelines about NDT. That's why he is concerned about the TSH as the BTA say the TSH is the 'exquisite test' and meds should be titrated accordingly. He wouldn't want to lose his livelihihood as the GMC may ask him to 'report' to them.
We, on this forum, know that several statements the BTA make are false.
The BTA allow thyroid cancer patients to use suppressive doses and I doubt they have come to harm
I know when my Endo added some T3 to T4, the thyroid nurse phoned urgently to tell me to stop the T3 as my TSH was undetectable. I refused (I had a month's supply of T3 left) so I was told to reduce the T4, so all was well. Armour or other NDT is complete in that the hormones are all in one tablet. I don't know if it would make a difference but I would miss out Armour the day before your blood test.
I take Armour and my TSH became supressed even on a relatively low dose. I am currently taking 3 grains and my TSH is 0.05. Dr Starr in his book on hypothyroidism says that any dose over 2 grains will supress TSH though mine was supressed at a lower dose than that. Do not take your Armour on the day of the test until after it is done as this does make a big difference to results.
Your doctor should read the transcript of the thyroid petition where Toft recants on the TSH:
"Dr Toft: Most laboratories—I think possibly now
all laboratories—will provide T4 and TSH for the
diagnosis of an underactive thyroid. There was a
spell, for which I was partially responsible, when
we thought that TSH alone was a perfectly
adequate test in the diagnosis of hypothyroidism.
The foolishness of my claim was soon discovered. "
Dr Toft was the doctor who was responsible for the guidelines that have been keeping us sick. He's now on the ropes ...
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