Why is it better to sometimes have a low tsh level when you have got hashimotos as opposed to middle range when have not got hashimotos.

[susiebow]

[shaws Administrator]

I am hypo and it suits me to have a TSH of 0.01. The dose one takes is personal to them but the main question to know if it suits you is 'how do you feel' and if well it is the correct dose. Some may need a higher TSH . The following is Dr Toft's recommendation

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

[susiebow in reply to shaws]

I went from hypo hashimotos to hyper when my tsh went to 0.01 and free thyroxine of 26,max level being 18.I was very ill due to this and am still recovering ,still feel hyper ,my tsh 0.85.I always feel better at 1.98 ish or above.This has been ove ra period of 3 months.If Dr Toft says supressed tsh good then what on earth would he consider tsh with Graves.

[shaws Administrator in reply to susiebow]

Hi susie

I am sorry you are having a difficult time getting to a dose which makes you feel better. I am 'lucky' in that I have hypo as I understand with hashi's it is swings and roundabouts.

Before the blood tests came in patients were dosed until their symptoms went and this is a link to Dr Lowe on how he dealt with patients. Dr Broda Barnes, Dr Peatfield and Dr Skinner followed the same method of treatment.

Dr Toft didn't say suppressed is good, he said that some people need to have a suppressed TSH, particular thyroid cancer, to feel well.

The best way to adjust to thyroid gland medication (in my view) is to take enough to make you feel better, and adjusting up or down gradually till you get to the right dose.

Dr Skinner said the TSH should be used as a 'tool' along with the usual clinical symptoms. This is the link to Dr Lowe:-

read the first question and the second.

web.archive.org/web/2010103...

[howlyn in reply to shaws]

My view as well