I am currently on 150mcg of levothyroxine. After a blood test recently, my gp contacted me saying that my TSH level was low at 0.20 (normal range 0.35 -6.00). She also stated that my level should be in 'the lower side of the normal range', but has suggested that I lower my does to 125mcg. I would've thought that if my level was low, then my does should be higher. Am I missing something..? Any advice appreciated. Have an apt with gp tomorrow, but just wondered if anyone could shed light..
Many thanks,
Tracy
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Tracylou21
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I believe your doctor is wrong. If you felt o.k. on your present dose she has no scientific reason to lower your dose. This is a link which will explain in more detail. Some of the links within don't work. PS physicians in the USA get paid to use certain pharmaceutical products.
It would appear that doctors are only told to go on the TSH. Dr Toft, of the BTA, himself has said that some of us need a very low or suppressed TSH or the addition of T3. email louise.warvill@thyroiduk.org if you require a copy. Question 6 applies.
It takes little cognizance in clinical practice to realize that this dose rarely is enough to keep a patient's metabolism normal. And rarely is this dose enough to free a patient from symptoms of abnormally slow metabolism. If patients are going to have normal tissue metabolism and good metabolic health while using T4, most of them must take a dose that suppresses the TSH level. It’s this fact that mainstream doctors need to come to understand, if they’re going to stop keeping their hypothyroid patients ill.
and
Dr Lowe: Your observations don’t suggest to me that your pituitary gland isn’t functioning properly. In fact, your observations are consistent with what science tells us about a patient's T4 dose, her TSH level, and her metabolic health or lack of it. If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours
I agree that your GP has no basis to reduce your dose on the TSH level.
However I would just like to explain something.
The TSH is NOT a thyroid hormone. It is a pituitary hormone, the Thyroid Stimulating Hormone. It is produced in the pituitary in response to LOW levels of thyroid hormone in the blood. As it senses there is not enough then it produces more TSH to give the thyroid a kick to get producing hormones. As the pituitary senses that there is enough Thyroid hormone (Either from the gland of from tablets) then it reduces the amount of TSH it is producing. In theory, then, a low TSH indicates enough Thyroid hormone in the blood. In other words, the lower the TSH, the more thyroid hormone.
And that's just the point. ENOUGH thyroid hormone in the blood.
For some strange reason, doctors deem it important to keep us in a state of permanent shortage of thyroid hormone because they feel the pituitary should be constantly calling for more!
The fact is, and it is so logical I cannot understand how they miss it. IF there is enough thyroid in the blood, then the Pituitary will not be 'switching on', or at least just enough to keep us ticking over! Hence low levels of TSH should be the desired result!
If you add to that the fact that the pituitary 'sees' the Thyroid hormone before any other organ because it is the most sensitive to thyroid hormone, then what you have is a delayed response in the rest of your body anyway. In other words, the pituitary may have plenty of thyroxine, while the rest of the body is starving.
Now I have to add that this is just my way of explaining using logic and the understanding I have gleaned.
The point of all this that it matters more how you feel than to make this hormone match up to an elusive 'norm'.
I hope I have not confused you with my musings, Tracylou!
Thankyou for your response..I think I sort of get the gist of it.. I do suffer with clinical depression, and it was whilst I had a spell in hospital for this, that they diagnosed hypothyroidism.. I guess I'll never know for sure whether my depression is affected by my thyroid problems - I'm always looking for reasons/causes, when there may not be any. My previous gp didn't test me for 2 years, so I switched to another, therefore getting this result. I've felt low and anxious for quite a while - maybe a year or two, and have often wondered if it's due to my thyroid. After re-reading your reponse Marie, I now think that my thyroid isn't affecting my depression. Tomorrow I will discuss it with my gp, and see if she can suggest anything else. She was going to rerefer me to the psych team, so I'm just waiting to hear..I really appreciate what you've said.. Thankyou..Sorry, if I've gone on a bit.
I suspect you really need to know what else is happening in your body first, because the link with depression and hypothyroidism is VERY strong, and in fact serious mental illnesses can result from under- or over-active thyroid. I am not saying DON'T go down that path, but really be sure in your mind that all other avenues have been explored, including diet.
I have been offered anti depressants twice when it was actually the thyroid which was the cause. Giving anti-depressants instead of treating thyoid deficiency can be dangerous. There are hidden effects of untreated thyroid deficiency which no amount of anti-depressants will prevent. The older you get the more they will start to appear. Prevention is better than cure!
Be absolutely sure that your thyroid is being properly treated first of all. I had agoraphobia and could not go out of the door for over a year. I am now optimally treated and my agoraphobia is disappearing. I can even go shopping alone. Yet my GP was doing his best to convince me it was nothing to do with my thyroid, and I needed anti-depressants to function.
I know some people DO need them, I am not dismissing them altogether, just really saying to be absolutely sure.
I know what you're saying about the link between depression and thyroid problems - it seems there are many people on this forum who have both. Looking back I've had depression since I was about 9 - I'm 46 now, and have been on Effexor 225mg for over 10 years, after trying other antidepressants, and seeing numerous therapists/counsellors. The first ever thyroid test I had done was 7 years ago. If there's such a strong link why isn't the thyroid tested routinely. I never know if the symptoms I get are thyroid or depression. When I said that I was down, anxious etc to a consultant, he said he wanted to know my thyroid symptoms, and not depression symptoms - how are you supposed to know the difference.. I think what you said about getting older, you get more symptoms - my anxiety/lethargy/ seems to be getting worse. It's good that you fought your cause, and can now go out. After everyone's advice, I feel better about going to see dr tomorrow..I hope I get positive results - I was an emotional wreck last time I saw her..!
I wish I had come on here before, maybe I would be feeling better now.
Many thanks! Marie for this brilliant explanation of TSH. I have copied it for further reference & when my GP starts to tell me yet again that my TSH is suppressed & wants to lower my medication, although I do have the basic understanding of TSH & it's effect on the thyroid but your explanation is far more enlightening. So armed with this info, I will now be able to enlighten him! thanks xx
These are a couple of links re depression/hypo. I think GP's should offer depressed hypo patients T3 added to the T4. T3 is the active hormone all our cells need to function properly and the brain contains the most and considering we are hypo T4 is supposed to convert to enough T3 and may not do so.
Hello Shaws, thankyou for that. I will mention it to Dr tomorrow, about the T3, and check out those websites.
Hi TraceyLou21, I agree with all of the above. You have to agree with your doctor to lower your meds. Dr Toft is now saying the FT4 is the most accurate way of seeing if you have enough tnyroxine. No blood test will tell you if any of these thyroid hormones are actually doing their job on the cells.
I got so sick of NHS doctors lowing my dose and making me I'll for months, i've now opted out and treating myself. I'm now losing weight and feeling improved.
I have had problems with depression for many years, i've found since treating myself 3 grains of Armour and 75mcg T3, plus getting treated for Pernicious Anaemia is helping a lot. Get your GP to check your B12, folate and iron. Mine was really low. I'm increasing my iron folate and having B12 injections, and my energy is increasing. The crippling anxiety is improving too. If you don't have enough iron for instance T3 can't travel to your cells where it's needed.
Thankyou Helcaster, for your response..My iron was checked in the last blood test, & I've heard nothing untoward. I'm not sure about B12 and folate. How do you go about treating yourself, and what is Armour..? I've never suffered with weight loss - in fact I've been underweight for most of my life, & seem to lose it quite easily, and other symptoms such as excessive sweating (which I suffer from..!), can be symptons of overactive..It's all quite mindblowing - maybe I've not discussed it enough with gp - like many others seem to say, they just go on numbers on paper, rather than talking to the person affected.
Many doctors say that the result of any test is normal if it is within the reference range. But people with thyroid problems need nutrients such as iron (for example) to be at OPTIMAL levels which is a much narrower range than the reference range. Usually it means that people need to have results in the upper third or the upper quarter of the reference range to feel their healthiest (although it depends on the nutrient - iron, for instance, breaks this rule, so always check on here first).
One piece of advice for anyone with thyroid and/or adrenal issues is...
Always, always ask for copies of your blood test results, and insist that the results include the reference ranges and units too. You need to keep a history of medications, supplements, symptoms etc, as well as the blood tests. You may be surprised at what your doctor considers normal!
Another thing to consider for the future... If you get to a point where you feel well for a few months, then ask your doctor for tests or (if necessary) pay for blood tests so that in future you can say "With my thyroid results and my nutrients at that level I felt well." It gives you something to work towards when things go wrong.
hey tracy, I don't have a thyroid anymore and I take 150mcg of synthroid. my ENT Dr increased my dosage to try and shrink nodules that have come back in my thyroid bed, (on the vocal nerve). I have asked him to lower my dose since my last labs shown that my TSH was 0.20. now I have recently been told I have Meniere's in my right ear and I'm thinking too high of a dose of synthroid since levothoxine is sodium. is anyone experiencing this same thing or even close? I have had symptoms of Meniere's since not long after I went on synthroid back in the 1990's.
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