Is it always the case that TSH should be 1 or under, and is there any medical evidence that would convince my GP?

My latest results were

TSH 2.75 (0.3-4.2)

T4 16.7 (!2-22)

T3 4.5 ( 3.1-6.8)

I gave up all medication more than a year ago because every variation and combination made me feel worse. I'm certainly feeling better than I did, but still not regained anything like my full energy. I had subacute thyroiditis and I understand that thyroid function can recover from that, so am very reluctant to go back on medication.

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  • No, it's not always the case. TSH is really irrelevant - it's whatever the patient feels best at.

    The TSH should really only be used as a tool/guide to diagnose, with increases in meds until patient is well, or tries an optional meds if levo isn't making her feel better.

    What evidence do you want to produce to your GP re the TSH.

  • Something from the orthodox literature that might convince my GP that people can still feel ill with a TSH lower than the magic 4 which he considers the earliest possible indicator that anything is wrong.

  • As I see it, the TSH level needs to be whatever it needs to be when you are doing well.

    If the combination of your hypothalamus, your pituitary and the response of your thyroid happen to end up with TSH at 2.0 rather than 1.0, then so be it. There are many factors which can affect exactly where your personal TSH will end up. Further, as is often pointed out, TSH varies significantly by time of day - someone tested first thing in the morning is more likely to be diagnosed than that same person tested in the afternoon.

    When people write about TSH being below 1.0, I usually read it as if they are actually trying to say that:

    People on medication might need their TSH to be not only well below the top of the reference range, but towards the lower end of the range. Some, possibly many, find they need their TSH to be 1.0 or below, even below range, to feel good.

    My own TSH has never been below 1.0 when tested.

    Having said that, my own first TSH test, which in the fullness of time did seem to be when my thyroid hormone levels were starting to drop, was only somewhere around 2, certainly lower than 2.75. So I would certainly be keeping a weather eye open on the thyroid front.

    Rod

  • Thanks Rod. I'm pretty sure that means my TSH should be around 1.75 which is what it was when tested before the thyroiditis struck. My dilemma is that every time I've tried taking thyroxine, or NDT for that matter, I've felt much much worse.

  • This is a link re 3 different subacute thyroiditis:-

    emedicine.medscape.com/arti...

  • your results look reasonable to me although i personally believe your TSh could be lower and your free t4 higher but if you feel fairly well i would concentrate on taking a really good multivitamin

  • Thanks, yes, I agree about the T4 and TSH, though what to do about is the problem.

  • Your actual hormones T4 and T3 don't look bad really. I don't think many doctors would offer you thyroid medication on the basis of those results.

    Perhaps the lack of energy is caused by something else - Low Iron, B12, Vitamin D, etc.

  • Thanks, but I've been supplementing for months and they're all at good levels now.

  • If you email louise.warvill@thyroiduk.org and ask for a copy of the Pulse Online Article (GP cannot argue with this). It's by Dr Toft on questions/answers.

    You should give a whole copy to the GP to read before your appointment and then you can discuss. Point out question 6 in your case. The other questions may give your GP important info on other questions.

  • Thanks Shaws - that's really useful.

  • I'm not sure how you can lower your TSH without medication. If NDT and thyroxine made you feel worse perhaps your personal optimal level is above 1.

    Have you tried NutriAdrenal or any thyroid support supplements to improve function?

  • Yes I was seeing Dr Peatfield for quite a while, and even he couldn't come up with a solution.

  • You haven't mentioned T3 monotherapy. It's unlikely that one would be allergic or intolerant to T4 hormone but if you were it would explain why you didn't get along on T4 and NDT.

    PM me if you want a link for an online source.

  • Thanks Clutter, but yes I have already tried T3 with exactly the same outcome.

  • The only thing I can think is that the excipients in the meds you have tried don't agree with you and wonder whether NatureThroid or Westhroid NDT which are hypoallergenic might suit?

    I don't know how long you trialled other meds but it is not uncommon to feel worse when you start meds and I have read of people taking 3-6months to comfortably transition to NDT.

  • Thanks again Clutter - I didn't know that Naturthroid and Westhroid were hypoallergenic. Definitely worth bearing in mind if I can work up the courage to try again.

  • I had subacute thyroiditis last May/June. I was on 50mcg thyroxine, never went much past 2.5 on tsh and generally felt as if I was lagging and things were harder work than they should be. I'm now on 75mcg thanks to my great doc and am feeling much better. I'm also hoping for a return to normal function but...

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