Hypo with low TSH- huh?

[Meds456]

I've just got my lab results back. 7 weeks ago my TSH was 4.7 so the doctor gave me 50mcg Levothyroxine as a starter dose. She said I was borderline hypothyroid. Just had my first set of bloods come back since taking levo and my TSH is 1.28 (range for both is 0.27-4.20). The comments on the report say: Results suggest that the dose of thyroxine is correct. Normal- no action.

But... I don't feel any better! I had a glorious few days when I first started taking levo where I felt awake, alert, sex drive came back, had energy, and then it petered out.

I have a GP appointment tomorrow. How am I going to handle this test result?

[Jazzw]

Hopefully your doctor will be one who treats you rather than your lab test numbers. You may be able to persuade him to up your dose by another 25mcg to 75mcg per day.

TSH of people on medication is usually comfortable just above or below 1.0. Scroll down to Guidelines and Treatment Options to read Dr. A. Toft's comments in Pulse Magazine thyroiduk.org.uk/tuk/about_...

It says: "Dr Toft states in Pulse Magazine, "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.

"This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

If you want a copy of the article to show your GP email [e-mail]

[Clutter]

Meds456, tell your GP what happened when you first started 50mcg and how the improvement in symptoms petered out until hypo symptoms resumed and ask for an increase to 75mcg. The link in Jazzw's post states that some patients need a slightly lower TSH in order to resolve symptoms and enable the patient to feel well.

[shaws]

I hope the GP ups your dose by 25mcg at least. If he/she suggests that your results are now in the 'normal' range tell him you are now having other clinical symptoms and that it is recommended that we get sufficient levo to bring the TSH to 1 or below.

If you go to the question dated April 22, 2007 to read the effect of too low a dose.

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

[puncturedbicycle]

You may already know to take the levo on an empty stomach and away from iron? But I thought I should mention it in case you don't. Sometimes doctors don't bother to tell you.

[greygoose in reply to puncturedbicycle]

Most doctors don't even know!

[greygoose]

Hi meds, that TSH result really isn't surprising. The reason they 'invented' the TSH test was to prove that synthetic T4 'worked'. But what they meant by 'worked' was just bringing down the TSH to within the unrealistic ranges they set - nothing to do with how the patient felt! So, even just a little T4 can bring the TSH down.

What you really need to estimate your thyroid status is the Free T4 and the Free T3 - especially the FT3, because T3 is the active hormone that works in your body. T4 is only a storage hormone. However, due to the state of supreme ignorance reigning in the NHS, a lot of doctors don't realise the importance of these tests and refuse to do them. And if they do order them, the lab most times refuses to do them if the TSH is 'in range'. It's all lunacy, but that's the way it is.

Even so, the most important is how you feel. You do need an increase in levo if you still have symptoms.

Hugs, Grey

[Meds456]

Thanks everyone. I didn't know you shouldn't take Levo before you get your bloods done. I took it about 2 hours before the test. Surely if you don't take it, it skews the result? Aren't we interested in the blood levels when medicated?

[Muffy]

You must have a thyroid hormone test, the TSH is a pituitary hormone! FT4 should be done and also FT3 and antibodies, but the FT3 and a.bodies are unlikely to be done.