TSH

[Fran777]

I live in the USA. I went online (private) to request my TSH blood. Got result of TSH of 86.350 (0.45 - 4.50), is this considered a medical emergency? Have been trying different NDT since April 2015. When my dr. gave me orders on 7-16-15, my tsh was 14.30 and within a month is up to 86.350. Your information will be greatly appreciated.

[Clutter]

Welcome to the forum, Fran777.

It's not a medical emergency but you should see your GP as soon as possible to have your dose increased. You should be very careful driving, TSH >20 has been shown to impair reactions more than being over the drink drive limit. What dose are you taking?

You can maximise absorption of thyroid replacement by taking it with water on an empty stomach, 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from iron, calcium, vitamin D and oestrogen.

[Fran777 in reply to Clutter]

Thank you Clutter for your prompt reply. I was taking Armour but in 2010 after the reformulation I did feel as good as before. I had a lot of stomach issues such as acid reflux and/or bile reflux, constipation, leg swelling, low motivation, weakness in legs and arms.

* April 9, 2015, I started taking Thyro Gold - 300 mg for 17 days and 600 mg for 14 days but did not agree with the me.

* I switched to Nutri Meds Porcine on May 14, 2015 taking 390 mg and ultimately went up to 520 mg by June 27, 2015. During this time on Nutri Meds my weight started climbing so on June 28, 2015 I switched back to Armour 90 mg.

*From June 28 to July 15 on Armour 90 mg, my stomach issues and weakness returned as well as constipation, low motivation, though I did lose a little weight.

*On July 16, 2015, had TSH blood test and I had followup with my doctor ( did not tell him of my self medication) my tsh was at 14.610.

*Restarted Nutri Meds on July 16 taking 650mgs for 13 days went up to 780 mgs for 16 days until August 13.

on August 14 had private online tsh blood, got results today of 86.350

*On August 14 started taking Thyroid S 90 mg.

*On August 17 took another TSH with another online provider thinking that perhaps the other one made a mistake and should get results within 24-48 hours.

Sorry for the long email, but felt I had to give a better picture of what has happened as I am trying to resolve my issues. One thing I noticed was that on all these otc NTD, my stomach issues greatly improved as well as the leg swelling. Thank you for taking your time to read my email.

[Clutter in reply to Fran777]

Fran, you've been swopping around rather a lot and that's not great for metabolism. ThyroGold 300mg is roughly equivalent to 150-180mg Armour so doubling dose to 600mg was probably extremely disagreeable. NutriMeds don't disclose how much active hormone is contained so it's anyone's guess as to how much, if any, is in 520mg.

Armour 90mg was too low a dose as your TSH was >14 16th July. Being hypo may be why you had gut issues but it may be that Armour doesn't suit. Good thinking to repeat the TSH test. Don't worry if TSH really is high, it will come down once you start increasing dose. I'm thyroidless and TSH was 107.5 4 weeks off meds. 6 or 7 weeks back on meds it was down to 0.16 which only slightly over the target 0.1.

Thyroid-S works well for a lot of people once they're on the right dose but 90mg isn't enough for you. Average doses on NDT are between 180-300mg but some people need considerably more. Increase Thyroid-S 30mg tomorrow and in 30mg increments every two weeks until you are on 3 tablets (180mg), hold for 4-6 weeks and have a thyroid test, ideally TSH, FT4 and FT3, before increasing further. Post the results and ranges in a new question and members will advise.

If Thyroid-S doesn't work for you, Thiroyd might, or stick with branded NDT like NatureThroid, WP, Erfa or the generic Acella NP which has had good reviews. You know for sure how much active hormone they contain and you can't tell with OTC supplements which won't declare in order to circumvent FDA rules.

This is a really useful link re dose adjustments thyrophoenix.com/adjusting_...

Gut issues in hypothyroid patients are often due to low stomach acid which causes poor digestion and reflux. Raise stomach acid by taking Betaine Pepsin or raw apple cider vinegar in honey sweetened water or fruit juice before every meal. Constipation should improve when you are optimally medicated but if not try 100% gluten-free diet which helps with gas, bloating and constipation.

[Fran777]

Thank you so much Clutter for your response. I will increase per your recommendation and I'll take from there. I will repost with new results. Also, thanks for the dose adjustment link.

[vcle1909]

My TSH was 146 at my last (and first) blood test - ( range 0.2 - 4.5). My GP immediately put me on 50 mcg of Levothyroxine . Today I have my second blood test due. I desperately need more levo as my symptoms are still terrible. My case wasn't treated as a medical emergency as such although I was called in immediately to start on levo. I think doctors are very cautious in their dosage. I am hoping my levo will be doubled to 100 mcg, maybe then I will start to feel better.

[Eddie83 in reply to vcle1909]

Unless you are a Hobbit :-), you will need more than 50mcg. Abbott (the US company) advertises that the full-replacement dose of T4-only is 1.7mcg/kg body weight. If you eventually also need to use T3, you can use that and the T3 power factor, to compute appropriate T3+T4 dosages.

[vcle1909 in reply to Eddie83]

Thanks for that information. In that case I need about 125 mcg. At least now I know what may make me feel more 'normal'! My concern now is that i will have to wait several months before I get a prescription for that amount.....

[Eddie83 in reply to vcle1909]

Just keep in mind that it's possible a full-replacement dose will not make you feel well. Peripheral conversion, as in my case, is sometimes not enough to meet the T3 need, when your own thyroid is no longer making any T3.

[Fran777 in reply to vcle1909]

Oh my God, that number looks scary. I hope that the small dose has helped you a bit. I thought my 86.350 was bad....hope your dr gets serious with your treatment, wish you the best.

[phoenix23002]

Many of us who are on branded NDT (Naturethroid, WP and NP) take our thyroid meds sublingually ( let them dissolve in the mouth, chewing just a little to break up the tablet) and divide our daily dosage and take the divided doses 2 - 3 times per day. For instance, take 1/2 or 1/3 in the am then, if dividing by 2, take the other dose in mid-late afternoon. If by thirds, take 1/3 after lunch and the last third in early evening. It is a very individual thing and go by how you feel etc. Taking it sublingually, you don't really have to take it on an empty stomach (usually 1 hr before eating if swallowing whole).

Try to be consistent with your NDT (natural desiccated thyroid extract) dosing (and how you are dosing.. sublingually or whole) and as long as you're taking the NDT, I would ditch the whole glandulars. It might be a good idea to keep a record of your daily temps, heart rate, your dosage and how you are reacting to it. When we are in that undertreated brain fog, it can be hard to remember what we have done from day to day.

Clutter has given you excellent advise, particularly about not raising your dosage too quickly. Many of us find that 2 - 4 grains (120 - 240 mgs) of NDT is where we finally end up feeling optimal but it may take weeks to get there. You might want to test more than just TSH. Here is a good link for the blood tests that will give you a better picture of what is going on. At least consider getting the first 6 labs. It will reveal if you have other imbalances that can make it very difficult to stabilize your thyroid meds dosage.

stopthethyroidmadness.com/r...

Then post your results on this site. I am sure there are those like Clutter who can guide you. Remember.... this isn't a race, it is a process. If you are like most of us, Iyou are desperate to feel better but you didn't get ill overnite and you won't get well overnite.

[Fran777]

Phoenix23002, thank you for taking time to respond to me, I truly appreciate it. I am taking Clutter's recommendation. Yesterday, I had another tsh blood test (with a different lab company) as I felt the previous blood results might have been erroneous. I received results this morning of 47.0 (drawn 8/17) as compared to 86.350 (drawn on 8/14). The difference is that on 8/14 i did not take Nutri Meds before getting blood drawn. Upon returning home, I started Thyroid S at 90 mg. I had already taken Thyroid S on 8/17 when I had blood drawn. I don't know if all this makes a difference with the new tsh results.

Nevertheless, I am doing what Clutter recommended and this a.m. I added 30 mg for a total of 120 mg and will retest within 4-6 weeks. God willing all this will start getting resolved. I really appreciate your input.

[Clutter in reply to Fran777]

Fran, taking thyroid meds before a blood draw skews results so TSH is likely to be higher than 47.0 but it's a lot better than the previous 86. Your TSH isn't going to come down quickly so you might as well wait until you've been on 180mg for 4-6 weeks before retesting. Leave 24 hours between last dose and blood draw to get normal circulating levels rather than peak levels from recent dose ingestion.

[Fran777 in reply to Clutter]

Thanks, Clutter, that's what I thought. I take my thyroid med between 3 am and 4 am when I go to the bathroom. Normally get out of bed between 6:30 am and 7:30 am. Blood was drawn around 2- 2:30 pm. Will definitely not take my med next time I get TSH test. I want to get the t4 and t3 but I don't know if I'll be able to afford them.

[Clutter in reply to Fran777]

Fran, don't bother with FT4 and FT3 while TSH is above 1.0-2.0, they're bound to be low until then. After that it would be better to test FT3 if you can't run to TSH, FT4 and FT3.

[Fran777 in reply to Clutter]

Thanks, Clutter, for all this valuable information you are giving me. I'll be following your recommendations. Have a wonderful and blessed day!