How do you manage to titrate the dose when you're close to the goal TSH?

I'm TSH 1.9, want to get it to one or below - that's obviously tricky, and I will easily slip over into hyper.

Any advice on how to manage that?

I can take my blood pressure daily with my little gadget.

I can watch out for headaches and not being able to sleep.

I can wear a pulseometer if necessary and keep an eye on it.

I can do tiny tiny increased doses and stop them if any of the above occur.

Is that the right kind of thing to do?

I am sorry to ask such an obvious, old question, I've internet searched and haven't found anything helpful. Not using the right search terms I expect.

9 Replies

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  • Aspmama,

    It's not ALL about the results but how you feel ...

    Granted many function better with a TSH of 1.0 or below so this would be the initial goal for many but try to be more flexible and don't forget symptoms may lag up to 6 weeks behind good biochemistry ..! ! ..

    Taking pulse, temp, etc is really good and can be useful in assessing too low or high thyroid meds. Don't forget to record everything.

    Flower

  • Having a very low TSH doesn't mean you will be hyperthyroid. If we take too much thyroid hormones we can become overstimulated but hyperthyroidism is different from hypothyroidism. Although we can call the symptoms of too much 'hyper'.

    If we do take a little too much it's easy just to either miss next day's dose and then reduce slightly from then on. The most important thing is how we feel.

    The first two questions on this link may be helpful:

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

  • Aspmama, 12.5mcg dose increase should be enough to bring TSH down just below 1.0. My TSH is <0.01 but I don't feel hyper and I'm not overmedicated because FT4 and FT3 are within range.

    ________________________________________________________________________________________

    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • My TSH has never tested below 1.0. At times, I have felt slightly over-medicated, a feeling I hate, and trimmed my dose a little. But I absolutely don't target a TSH number, and can't target FT4 or FT3 because they never get tested!

    I am never sure what is right - but over a few years my TSH has tended to be within a small range. So perhaps my own judgement is as good as a blood test? (Well combined with the observations of someone else who very effectively lets me know if I appear under- or over-dosed! :-) ) I have adjustred my own dose - by small amounts - as needed. I tend now to look at annual tests as a long-stop - if nothing else has yet alerted me that is there to catch it.

  • Aspmama,

    According to my GP my TSH has always been low (I am sure she means since I have been on Levo). Recently though they started to get worried and wanted me to reduce my Levo, because in May it was 0.06 (in the range 0.3 - 4.2) citing risk of Atrial Fibrillation and/or Osteoporosis.

    I didn't want to reduce my Levo, because I did that on their recommendation last year and ending up feeling so ill. I have never completely resolved my Hypo symptoms either. So I researched the risks and found that they had been overstated when linked to a low TSH.

    My understanding, although I am not an expert by any means, is that it is the level of T3 (and possibly T4) that can mean over medication. For e.g. my T3 remains stubbornly mid range and my T4 towards the top of the range. If these were out of range, I might be worried, but my low TSH doesn't worry me as long as I feel well.

    Having said that, I have had 'wobbles' when changing the dose up or down, but recognising that I need to give my body a chance to settle to the new dose and not to panic!

  • Yes, as I was looking around I found Kalra et al in an Indian research piece 2011 (sorry for no link):

    "Patients’ wellbeing does not seems to correlate with “biochemical wellbeing”. When assessed by a visual analogue scale of wellbeing, patients reported best results on doses of thyroxine that were 50 mg higher than ‘optimal’ replacement. (!!!!) Highest wellbeing scores were obtained when serum TSH was <0.2 mμ/ml.[9] Left to patients, they would prefer clinical assessment, rather than TSH estimation, to titrate thyroxine doses.

  • That would seem to confirm it Aspmama. What a pity we don't seem able to get this across to GPs and Endocrinologists :(

  • I take T3 and haven't done any thyroid testing in ages. (I don't bother my doctor with anything thyroid-related.)

    When I was trying to find the dose that worked for me I went a little bit over the top, but didn't realise I had done so to begin with. I started sweating more than usual and my heart went a little bit fast. So I dropped back by a 1/4 tablet.

    After about three weeks I tried again to go back up to the higher dose with the same result. So I dropped back again and I'll be staying where I am.

    Going overboard for a short time isn't going to make the sky fall in. And if you are monitoring yourself and your symptoms you will soon know where you feel best.

  • My first thought was...what has your tsh got to do with how you feel?

    I'm like humanbean, I don't have blood tests but monitor how I feel. My tsh used to test below 0.01, which panicked the GPs but didn't worry me. They tend to cite the usual drivel about osteoporosis and heart problems. The GP even sent me for a dexa scan, though goodness knows what that tells you about thyroid medication. As I pointed out, you would have no way of knowing if thyroid medication had produced osteoporosis unless you could clone yourself and monitor bone density without any medication. I don't bother my GP.

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