Silly question! Hyper

[wildpoppy]

What is the perfect TSH and T4 range? Ok, perhaps perfect is wrong as we are all unique... I guess I'd like to know a good range or is it vastly different for everyone? TIA

[shaws Administrator]

The most important question when taking thyroid hormones is how the patient 'feels'. If we feel good with no clinical symptoms that is the right dose for us.

It is recommended on this forum that the TSH is around 1 or lower. The doctors believe anywhere within the range is o.k. and may stop increasing the hormones or adjusting hormones and tell you you are 'normal' and don't need an increase.

T4 should usually be in the upper part of the range but the most important hormone T3 (the Active hormone required in our receptor cells) is rarely taken as it assumed the dose of T4 is sufficient to convert but doesn't always do so efficiently.

[wildpoppy in reply to shaws]

thank you, thats REALLY useful information... How do we find out if we have conversion problems? Just by taking a blood test?

Many thanks yous for your help

[shaws Administrator in reply to wildpoppy]

This is an excerpt from TUK and following on in this link is re hyper:

Some people do not convert their thyroxine adequately into T3. This could be due to lack of certain vitamins and minerals or possibly due to a faulty gene. The DIO2 gene was researched in 2009 and the results were published in the paper entitled, "Common Variation in the DIO2 Gene Predicts Baseline Psychological Well-Being and Response to Combination Thyroxine Plus Triiodothyronine Therapy in Hypothyroid Patients" by V Panicker, P Saravanan, B Vaidya, J Evans, A Hattersley, T Frayling & C Dayan - jcem.endojournals.org/content/94/5/1623.full.pdf+html

The researchers found that patients on levothyroxine (T4) alone felt worse if the faulty DIO2 gene was inherited through one parent and worse still if they inherited the faulty gene from both parents.

The patients on this study were given T4 only for a set period and then combination treatment of both T4 and T3. The patients who had normal genes did not feel any different on combination treatment. However, those who had one faulty gene felt better on the combination treatment and those with both faulty genes felt better still.

This means that there is a possibility that patients who are on levothyroxine alone and still have symptoms may improve with the addition of T3.

Because this faulty gene causes a deficiency of T3 within the cells, the usual thyroid hormone function tests will not show up a problem. This means that your TSH, FT4 and FT3 blood tests will look normal.

The researchers concluded, “Our results require replication but suggest that commonly inherited variation in the DIO2 gene is associated both with impaired baseline psychological well-being on T4 and enhanced response to combination T4/T3 therapy, but did not affect serum thyroid hormone levels.” This means that some people do not convert but this doesn’t show in their blood tests.

Thyroid UK is now working with a laboratory that does this test – Regenerus Laboratories Ltd. For more information on the DIO2 test and how to get tested click here click here

Some people feel better taking natural desiccated thyroid (NDT). This is what was used before synthetic levothyroxine came on the market. It is available on the NHS on a normal prescription on a “named patient basis” but some medical bodies do not like patients being prescribed this even though patients may feel better on it.

On 19th November 2008 The Royal College of Physicians, in particular its Patient and Carer Network and the Joint Specialty Committee for Endocrinology & Diabetes; The Association for Clinical Biochemistry; The Society for Endocrinology; The British Thyroid Association; The British Thyroid Foundation Patient Support Group and The British Society of Paediatric Endocrinology and Diabetes issued a statement, endorsed by the Royal College of General Practitioners, entitled “The Diagnosis and Management of Primary Hypothyroidism”. This statement was also mentioned in the BMJ Editorial entitled, “Diagnosis and treatment of primary hypothyroidism - New guidance highlights how to do it in primary care”.

This Statement includes a statement in the “Conclusion”, “The College does not support the use of thyroid extracts or thyroxine and T3 combinations without further validated research published in peer-reviewed journals. Therefore, the inclusion of T3 in the treatment of hypothyroidism should be reserved for use by accredited endocrinologists in individual patients.”

Dr John Lowe published a rebuttal to this Statement where he discusses various papers in respect of direct comparisons of levothyroxine and natural desiccated thyroid and which showed that the effects were similar on hypothyroid patients. One of them states, “a daily dose of 100mcg of T4 was on average equal in biologic activity to 101mg of desiccated thyroid; 60mg of desiccated thyroid was equal to 60μg of T4."

The article does state, “If no obvious cause is found the patient should be referred to an accredited hospital endocrinologist or general physician.” However, many doctors are unwilling to refer patients to endocrinologists for hypothyroidism.

Thyroid UK has often heard that doctors state that “There are no studies comparing natural desiccated thyroid (NDT) with levothyroxine.” If your doctor states this, give him a copy of Dr John Lowe’s paper -

'Stability, Effectiveness, and Safety of Desiccated Thyroid vs Levothyroxine'

Thyroid UK has also often heard that doctors tell their patients, “You never know how much of each hormone is in the tablets.” This is untrue. NDT goes through the same process that levothyroxine goes through and is tested to ensure that the correct amount of T4 and T3 is in each tablet. United States Pharmacopeia (USP) is the official public standards–setting authority for all prescription and over–the–counter medicines and other healthcare products manufactured or sold in the United States. Thyroid USP state that thyroid tablets should contain not less than 90% and not more than 110% of the labelled amounts of levothyroxine and liothyronine, the labelled amounts being 38ug of levothyroxine and 9ug of liothyronine for each 65mg of the labelled content of thyroid.

The American Food and Drug Administration (FDA) have had concerns about potency and stability in brands of levothyroxine. In October 2007, the FDA announced that it is tightening its potency specifications for all levothyroxine (sodium) to ensure the drug retains its potency over its entire shelf life. Thyroid UK wonders if this could be a problem in the UK too but it is very difficult to obtain this information.

Last updated: 27.11.15

[wildpoppy in reply to shaws]

Oh wow, thank you... thats so interesting... It amazes me that our specialists/Endo's are not interested in this kind of research? How can they call themselves doctors?!

Thank you so much for your help

[wildpoppy]

Excellent, yes, I noticed my temperature was high with high T4... I will do this, thank you!