I was diagnosed with hypothyroidism in May 2016 when I believe my TSH level was over 100 and prescribed 50mcg Levothyroxine.
Second test in August when I was told the TSH level had fallen to 33, after which I was prescribed 75mcg.
May I ask for some assistance with the following please. I have asked for blood test printout details from my GP and I am not sure of what it all means.
In August 2016 : Serum free T4 level 8.5
In October 2016 : Serum TSH level 2.6
(No other details)
I feel fit and well, so I assume the readings are more or less within range for normal.
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Ziggy999
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When you give blood results you have to give the ranges too. The figures are in brackets, the reason being that labs use different machines so we get different ranges.
The answer always should be 'how do I feel' and if you feel fit and well it is assumed you are on the correct dose. We usually find it's around 1 but it obviously differs.
If you feel any clinical symptoms arising, you should get another blood test which should be TSH, T3, T4, Free T3 and Free T4 and antibodies (antibodies only need to be taken once), plus B12, Vit D, iron, ferritin and folate if you've not had them done.
When you have a blood test for thyroid hormones it has to be the earliest possible, fasting and leave about 24 hours between your last dose of hormones and the test. This procedure gives the best results.
Always get a print-out of your results with the ranges as ranges are helpful.
This is an excerpt from Thyroiduk.org.uk (I don't believe about normalising TSH as we usually find around 1 is good):
Taken from Medicine International 1993
"The aim of thyroxine replacement therapy is to normalise plasma TSH and to achieve a clinically euthyroid state. To obtain this, FT4 and TT4 have to be maintained at, or just above, the upper reference interval".
NB: Dr. Toft, Consultant Physician, states in the British Thyroid Foundation newsletter Issue No. 23 that normal ranges are: T4 (10 – 25) and TSH (0.15 – 3.5). He also states that "the correct dose is that which restores good health; in most patients this will be associated with a level of T4 in the blood towards the upper part of the normal range or even slightly high and a TSH level in the blood which is in the lower part of the normal range.
It's not possible to interpret results without the lab ref ranges (the figures in brackets after the results).
TSH 2.6 is a great improvement but it would be too high for most people on thyroid replacement. Most people need TSH 1.0 or lower with FT4 in the upper range to feel well.
Bottom line is that you feel fit and well so the results are good for you even if they wouldn't suit everyone else.
TSH is normal 0.30 - 5.00 but most people need it 0.35 - 1.0 to feel well. You are under medicated because FT4 is below range. Your GP should increase dose until FT4 is in the upper range, say >16.0. Low FT4 means you won't be able to convert sufficient T3 and your FT3 will drop. It's low FT3 which causes hypothyroid symptoms.
Clutter, In august TSH 33, fT4 8.5. Levo increased from 50 to 75 mcg. In October TSH 2.6 no fT4 given.
Ziggy, As you feel well it is fine to have a TSH of 2.6. It's just that a good number of patients need it to be around 1.0. However, you are only recently hypothyroid so it is likely you will need more hormone in the future as your thyroid fails. So, if your symptoms start to come back go and see your doctor.
If you are female and are thinking of becoming pregnant you will need to have your TSH monitored and kept below 2.5.
Thank you jimh111. I take your point, I may well need higher levels of hormone in future. I was recently diagnosed and have been taking medication for just six months. I shall keep your advice in mind for the future.
Incidentally I am far too old for childbearing, and anyway I am male.
Just to add a general comment. In healthy people their TSH averages about 2.0 but some have a natural level of 1.0 and some around 3.0. You may fall into the latter category.
There are many patients who have severe symptoms with quite a low TSH and I believe this is due to other problems with thyroid hormone action rather than a failing thyroid gland. Those of us in that situation are hard to treat. Of course some patients will have both conditions.
When we are healthy we may have a TSH of 3 or even 5 or 10 and feel fine. The TSH has two main functions, it responds to low hormone levels by increasing (a feedback mechanism) and as it rises it stimulates more hormone production in the thyroid gland. I have a hunch, and it's just a hunch not scientific fact, that patients with a failed thyroid gland need a lower TSH because they have lost that ability to respond to TSH with increased hormone production. Once the thyroid has packed in the TSH can't go to the medicine cabinet and grab a little more levothyroxine. There isn't the safety net a healthy thyroid provides.
I suspect your thyroid is about half way gone. As it progressively fails (it probably will) you may find you need a lower TSH to be well. So when you see your doctor and he asks how you are doing with a TSH of 2.6 you can say you're fine at the moment but if you should get worse you would like to keep the option open to have a lower TSH. The blood tests should really be subserviant to your signs and symptoms but most doctors don't work that way.
So don't worry about your blood tests, if you feel fine great. I wouldn't let your TSH go above 5 since although you may feel OK it can increase your cholesterol and lipid levels. I'm a patient not a doctor but from all the posts I've seen on this forum you seem to have the best case of hypothyroidism, in terms of ease of treatment and successful outcome.
Your comments are most welcome. I am still learning and trying to ensure I am adequately prepared to deal with future developments. You have helped me in this matter and I am grateful to you.
I would feel rubbish with those results but I am me and you are you. There is no such thing as normal, just normal for you. If you feel good that's great you are moving in the right direction but you're not quite there yet. Your Free T 4 needs to be higher. Whatever the range is you need to be at the top of it.
It's not surprising that you feel well after a TSH of 100 you are feeling practically reborn I should think
Thanks Redditch, I am getting the picture now. You are right in saying that compared with "before', the 'after' seems good. However, I believed the symptoms prior to medication were down to getting old (past 70 now) and were nothing more than a collection of irritations. Diagnosis followed a health check at my medical practice and not because I felt so bad to seek relief.
But I take your point regarding where I should be and will pursue this with my GP.
You should also have your vitamin D checked, along with B12, folate and ferritin. These, if not optimal (and not just in range) can inhibit conversion of T4 to T3, so although having raised currently you feel better, this may well drop back and a further raise will do the same if these are not improved.
D3 can improve some of the things that you are putting down to age, as can B12! Memory loss and cognitive function are two.
Thank you mistydog, I will add this to my list of tests that I will aim for next time around. I am learning how all these elements link together and it is not as simple as I first thought. Thanks again.
Your levels are not normal so I don't know why you feel well and fit. But if I were you I would get the book; STTM-stop the thyroid maddness. It is a wealth of information and includes how to read your labs and what labs are important. Your lab results don't include T3 or RT3 which are vital for interpreting the levels you have. You could have a conversion problem meaning our bodies convert T4 into T3 which is the only form our cells can use. If you have too much T4 and are not converting you will have a lot of RT3 (reverse T3) which will bind to the receptor site that the T3 is supposed to bind to and it will prevent the T3 from entering your cells. There is also a facebook group called FTOP-thyroid issues and several spin off groups for thyroid issues related to hashimoto's or Lyme, gut issues, thyroid cancer, etc. I have learned a ton of info just by cruising the site and reading other posts. Good luck!
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