Suppressed tsh - do I need further bloods?!

[Munny1]

Hello all, I have been to my doctors to collect my recent blood tests.

TSH 0.01 mU/L (0.35-5.00 U)

Free T4 19.8 pmol/L (9.0-21.0 U)

My GP is happy keeping my dose of 125 levo, even though TSH is suppressed. She cared more about how I am feeling (yes!). I was honest and said I didn't know if I felt hyper, because I have so many other things going on. (Asthma flare up and grieving)

So whilst I generally feel well for once, even though my ducks need work. Am i right in thinking a suppressed tsh only means i have a large amount of levo stored. Would I be best to get a private bloodtest to check tsh, free t4 and free t3. Would this give me an indication of whether I am converting?

Thanks in advance!

[Raventhorpe]

If your feeling well I wouldn't bother to get t3 checked, your t4i is up towards top end of range that's good and suppressed Tsh is nothing to worry about, so all good.you are very lucky to have gp that cares about how you are feeling and not just looking at tests.

[Clutter]

Munny1,

Treasure that GP. There aren't enough like her!

You wouldn't feel well if your FT3 was low due to poor conversion. A suppressed TSH means your pituitary gland has detected sufficient circulating FT4 and FT3.

[Munny1]

Thanks for all the replies, they are very helpful. It means I can concentrate on those ducks

[SmallBlueThing]

My TSH dropped to 0.11 (0.3 - 5.0) with fT4 of 16 (9 - 25). I had no tachycardia, heat intolerance or more frequent bowel movements, but I lost a lot of arm strength and suffered a painful frozen shoulder.

I cut my dose by 25 mcg and TSH climbed to 0.89 while fT4 fell to 12 (probably due to ceasing supplement containing biotin, three days before test). Dopey and cold, with 35.2C daytime temp. Increased dose by 25 mcg alternate days, and TSH is now headed for 3.0

[SilverAvocado in reply to SmallBlueThing]

Smallbluething, 0.11 (0.3 - 5.0) with fT4 of 16 (9 - 25) is not overdosed. With a freeT4 below the half way point, your freeT3 will also be low.

FreeT3 is the most accurate measure of how much hormone is in your body out of the 3 measures. TSH doesn't give much indicator, especially once you're taking thyroid replacement. You want freeT3 to be in the top third of the range, and if you're taking Levothyroxine or equivalent you will need a high in range freeT4 to achieve that.

You had a lot of space to increase at the time you started reducing your dose. Don't let anyone reduce you based on blood tests, only do it if you feel hyper symptoms yourself!

[SmallBlueThing in reply to SilverAvocado]

I was most definitely overdosed when TSH was 0.11, but didn't want to admit it to myself, initially.

I had started a different calcium channel blocker, which was producing hypo symptoms when taken within a couple of hours of my thyroid meds. The only suggestion found, on this forum in fact: increase the time gap to four hours. I also delayed the taking of my ACE inhibitor. The combined effect seems to have been to improve absorption and/or conversion. Frozen shoulder was noticed first, but is also a possible side effect of the calcium channel blocker, so I was put off the scent, but acknowledged the problem with results from regular blood test, just under a month after starting that pill. On past experience, I would've expected a rise of TSH over the winter.

My most recent test hadn't been authorised. It's happened before and is embarrassing. The phlebotomist read "Normal, no action required" off the screen, which I assume was the lab's verdict on the previous test, rather than a comment from my GP. Frustratingly, this of all times my fT4 wasn't recorded. I was expecting my TSH to have dropped to about 0.5, but it's risen to 2.9.

A year ago, due to changes of other drugs, I hadn't been allowed an increase and my TSH increased to 4.6 and the time between tests was increased from two to three months. A TSH of 4.4 was considered fine when I was in the early months of treatment, so my GP must feel happiest with levels at the top end of "normal", and bu**er the patient (although I have been allowed to hold it at 0.4-ish).

My forthcoming appointment should be interesting.

[Glynisrose]

Suppressed TSH is fairly normal when you are taking any form of thyroid replacement hormone.

[SilverAvocado]

As others have said, a suppressed TSH is often necessary to get your freeT3 and freeT4 to decent levels, it doesn't matter.

If you're very well and have no concerns you don't need a freeT3 test. If you're continuing to adjust supplements and hoping to get some big improvements, it's nice to have as a bit of extra info. Even just to give you something to compare in 6 months or a years time to confirm if your supplements have helped. Or even in 10 or 20 years to get more of a sense of your history.

If you still feel quite unwell, it is definitely worth it, as as you say, it will show you if you've got a conversion problem.

The decision might come down to price. BlueHorizon does the single test for around £30-40 I think. It may be less. If you can easily afford it, personally I would err on the side of more caution/information.

[Munny1 in reply to SilverAvocado]

Thank you SilverAvocado. I called the practice later to check what the next step was as I'd forgotten to check future treatment/checks. So next bloods in 6 weeks again due to stress etc gp wants to ensure we aren't missing anything. In the meantime working on my supplements. If they can't check/ request ft3 I'll pay for a private test, the cost isn't too concerning as it's only a basic test I'd get. On a positive note I have noticed the puffiness in my face has gone down. Energy has improved, no cravings, sleep has improved and was even able to get up in the morning without too much of a struggle. Fingers crossed that I may be on the right path.