Thyroid UK
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Liver disease and high TSH

Hi guys I'm asking about my dad.

He has the last stage of corrhosis of the liver and his recent blood test showed his TSH levels were at 8 and on my doctors scale "Normal" is 5.5. They have prescribed him t4 but he is reluctant to start on t3. What is the best option for him?

Thanks all xx

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I don't quite understand. You say they have prescribed T4 but he's reluctant to start T3. Have they prescribed T3 as well then?

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Nope. I have to buy my T3 as my doctor won't prescribe it too me. My doctor only prescribes t4 and same with my dad they are only giving him t4

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So are you wanting your dad to self medicate with T3 instead of or in addition to T4?

How do you know T3 is needed? Do you have test results for FT4 and FT3 done at the same time?

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I take a combination of both which I did self medicating and for the first time In 7 years I'm finally ok and healthy. So would self medicating be a good idea?

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Not without testing to see if T3 is needed. Taking T3 when it's not needed can raise FT3 and FT3 over range long term can cause health problems.

If he has been prescribed T4 then the best thing is to take it and retest 6-8 weeks later to see how things are going. It's very doubtful that FT3 will be tested by his GP unless there is something wrong with TSH and FT4 results. You could, of course, get your dad to do a private test with Blue Horizon or Medichecks that includes FT4 and FT3.

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Okay cool :) thankyou!

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Be very careful about taking T4 in his condition. He has a severe nonthyroidal illness and probably feels exceedingly unwell. In NTI of this severity TSH can sometimes rise slightly above normal and is not indicative of thyroid disease per se. In older people with NTI extreme caution is necessary if deciding on T4 therapy (and even more caution for T3).

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Wow okay. The doctor has prescribed him t4. What's the best way to go about it? I said to have another blood test and see then what the TSH levels come up as?

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If T4 is to be given it should initially be in a small 25 ug dose to see what happens to the TSH. Don't under any circumstances rush in at the 50 or higher level.

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Okay thanks. Yeah they have given him 25 to start with. What about t3? Not to take it at all?

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Do nothing with T3 until you know the response to T4. And then probably do nothing.

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By coincidence I'm just reading a paper on thyroid parameters in men who have lost androgenic elements (eg testosterone) owing to prostate cancer. TSH is raised somewhat in such cases of severe NTI but T3 remains the same as in health. This is nothing to do with the thyroid itself but the body's overall response to a different illness in which the thyroid and pituitary play a bystander role. This parallels a lot of NTI responses by TSH.

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