Thyroid UK
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Blood Test Confusion

Hi all, my first post on here, I had a total thyroidectomy in February this year due to having a multi-nodular goitre. I am now on 100mcg of Levothyroxine, my TSH is currently 1.8 and have been told that this is fine, but I am reading on here from other people saying it should be below 1!?, am totally confused as both my gp and my endocrinologist say the range is 0.25 - 5.

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How are you feeling? That's the most important thing. Have you still got symptoms? People differ and your level may suit you. Doctors need to check FT4, FT3 and TSH as well as antibodies to find out what is going on with the thyroid if you don't feel well.

Some people don't seem to utilise T4, Levothyroxine very well so they don't have enough T3 in their system. This shows up in blood tests. Then they may have room to increase their medication if their TSH is 1.0 or higher, however, if you are not feeling well you should investigate your vitamin levels first and optimise them because your levothyroxine will work much better if your vitamin levels are good (not just anywhere near the bottom of NHS range).

Check vitamin D, folate, ferritin, B12 to begin with. There is a lot of research showing that people with thyroid conditions have a propensity to be low in vitamin D so check it out if you have not done so.

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I feel fine, I never had any symptoms only reason my thyroid was removed was due to it being enlarged multi-nodular, my doctors do check my T3 & T4, which are within normal ranges I was just confused as to why people were saying tsh should be under 1 when you are on Levothyroxine.

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Great, so glad you're feeling well.

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Teddy71,

If you feel well you are fine with TSH 1.8 on your current dose. Some people need T4 and T3 high in range to feel well and this will mean their TSH will be lower, usually between 0.25 - 1.0 but sometimes suppressed <0.1. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

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My T4 is 20.8 at the moment, which is at the higher end so that's a good place to be and hopefully it will stay there,

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The range they talk about is for people who don't have a problem with their thyroid gland. That's their biggest mistake.

Initially if we start having clinical symptoms and in other countries - along with symptoms being taken into account - if TSH reaches 3+ we will be diagnosed. In the UK for some unfathomable reason we have to wait till it reaches 10. Thereafter with levothyroxine it should be gradually increaed until it is at the bottom of the range, i.e. 1 or lower but many are kept unwell by the professionals' advice that 'they are in normal range'.

Not much fun if the person is symptomatic. The following is an excerpt from an article in doctors' online magazine by Dr Toft who was President of the British Thyroid Association and if you require a copy, email louise.roberts@thyrioduk.org.uk to request and to give both a copy.

The fact that we have to do all the searching and uncovering because the Professionals who are supposed to be 'caring' for their patients haven't a clue.

Excerpt:

"6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

Let's see if your Endocrinologist and doctor can learn from Dr Toft article.

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Thanks for your reply however my Doctor & endocrinologist are very good, they don't just go by what the figures say but also by how I feel as they realise not everyone is the same even if the bloods are considered to be in the normal ranges.

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Shaws has explained it so well!!

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