TSH if 98 should I be worried

[CLIles]

Recently diagnosed and put on 25mg of thyroxine, latest blood test showed TSH 98, thyroxine increased to 75mg and also tested for autoimmune came back positive. Any advice please x

[helvella Administrator Thyroid UK]

CLIles,

If you have issues which mean you really should have been started on 25 micrograms, it is madness to then increase the dose by 50 micrograms in one go!

Or, if you don't have those issues, why on earth were you not started on 50 micrograms? Usually we should expect increments of 25 micrograms at a time.

(Issues would include heart disorder. Or, on the basis of precaution, over 60 years of age.)

High TSH such as 98 does show you need more thyroid hormone. Trouble is, you cannot know how much you need from a TSH result alone. So the usual approach is to keep increasing, re-testing, etc. approximately every six weeks, until your TSH is closer to 1 or below. (You really should have Free T4 and Free T3 tested as well. But the medical establishment misguidedly thinks TSH only is sufficient.)

It is more dangerous to increase too fast than to do so slowly and carefully - even if TSH remains high for quite a long time.

[Nanaedake]

Make sure you book a blood test every 6 weeks and increase your dose until you feel well and reach a TSH level of about 1.0 or a little lower. If you still do not feel well then ask your GP to test vitamin levels which can be low in people with thyroid conditions.

Ensure you take your levothyroxine on an empty stomach and leave an hour before eating or drinking (except for water). Take supplements or other medicines 4 hours later. Make sure you take your blood tests fasting and as early in the morning as possible and take your levothyroxine dose after the test.

[Clutter]

CLIles,

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.4 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

If thyroid peroxidase antibodies are positive it means you have autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose increase. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after increasing Levothyroxine dose. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...