Thyroid UK
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Clinically Thyrotoxicosis Tsh 8 normal t4 PLEASE HELP

The endocrinologist says that my symptoms don't match hypothyroidism, said that I display symptoms of thyrotoxicosis my TSH

Is down from 30 to 8 and t4 is 20 been normal throughout, sorry I do not know ranges. Current dose is 75mcg been on this dose for 6 mths

Private endocrinologist said take more thyroxine 100mcg and NHS endocrinologist said reduce dose to 50mcg

Main symptoms tiredness, foggy head, tachycardia, dry hair puffy eyelids....

14 Replies
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TSH of 8 means you do need to increase as the private Endo advises.

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Richard

If your endo thinks a TSH of 8 is thyrotoxic then he shouldn't be seeing thyroid patients, he has absolutely no idea.

You haven't put the range but 8 is bound to be over range and the aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges.

Your private endo is the one to listen to.

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They need to check your fT3, these numbers are consistent with impaired deiodinase. Selenium deficiency?

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Thank you for reply, Ft3 is 4.1 never had a clue what that means

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Richard123 if I had to follow anyone then it would be SeasideSusie....trust her. x

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TSH means Thyroid Stimulating Hormone - it is from the Pituitary Gland which rises to try and raise up more thyroid hormones.

A normal TSH is around 1 so if we've been diagnosed as hypo and TSH is 8 we need more levothyroxine to bring it to around 1 or below. Unfortunately your Endo seems to think if we're below 10 we have a problem, instead of the other way around.

You also have to quote ranges when you give a result as labs differ and it makes it easier to comment.

The most important tests are FT4 and FT3 and I will give you a link and read about them. These are rarely done and most have had to get their own.

Levothyroxine is T4 only and inactive and it has to convert to T3. T3 is the only Active thyroid hormone and it has to be sufficient dose to saturate the T3 receptor cells to enable our metabolism to work normally and be without clinical symptoms.

thyroiduk.org.uk/tuk/testin...

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I know who I would follow and it wouldn't be the NHS. He has no idea and he has only looked at your TSH and 'assumed' if it is low or below range you are thyrotoxic. No way with a TSH of 8 is and you are aiming for a TSH of 1 or lower.

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But free t4 and free t3 have remained in upper level prior to diagnosis and since treatment it's just the Tsh that has been consistently high and high TPO antibodies. I'm so lost as to what's correct. Scared to reduce dose and unwell with increasing doses!!

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If you're unwell with increasing doses of levothyroxine then you should have your vitamin levels tested. Sometimes taking levothyroxine unmasks our deficiencies and makes us feel ill. Levothyroxine won't make you feel well if your nutritional levels are low. As you have antibodies, you've most likely got poor absorption of nutrients due to low stomach acid or intestinal bacterial imblance.

Test for:

Vit D

Folate

Ferritin

Vitamin B12

When you have results post them here as docs often say they are fine when they're bumping along the bottom of the NHS range which will never make you feel well. They all need to be mid-range and B12 near top of range to feel well and for levothyroxine to work well.

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You said FT3 is 4.1, but what is the range? The results by themselves mean nothing. We need the range to understand them.

But, unless your FT3 is over-range, you do not need to decrease your dose. :)

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richard123,

When laboratory results are discordant, there are several things that can be done. One is to get tests re-run with samples going to two (or more) different laboratories that use different technologies.

For example, some people have antibodies to TSH itself. Some TSH tests show high results because of this, but others are not affected. Doing a repeat test will often reveal that sort of difference.

The idea of doing this is no more sophisticated or clever than checking your speedo against your GPS! :-)

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Richard, we will need more details, getting the reference intervals will help especially as an fT3 of 4.1 could be a bit low depending on the assay used. (The thyroid produces mostly T4 - thyroxine - but T3 is the active hormone and is produced by an enzyme called 'deiodinase' which removes one of the iodine atoms off T4 to make T3).

It would also help to know your results from when you were diagnosed, what your signs and symptoms were then and what they are now. Also, when was the tachycardia discovered? Have they been monitoring your pulse / heart rate all the time?

Sorry for all the questions but your case looks a bit complex, tiredness can be hypo or hyper, tachycardia could be thyrotoxicosis and dry hair / puffy eyelids are a bit vague but are usually hypo.

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Many Thanks I will get ranges next week and post. Diagnosis was 1 year ago at the time I had a flu, Gp did blood tests as I was tachycardic and put me on thyroxine.... ill post as soon as I can Thanks

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Have you had your adrenals tested via blood or saliva cortisol? Low adrenal function can knock out the thyroid and raise tsh and resolves when treated. Have you also had total t4 tested?

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