Low TSH

[ElsaElsa55]

Had a phone call from my doctor today to say that my recent blood test shows a tsh level of 0.02 so he wants to reduce my meds from 100 to 75. Is this level too low? I feel ok. Thanks

[Hidden]

I have no idea I have just started taking Levo and am on 50mg this is day 4

I am sure someone will be along shortly to answer your question - wishing you all the best

[greygoose]

It is irrelevant. Refuse to reduce your dose unless he tests the FT4 - and, ideally, the FT3. He should not be dosing by the TSH alone.

[SlowDragon Administrator]

For full evaluation you need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

Do NOT reduce dose, insist that al, these are tested first (NHS rarely do FT3 or TG antibodies)

TSH is largely irrelevant on Thyroid replacement hormone. You need to know FT4 and FT3, if they are in range level is fine

Low vitamins stop thyroid hormones working, then bloods appear to show over treated, but actually remain hypo

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the article to show GP by emailing [e-mail] print it and highlight question 6 to show your doctor.

If you can't get full thyroid and vitamin testing from GP

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

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

[Mstiles in reply to SlowDragon]

Slow dragon does this apply also to hyper, Graves patients? I.e. not dosing by TSH? My endo wants TSH at 4, but I felt better when it was much lower. I have both TSI and TPO antibodies. Thank you.

[Hidden]

Yet another doctor deciding doses based on TSH alone. He/she is panicking because they think a below range TSH means you'll get heart and bone problems. If your T4 and T3 are in range (near the top) and not over range then you are perfectly fine, especially if you feel OK! So agree with greygoose, you need your FT4 and FT3 measured (they likely won't do FT3, but you can ask anyway).

Many doctors treat the TSH value as the be-all and end-all of diagnosis, which it isn't, it's a terrible way to treat patients as they end up with dosages of Levo yo-yoing up and down and of course you'll feel dreadful.

If your FT4 is over-range, that's another matter, but you'll need the tests first.

[Angel_of_the_North]

Dosing shouldn't be done by TSH level, but by free t4 and free T3. I would refuse the decrease unless Free t4 is well over range and say you'd like to stay on 100 for another 6-8 weeks and test again unless you feel very hyper. I'd also get a copy of the Dr Toft Pulse article from louise.roberts@thyroiduk,org to show your doctor as I don't think he knows a lot about treating the thyroid

[Hidden]

Do you have Hashimoto's disease aka autoimmune hypothyroidism? When I was on T4 only drugs, I noticed my antibody levels would inevitably go up if my TSH was "normal", but would immediately go down if my TSH was between 0.01-0.09. The doctor who treated me at the time said that patients with Hashimoto's need a suppressed TSH to keep antibody levels under control.

[ElsaElsa55]

I don't know if I have hashimoto's as I don't think I have ever had a blood test for antibodies. All I was ever told was that I had an underactive thyroid. I did mention to the doctor about FT4 and FT3 but he dismissed it so I know they won't test me for these to see if my levels are ok. I think I will have to get some private blood tests done so I know what the whole picture is and then I can discuss it with my doctor. I certainly don't want to go back to how I felt earlier in the year when I was on 75 although, having said that I was on Teva and had to change to Activis as Teva made me feel very unwell. I had just collected a month's supply of 100's before the phone call which I will keep and will be collecting 75's on Monday so I have got plenty of meds. When I get my results from private tests I will post them and get advice of what to do next. Thank you for all your replies

[Blue_Bee]

Elsa, 12 months ago I was just beginning to feel well(...er) on 100mcg thyroxine after 6 months of slowly increasing the dose under junior (<10 years specialist practice) endo’s advice. She then wanted to tweak my dose down to get the TSH in range. I complied and 6 month’s later I hit rock bottom Hashimoto’s symptoms. Ending it all looked ... well worth thinking about, except I was just too exhausted to do ANYthing. I’m not meaning to make light of that dark place. Under-treated Hashimoto’s can be that serious. I wish I could tell you that it was as simple as changing my endo, seeing a Functional GP and increasing my dose back to 100mcg.... nup. Although now, 6 months later, I am better than I was at that low-point, nearing where I was before she tweaked my dose, and steadily (slowly) improving with support here, the Australian Thyroid Foundation, and a very experienced up-to-dat endo and supportive, excellent GP. Follow the abundant good advice here, and get yourself the very best medical expertise you possibly can. You haven’t got time to be educating your doctor. You need a doctor who is super knowledgeable in this area. All the best!

[ElsaElsa55 in reply to Blue_Bee]

Hi Blue Bee. Thank you for your thoughts, I don't intend going back to where I was earlier this year, I felt awful!! When I get my test results from private blood tests I will then have all the amunition I need! take care