TSH Levels

Hi new to this so here goes, i have been on thyroxine for the last two years and today my doctor told me me TSH level was 4.66, and is keeping me on the same medication, he doesn't feel he wants to put the dose up and will re test in six months, does this sound right?

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Trish

No, it doesn't sound right. Did you also have results for FT4 and FT3? It helps to post reference ranges when posting results, ranges vary from lab to lab so we can't interpret results without them. Is your TSH over range?

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. You need an increase in your dose and to support this use the following information from thyroiduk.org.uk/tuk/about_... > Treatment Options:

"Dr Toft 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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org

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Definitely sounds WRONG. Once diagnosed we have to read, learn and ask questions as many doctors appear to be trained like yours, i.e. they believe that if TSH reaches 'somewhere' in the range you're on sufficient dose. NO you aren't.

The aim is a TSH of 1 or lower and yours is nearly top of the range.

When you have blood tests for thyroid hormones, it has to be the very earliest possible, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levo and the test and take afterwards. This helps keep the TSH it its highest and yours (I believe) must be towards the top of the range.

Always get a print-out of your results with the ranges to enable members to respond. Ranges differ in labs.

Levo should be taken first thing with one full glass of water and wait an hour before eating (or at bedtime - if you've last eaten protein leave about 3 hours before taking tablet -2 hours is enough if no protein was eaten). Being hypo our digestion is slow.

Email louise.roberts@thyroiduk.org.uk and ask for a copy of Dr Toft's Online Pulse Article. In it highlight question 6 (he was President of the BTA).

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).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added. "

Dr Toft was president of the BTA. Show your doctor and ask for an increase.

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Hi ya just re read your answer and have received a print out of my blood test, it says that my level is 4.66 range is( 0.2 - 4.5 ) it says its a raised level and that if i am on levo my dose needs to be raised or poor compliance, could it be that when i was in Australia i was taking it weird times on the plane over and then whilst there took it morning there , i go over ever year though and this is the first test its been higher, the doctor did ask my how I 'd been feeling and I said fine, but am feeling colder when others aren't.

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If you put up a new post and list your blood test results, with the ranges for more comments.

You should be consistent when taking thyroid hormones and usually members take it when they get up with one full glass of water and it is recommended to wait one hour before eating. Food interferes with the uptake of the hormone.

If you were taking levo at 'odd' times - was your stomach empty? As our digestion is slow due to hypo it takes longer to digest food. So a wait of 2 to 3 hours after eating is advisable. To save all this bother either take it when you get up or when you go to bed (as long as you've last eaten about 3 hours previously.

You need an increase in levo and although you don't feel much different your body will be lacking without you realising it. You don't want to develop other more serious illnesses like heart disease etc. Our brain and heart need the most T3 and our whole body has T3 receptor cells which need T3.

Levothyroxine is T4 and has to convert to sufficient T3 so TSH alone doesn't give much information, except yours isn't 1 or below. That's the aim.

You need an increase, no matter how you feel

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No it b well is not

TSH alone must never be used

Tsh should be 1.0 or below

Freet4 around 19

Freet3 around 5.5

Ferritin

Folate

B12

Vit d3

Must all be at least halfway in their ranges otherwise your body cannot utilise or convert the T4 in Levo into T3 that every body cell needs to function

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I am going to ask for the full report on Monday.

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Ask for Patient Access at your GP surgery and get your medical record online. You will then see all your results listed online. This applies to those who live in England only I’m afraid.

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Full blood results give a better picture but more importantly, how do you feel? Have your symptoms gone?

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I feel a bit flat but was putting it down to this time of the year , will be making an appointment to see doctor about it.

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Yes, time to look into it then :-)

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I never had symptoms in the first place so was surprised when they told me I was hypo, I can say that i feel much colder than most others around me but i always have, i am from australia and felt fine over there recently, when back in the UK I got a bit flat but put it down to jet lag and coming into UK weather.

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