Does GP or Endocrinologist adjust dose accordin... - Thyroid UK

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Does GP or Endocrinologist adjust dose according to the TSH?

shaws
shawsAdministrator

This is an excerpt of a question from Dr Lowe:-

January 25, 2002

I am going to an endocrinologist for the first time in 15 years on Friday to discuss my continuing symptoms of hypothyroid. My question comes here. I had my doctor's office fax my blood test result to me, and I’m very perplexed. The normal range for the TSH my doctor looks at is 0.49-to-4.67. My last two blood tests read less than 0.03. Now, I had my thyroid burned out, so why would my TSH reading be so low, indicating that my thyroid is producing enough hormone. I’m so confused and upset by this and really need some answers. I know I’m going to a specialist in a couple days, but I’d like to go to my appointment armed with as much knowledge as possible. Could it be that my pituitary gland is not functioning properly? I truly appreciate your input.

Dr Lowe: Your observations don’t suggest to me that your pituitary gland isn’t functioning properly. In fact, your observations are consistent with what science tells us about a patient's T4 dose, her TSH level, and her metabolic health or lack of it. If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours.

The TSH level is not well synchronized with the tissue metabolic rate. (Probably most doctors falsely assume that studies have shown that the TSH and metabolic rate are synchronized. But despite my diligently searching for years for such studies, I’ve yet to find them.) Adjusting the T4 dose by the TSH level is like adjusting the speed of your car by a speedometer that's out of synchrony with the actual speed of the car. Adjusting the speed of a car by an out-of-sync speedometer, of course, will get the driver into trouble—either with other drivers who'll object to the car traveling too slowly, or with a police officer who'll object to the car going too fast. And adjusting the thyroid hormone dose by the TSH level gets most patients in trouble—almost always because their tissue metabolism is so slow that they are sick.

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4 Replies
oldestnewest

My Endo has sanctioned my prescription for T3 which I was delighted about, I am now on a combination of 50mcg of Levo and 10mcg of T3. Unfortunately I am still symptomatic including being unable to lose weight, and over 3 stone heavier than I was before becoming Hypothyroid. My last blood test results showed below range T4 and only just in range (lowest figure on the scale!), but because my TSH is suppressed the Endo refused to increase either medication. She also commented that she assumed the draw was pre dose and therefore the results would have been higher post dose. Her assumption was right, it was pre dose, so does that mean leaving the dose was the right decision? despite losing the outside borders of my eyebrows and eyelashes, lethargy and being obese even though I am eating a diet plan recommended for Hypothyroid sufferers - wholemeal bread, wholemeal pasta, rice etc. Butter, cream, plenty of meat, fish, eggs, full fat cheese, fruit & veg. I have cut out cake, biscuits, fizzy drinks and sugar. I also walk my dogs for about 2 hours a day. Any comments would be appreciated.

shaws
shawsAdministrator
in reply to Baggiebod

Your combined dose seems small i.e. 50mcg levo + 10mcg of T3. 50+30 = 80mcg of hormones which is quite low. We used to get doses between 200 and 400mcg (NDT) but we were dosed according to symptom relief i.e. starting off with 1/2 or 1 grain and slowly increased until symptom-free and no blood tests were available then and it should still be adjusted according to symptoms. Not stopped due to being somewhere in the range for TSH which should be 1 or lower. TSH isn't a thyroid hormone it is from the Pituitary Gland it means Thyroid Stimulating Hormone which rises when it is trying to flag the thyroid gland to provide more hormones.

Weight gain is the commonest query on the forum. It is distressing for many who cannot understand why. It is due to hypothyroidism - hypo meaning slow or low and I'll give you a couple of links which might be helpful.

If doctors are not 'treating symptoms' (to relieve them) they aren't doing their job. We know they are treating the number on the blood test but that's not what they should be doing but that's what they've been told by the Associations who should really know better.

stopthethyroidmadness.com/h...

hormonerestoration.com/

hormonerestoration.com/Thyr...

Baggiebod
Baggiebod
in reply to shaws

Hi Shaws thank you for your reply & info. I am a bit anxious about self medicating, do you think the result was likely to be lower because it was pre dose? I am considering getting a private test done half way between doses? Do you think it would give a more accurate result and therefore give me an opportunity to request a review of my doses? Thanks in anticipation, Baggie x

shaws
shawsAdministrator
in reply to Baggiebod

I think most of us, myself included, were nervous of self-medicating but you do so as we aren't improving and even feeling worse under doctors' care.

All blood tests have to be at the earliest, fasting(you can drink water) and a gap of 24 hours between dose of hormones and test. This keeps the TSH at its highest as that's all plus the T4 they take instead of the Free T4 and Free T3. These are more informative.

If they ignored the TSH and concentrated on the FT3 and FT4 many patients would feel much better more quickly. They should ideally take into consideration clinical symptoms as that is the idea of hormone replacement, relieving clinical symptoms. They have no idea what a symptom is anyway.

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