Advice please TSH Levels

[Maggiv]

Hi,

Ive recently been prescribed Levothyroxine on the NHS after having to have a long drawn out discussion with my GP. My test were as allows:

30/4/18 - TSH 6.25 (prescribed 50 levo)

18/6/18 - TSH 3.72 (increased Levo to 75)

8/8/18 - TSH 3.14 (Doctor states TSH level is adequate but I still have symptoms)

What do you suggest I do before I go to see my doctor. Is he correct?

Thanks

[SeasideSusie Remembering]

Maggiv

For a treated hypo patient, your TSH is too high. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well. So you need an increase in your dose.

See article in Pulse magazine by Dr Toft, past president of the British Thyroid Association and leading endocrinologist, which says

"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 by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

Also something else to point your GP in the direction of - see pathology.leedsth.nhs.uk/pa...

Scroll down to Thyroxine Replacement Therapy in Primary Hypothyroidism

and you will see in the box

0.2 - 2.0 miu/L Sufficient Replacement

> 2.0 miu/L Likely under Replacement

But TSH alone isn't the full picture, you really need TSH, FT4 and FT3 although the actual thyroid hormones (FT4 and FT3) are rarely done. Doctors appear to have had an information bypass that it's the actual thyroid hormones that are important not the TSH.

[Maggiv in reply to SeasideSusie]

Thank you.

[SlowDragon Administrator]

You need vitamin D, folate, ferritin and B12 tested too, as well as FT4, FT3 and both TPO And TG antibodies

Either go back to see GP and ask for vitamin and antibodies tested or get full blood test privately

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

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 ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's very important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

[Maggiv in reply to SlowDragon]

Thank you. I had my antibodies checked in April. They were well below the reference range so I guess it’s not Hashimotos.

[humanbean]

You might find this thread to be of interest :

healthunlocked.com/thyroidu...

[Maggiv in reply to humanbean]

As I’m 55 I don’t think this applies to me.

[humanbean in reply to Maggiv]

If you take a look at the table beneath the graph it points out that the median (middle value) TSH for females aged 50 - 59 with no known thyroid disease is 1.5. The range went from 0.5 - 3.6.

With your TSH at 3.14 you are quite high up that range. 50% of the healthy women aged 50 - 59 had a TSH between 0.5 and 1.5.

Many people on this forum have discovered that they need a TSH which is lower than that of healthy people. If 50% of healthy women aged 50 - 59 have a TSH of 0.5 - 1.5 why can't your dose be raised so that your TSH drops into that range too?

If you look at the link that the graph came from (which is based on people of all ages in the study) it has lots of useful info.

web.archive.org/web/2004060...

Quote :

The centre of the Reference Range for the test kit used in the study is 2.35. Almost 85% of the healthy population have a TSH reading below this value.

Your doctor is keeping your TSH higher than that of healthy people. You might feel better with a higher dose of thyroid meds.

[Angel_of_the_North]

TSH is not really a very useful measure once you are on medication but most GPs are obsessed with it. TSH should be under 1 and Free T4 abd free T3 (the important ones) in teh top quarters of their ranges. You need another 25mcg increase in levo, retest in 6 weeks and then another increase and so on. You can get a copy of the Dr Toft Pulse article explaining this from TUK.

[Maggiv]

Just to update:

Ive spoken to my doctor who has agreed (after a long conversation) to increase my Levothyroxine to 100 from 75 per day. He has stated that he believes this to be too high and will put me at risk of side effects. Does anyone know if this might be correct?