Am I now Hyper?

[WSimpson]

I've been on Thyroxine since April following blood tests where my TSH was 13. I started on 50 mcg but for the last 6 weeks I've been on 75mcg.

I went to the Doctors on Friday to get recent blood test results and they now think I'm Hyper ( even though I still have Hypo symptoms).

My blood results were:

TSH 0.08 (0.25 - 4)

T4 20 (11 - 22) sorry reading this off a graph so may not be accurate.

Consequently, they want to lower my Thyroxine back to 50. Does this sound right?

I'm so new to this I don't know what to think. Help please!

[SeasideSusie Remembering]

WSimpson

If you have been diagnosed with an underactive thyroid, and a TSH of 13 confirms Primary Hypothyroidism, it's impossible for your thyroid to then become overactive.

What can happen is that you can be overmedicated.

However, your current results, if FT4 is correct at 20 (11 - 22) doesn't show signs of overmedication. Your GP is looking at your below range TSH but that is wrong. S/he needs to look at the whole picture - TSH, FT4 and FT3. Only when FT3 is over range are you overmedicated.

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.

From thyroiduk.org/tuk/about_the... > 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 Dionne at [e-mail] print it and highlight question 6 to show your doctor.

So I would ask for a print out of your test results to be absolutely certain of the figures. If you feel well with your current dose and your GP wants to lower it, ask for FT3 to be tested at the same time as FT4 - referring to Dr Toft's article above.

[WSimpson in reply to SeasideSusie]

Thank you for the information. I have started to feel better so I don't want to reduce my meds as I think this level suits me. I don't stand a chance of getting my T3 level as they aren't planning to refer me to an Endo.

[SeasideSusie Remembering in reply to WSimpson]

Sometimes we have to fight to get well, especially as most doctors know very little about treating thyroid conditions. You can always do a private thyroid panel like hundreds of us here do. Medichecks and Blue Horizon are two well respected labs recommended by ThyroidUK who offer this.

[shaws Administrator]

Refuse as doctor is only taking account of the TSH, which is from the pituitary gland and they -unbelievably believe - that we can go from hypothyroidism to hypErthyroidism due to a TSH result which is below range at 0.08. TSH is from the pituitary gland and rises if thyroid gland is flaging but yours is not, as your TSH can be below range if we're taking thyroid hormone replacements. They ruin people's health by doing the wrong thing. They are so poorly trained.

[SlowDragon Administrator]

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 test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Is this how you did the test?

Just dosing according to TSH and FT4 is completely inadequate.

Your GP is just looking at low TSH

You also need FT3 tested and both TPO and TG thyroid antibodies

Ask GP to test vitamin D, folate, ferritin and B12 as well

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.

[WSimpson in reply to SlowDragon]

Thanks for the tips. I didn't realise do many people did private testing.

I didn't take my Thyroxine before my blood tests ( which were sf 9 am) as I had already read this tip on the forum.

I have had an antibody test ( as my sister has Hashis). Mine came back negative.

I have radiation induced Hypo due to radiotherapy across my neck in 2016.

[SlowDragon Administrator in reply to WSimpson]

So you had Graves' disease previously ?

As your thyroid is in effect knocked out, you likely need high FT4 and to test FT3

TSH often remains suppressed after being hyperthyroid, so is especially unreliable. Testing FT4 and FT3 essential

Plus testing vitamins too

[WSimpson in reply to SlowDragon]

No, I didn't have Graves. I had radiotherapy for non Hodgkins Lymphoma. Unfortunately the radiotherapy field included my thyroid gland.

Oncologist has confirmed that Hypo can be a side effect as a bit if my thyroid may have died after treatment.

[janveron1]

Change doctors!!

[WSimpson in reply to janveron1]

I was thinking the same. I had booked to see my Usual GP but ended up with a locum.