I’m confused as to why docs use tsh level only to gauge hypothyroidism? At diagnosis in June, My free t4 and t3 levels were fine but my tsh was raised a little - but I had a ton of symptoms so was given 50levo. (Private test show huge ATPOs and hs-CRP, low reverse t3 ratio.)
My doc didn’t retest my t4 and 3 levels upon follow up, just the tsh which is now 2.5.
Can I conclude that the t4 and 3 levels are not as relevant as how hard your thyroid is working to stimulate their production? And what does that mean? Does a struggling thyroid indicate anything else?
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JAmanda
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If you believed in conspiracy theories - then you would think they do not test FT4 and FT3 so they can keep us unwell and needing lots of other pills and potions making oodles of dosh for You Know Who ...
Docs are under the mistaken idea that the TSH tells them everything - poor training at Med Schools - and again the influence of Big Pharma. Also there is the mistaken idea they are saving dosh by only testing the TSH - which of course as we all know is not cost-effective long term. Also there is a school of thought that thinks NHS patients are slowly being pushed into the private sector ...
I would stick with this Forum for advice and think of something you can give up/sacrifice so you can afford private testing in order to have the complete picture.
If there were no TSH test, we would judge how one is by symptoms, Free T 3 (should be in top 1/4 of range), Free T 4 (should be mid-range), heart rate and body temp. Being in range with thyroid hormones doesn't mean those numbers are optimal. In the old days, before synthetic hormones (levo/synthroid) and the cursed tsh test, docs treated by tracking body temp/heart rate/blood pressure and the alleviation of symptoms. Many things can interfere with the thyroid producing thyroid hormones. Sometimes the thyroid is producing plenty of hormone, the hormones just aren't getting into our cells where we need them. Other times, something may be binding up the hormones and again, preventing them from getting where we need them.
It might be helpful if you posted recent lab results with ranges. Also testing B 12, D 3 and iron levels next time you have labs done.
NHS guidelines saying standard starter dose is 50mcgs. You should have dose increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range. Most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine
And yes, you are correct, just testing TSH is completely inadequate, especially with high TPO antibodies (Hashimoto's)
For full Thyroid evaluation you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12
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.
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins
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 test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.
Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine
Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
Many thanks SlowDragon. I have some 25mg tablets but every time I take them, I get hot and panicky - even adding 25 every other day. Might try again and hope Endo does a better range of tests - when I eventually get appt. thanks again for info.
Yes you and SlowDragon are right! The 25 is teva and the 50 is activis. The teva give me an instant itch in my throat and in ears - thanks, clearly I don’t get on with teva. So I’ll ask the doc how I can slightly up my levo from 50 but avoiding teva. Many thanks, really. (You know when you have so many varied symptoms, it’s easy to just ignore an irritating itch that passes - I didn’t so much like the heat and racing pulse an hour later. )
Should have also said, my private tests showed v low b12 and low folate - was also treated by docs fir v low folate last year. Doc had no interest in private test results - wouldn’t look at them - but have been taking v good b12/folate recommended here for almost as long as levo - so no idea if hair regrowth in arms, less stiff joints, less cramp in muscles etc etc etc is due to vits or levo really. Have ordered selenium/zinc to take fir a month or so before paying for new private tests if endo doesn’t order them. Ok, I’ll stop for now! Little by little I’ll get there! Many thanks to this forum.
I'm a cynic - but TSH test is cheap and means that Doctors don't hve to treat many people with symptoms, They go on what they are told by pharmaceutical companies and believe that TSH always perfectly mirrors the levels of free t4 and free t3 and no sick person could possibly have a problem with the hypothalamus or pituitary gland, or a dodgy feedback loop. Modern medicine is all about "do a blood test - spend as little as possible - then look up on the computer what drug to prescribe - do not touch the patient (or look at them unless you have to).
Actually free t3 and free T4 are the important test as they are the actual thyroid hormones. No one gets TSH tested when they are healthy, so it is not known what an individuals ideal TSH level is - and when you start to have thyroid problems, it seems highly likely that the feedback loop is broken.
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Feedback loop TSH/T4/T3
ONLY TSH!!!
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