Thyroid levels

[Butterfly_79]

Hello, I’m looking for any advice that can be given please. I have been to the doctors this morning for my medical review, my TSH is 0.02 (range 0.20-4.50) and my T4 is 16 (range 7.0-17.0)

I feel well, normal, not asleep every time I sit down. I’ve had this condition since I was 23 and I’m now 39! The doctors want to reduce my thyroxine because they don’t look at T4 they go off TSH and they say it’s too low. Nor do they take into consideration that I feel good.

I don’t want the to reduce it. They want me to have another blood test next month.

I’m wondering if to reduce what I take so the next blood test fit within their range and feel ill for a month, so I can then not have medicine reduced and then continue to take my medicine and feel well again? Hope it makes sense.

[SlowDragon Administrator]

Your doctor is there to advise, not dictate

Also just testing TSH and FT4 is completely inadequate

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

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, take last dose 24 hours prior to test, and take next dose 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?

When were vitamin levels last tested? Do you supplement regularly to maintain levels? If so what

Suggest you inform your GP that you will be getting full private testing and provided FT3 is within range you will not be reducing dose

[LapisSW]

Hello, Do you have a reference for Dr Toft's article please

[SlowDragon Administrator in reply to LapisSW]

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

[FerryMan]

So mine are at the very bottom of the range for both T3 and T4. What does that mean and how do I convince someone to treat it. Besides the fatigue and the inability to lose weight, my drs advice was to eat under 1100 calories /day. That isn't going to happen as it is totally unsustainable. Thanks