Is a TSH under 1 okay?

[momo33]

Hello,

I am due to get my annual thyroid blood test in a couple of days. Last year my TSH was 1.2, and I was feeling okay, but since I have cut out dairy until four hours after taking my levo I'm feeling much better. I read somewhere that calcium can reduce the absorption of levothyroxine, so presumbably I'm getting more thyroxine in my system than I was before.

My doctor is a bit unsure about how to treat my thyroid and has said so on several occasions. He tends to rely on the advise of endocrinologists (who aren't always the most helpful..). Anyway, I'm worried that my TSH would have dropped since I cut out my morning dairy to below one and he might panic and reduce my dosage of levothyroxine (even though I feel better that I've felt in years) because of the risk of osteoperosis, etc.

Does anyone have anything that I can print out that shows that having a low TSH is okay if the patient feels well? I'd really appreciate some evidence that I can bring with me and show him. The last thing that I want is to go back to feeling like I'm on death's door!

Thanks so much for taking the time to read my post. Hope to hear from you soon,

momo x

[SeasideSusie Remembering]

momo33

If it's below 1 but in range there wouldn't be a problem.

If it's below range then you can refer to Dr Toft's article in Pulse magazine (the magazine for doctors)

"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)."

[Total T3 is not normally measured in the UK, but FT3 would need to be in range, so if there's any problem then ask your GP to test TSH, FT4 and FT3 all at the same time.]

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.

[momo33 in reply to SeasideSusie]

Hi SeasideSusie,

Thank you so much for your helpful and informative reply. It's exactly what I needed puts my mind at rest! I will request a copy of Dr Toft's article.

Thanks again, I really appreciate your help.

Best wishes to you.

momo x

[Venicefan]

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

This is a recent article from Dr Toft that is also very good to share with GPS and Endocrinologists who stick slavishly to the guidelines

[momo33 in reply to Venicefan]

That is really helpful. Thank you so much! I know exactly what you mean about GPS and Endocrinilogists and the guidlines. Had this problem before but this time I want to come armed with information. Thank you so much.

[Muffy]

Don’t take your thyroxine before your blood test and have your blood drawn as early in the day as possible, preferably around 8 am .

[momo33]

Hi Muffy, thanks for that. I had my appointment today and took my levo when I got home this morning. There's so much to know and everyone here is so helpful. Thanks again!