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Thyroid UK
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Tsh

Hi all

I had a TT 2018 and RAI in October

My last bloods were

TSH 0.49

Could I still be hypo?

Symptoms

Chills

Cold hands

Tiredness

Depression

Memory loss and fog

13 Replies
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Just testing TSH is completely inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common.

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

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

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Many people are either on too low a dose of Levothyroxine after RAI or need the addition of small dose of T3

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

tukadmin@thyroiduk.org

Professor Toft recent article saying, T3 may be necessary for many. Note especially his comments on current inadequate treatment following thyroidectomy or RAI

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

Come back with new post once you have FULL test results

4 likes
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Follow SlowDragon's advice, however, it might be worth also testing calcium and parathyroid hormone levels since I presume you had TT for thyroid cancer? There is often little support for symptoms following thyroidectomy. Many of us have had to work out how to get well on our own and with the help of this forum. Nutrient and vitamin levels are crucial to wellbeing without a thyroid. You could start taking vitamin C twice a day to support adrenals and bones. Your body excretes any excess that you don't need.

With a bit of luck you can get your GP to test all your vitamin levels and save the cost of a private lab. Also ask GP to test FT3, FT4 and TSH to confirm whether you are on an optimal dose of thyroid replacement. NHS does not like to do FT3 but you might be able to persuade GP on the basis of TSH being low but symptoms not concordant.

Remind the Doc of your diagnosis, they don't have time to read your notes. They are used to autoimmune thyroiditis but not thyroid cancer patients if that is your diagnosis. They've probably never seen a thyroid cancer patient in their practice before.

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Hi yes cancer

My ft3 was 6.7. Top range is 6.2

All my vit levels are in the bottom quarter of the range.

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Is that a recent blood test result? Your FT3 might drop with time. If you've not had it tested at least 6 weeks ago, I'd ask for another blood test now and get calcium levels checked too.

In the result you've given, FT3 is over range but what was FT4 and TSH? If the FT3 is a recent result, can you drop levothyroxine dose down slightly, say by taking 50mcg less one day a week initially and retest in 6 weeks? Sometimes symptoms are confusing so it's hard to judge levo dose by symptoms when on TSH suppressive therapy.

If you post your vitamin test results, people here will give you great advice. Quarter through range does not sound great for vitamins but we need the results to give best help.

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There's no FT4 result in your link. I would not increase thyroid meds on the basis that FT3 is over range. It can take about 6 months for vitamins to start making a difference and probably a year until they are really making a difference. It's a slow process to help your body back to health. Thyroid hormone will work better when they are all optimal since they all work together.

Check calcium levels too. Are you taking magnesium and K2-MK7? They are the co-factors for Vitamin D3. Magnesium citrate is ok but there are others such as magnesium malate which might be better. Magnesium helps body to absorb vit D and K2 prevents calcium from lining arteries and directs it to bone apparently. 6 prunes a day will give you boron, also needed for bones.

Ensure you leave at least 2 hours after taking levothyroxine before taking any supplements or medicines and 4 hours between iron supplements. Make sure you take levothyroxine on an empty stomach, nothing but water for an hour. Stick to one formulation of levothyroxine that suits you and don't let the pharmacy switch it.

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Thank u

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How long a gap did you leave between your last dose of thyroid hormone and the blood draw?

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Had my last dose at 6am and then bloods at 9am the next day Levo after the blood

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Oh, so you don't take T3? Looking at that FT3, I thought you were. :)

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Hi. No just T4 Levothyroxine

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OK :)

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