Mystery

[annnsandell]

So latest blood tests back on top of those a few weeks ago.

T3 4.6pmol/L (3.10-6.80)

TSH <0.02 mU/L (.30-4.5mU/L) TSH suppression target 0.1mu/L

Cortisol

Androgen

Sex binding hormone

Liver function

All ok

Testosterone Abnormal 3.2 nmol/L (<1.40nmol/L

Doctor doesn't know what is going on so I have at last got a referral to an Endocrinologist on 22 May

Does anyone know why my TSH is so low? Presumably if I took more Levothyroxine it would go even lower. What would some T3 instead of all T4 do?

[SlowDragon Administrator]

As you have no thyroid you are likely to need addition of small dose of T3

But FIRST essential to get FULL thyroid and vitamin testing. Low vitamins are extremely common and need regular testing and very often regularly supplementing to maintain at good levels

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

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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT4 and FT3 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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

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 . Note especially his comments on current inadequate treatment following thyroidectomy

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

New NHS England Liothyronine guidelines November 2018

sps.nhs.uk/wp-content/uploa...

Dossier presented to Lord O'Shaughnessy November 26th

drive.google.com/file/d/1c2...

Liothyronine gender inequality

england.nhs.uk/wp-content/u...

medscape.com/viewarticle/90...

Cost is not a reason to deny clinical need

[annnsandell in reply to SlowDragon]

I have just had full vitamins done, D has been increased everything else ok. I still suspect like you that I need some T3 but results don't show it and TSH well suppressed. I wonder about the relationship between increased dose of T3 and reducing T4 on my low TSH result as it certainly doesn't want to go any lower. Understand high Testosterone can be a symptom of Hypothyroidism especially as all other results are ok. I asked for T4 but they only did T3 and TSH this time but results are in line with what they have been for years. Just hope I get a good Endocrinologist. I'll reread this lot. Thanks.