TSH Suppressed

[Jay23]

I had my annual blood test yesterday and got a phone call from a doctor this morning to say it looks like I am over medicated as my TSH is suppressed, T4 is 19 but TSH is <-0.02. I am currently on 125mcg of levothyroxine and they want to reduce to 100mcg and get tested again in 3 months (unless I don’t feel well). When I mentioned that I thought the TSH was not important they said that it’s not normally unless it is completely suppressed and then there is a risk of heart arrythmia. I have agreed to reduce because of this but not entirely happy as I actually feel like doing things. I had just asked on my last repeat prescription for it not to be Teva for the 25mcg as I wondered if that was making a difference as they keep changing the brand for this one and I could not understand why I had periods where I sometimes felt ok and then went back to feeling awful again and it just clicked that I was suddenly feeling ok and I had been taking the new brand for a couple of weeks that was not Teva. Just really looking for advise on the TSH being suppressed.

[SlowDragon Administrator]

Personally I would tell GP you had bad reaction to a Teva brand. That you want that noted on ALL future prescriptions "NO TEVA"

And insist you stay on same dose and get FULL Thyroid and vitamin testing 6-8 weeks later after being on constant dose AND unchanging brand of Levothyroxine

You will almost certainly need to get TSH, FT4 and FT3 tested privately, though you could argue that as TSH is abnormal and out of range FT3 should be tested by NHS

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

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 or all 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

Guidelines on dose is 1.6mcg per kilo of weight

So multiply your weight in kilo by 1.6 to give guidelines on dose you need

[Jay23 in reply to SlowDragon]

I mentioned the TEVA to her and they said that it is on my prescriptions now. I also asked about getting T3 tested and she said they don’t do that.

I have had those testspreviously from Medichecks and Blue Horizon and have had the antibodies tested and have Hashimoto’s.

I always get my tests done first thing in the morning as been advised about that previously and then take my dose afterwards.

Already take Vitamin D, B12, Iron, B Complex, Zinc and Selenium.

[SlowDragon Administrator]

Two years ago your TSH was just as suppressed

healthunlocked.com/thyroidu...

FT3 low despite low TSH on this Medichecks test

healthunlocked.com/thyroidu...

Suggest you get full Thyroid and vitamin testing again

As you have Hashimoto's are you on strictly gluten free diet

[Jay23 in reply to SlowDragon]

My TSH was previously <0.02, now it is <-0.02 so not suppressed before but it is now.

I tried gluten free diet but it did not make any difference to me.

[SlowDragon Administrator in reply to Jay23]

Personally I would insist that FT3, FT4 and Tsh are tested BEFORE reducing dose (assuming you don't feel over treated)

Would suspect your FT3 is low already, and would drop even lower if dose reduction

Many Hashimoto's patients have suppressed TSH and still inadequately treated, if poor converter, and/or low vitamins and/or have common DIO2 gene variation

thyroiduk.org.uk/tuk/testin...

thyroiduk.org.uk/tuk/testin...

[Jay23]

Hi SeasideSusie do you have any advice on suppressed TSH?

[SeasideSusie Remembering in reply to Jay23]

Jay23

No advice, but a suggestion.

First of all, unless you've actually seen a print out which says <-0.02 then I wouldn't believe it. I have results going back to 1995, most of the time my TSH is suppressed. I have never, ever had a result which has a minus sign. My lowest has been <0.005 (private labs) and the lowest the NHS tests go has been 0.03

Also, before reducing your dose, if you feel well on the current dose and only TSH or TSH and FT4 have been tested, then insist on FT3 also being tested as that is the result that tells you if you are overmedicated.

As for TSH being suppressed, out of 51 tests I have results for, TSH has just scraped into the very bottom of the range 7 times, the rest of the time it is suppressed or below range. My understanding is that suppressed is <0.1

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

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

then I am not going to worry about suppressed TSH.

You can obtain a copy of the article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

[Jay23 in reply to SeasideSusie]

Thanks SeasideSusie . I did ask if they would test T3 but she said there was no need!!! I'll get them done at Medichecks again to see what they say or I might try calling back to discuss again.