Thyroid Blood Range

[pshah13]

Hi everyone. I’m sure this has been covered preciously - but search didn’t come up with the answer hence posting.

I’ve suffered from hypo for over 25 years. I realised part way through that I could do something about feeling better and sought help. However that help is no longer there and as most of us know, Endos and GP’s don’t have a clue how to treat Hypo and don’t care to ask about the symptoms just blood results.

I had been on T4 and T3 until I could no longer reliably obtain T3. I’ve now been on 200mg T4 (Levo) for many years. I’m feeling fine although I experience ‘crashes’ every few months which I’ve learnt to accept. I also no longer focus on my ‘illness’ or bloods or dose and just get on with it as long as I feel I can manage as it was really getting me down.

Just been for my biannual endo appt and saw a new endo. My TSH has been 0.01 and Endo has just reduced my T4 dose down by 50 mg.

My question is what should OUR (not per NICE) normal blood range be for T3, T4, TSH ETC?

Thanks in advance. Priti

[greygoose]

They should be wherever you need them to be to feel well. But, don't expect any doctor to understand that. The only thing they know is the TSH - it's all they learnt about in med school. Did you not protest at having your levo reduced? Even if your levo really did need reducing - and he would only know that by asking how you are and looking at your FT3 - it should only be reduced by 25 mcg at a time. That endo is useless. I wouldn't go and see him again, if I were you.

[pshah13 in reply to greygoose]

Thanks Greygoose. I don’t have the energy to fight the gps and doctors anymore. Have been fighting too many years.

[greygoose in reply to pshah13]

But, what's the alternative?

[SeasideSusie Remembering]

My TSH has been 0.01 and Endo has just reduced my T4 dose down by 50 mg.

What were the results for FT4 and FT3 (with reference ranges). Your endo is guilty of altering dose by TSH result only and ignoring hormone levels by the sound of it.

As Greygoose says, we need our levels to be wherever they need to be for us to feel well.

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.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

Considering Dr Toft's position in the thyroid world, I do wonder why this information hasn't filtered through to other endos.

How come you've been on 200mcg Levo for "many years" when your first post on the forum 2 years ago said your doctor had stopped prescribing T3 and you had tried NatureThroid and you were looking for suppliers of other brands of NDT.

[pshah13 in reply to SeasideSusie]

Hi thanks for your message. I was on T3 years ago but could no longer obtain it and I am just on T4 now. Didn’t notice any difference in transition to be honest.

[SlowDragon Administrator]

Just testing TSH is completely inadequate and dose should never be reduced based solely on low TSH

Dose of Levothyroxine should only ever be reduced in tiny doses ......25mcg as absolute maximum

Strongly suggest you get FULL Thyroid and vitamin testing BEFORE considering reducing at all

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also 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).

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many people need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Come back with new post once you get results and ranges