Is TSH measurement higher in afternoon?

[Fifteen]

My GP is refusing to give me a prescription for my Thybon 20 Henning as he is now following the advice from Prof. Karim Meeran (the Diabetes Medico who sent out the 'edict' stopping the prescribing of Liothyronine). In a provate consultation, Prof Meeran insists that T4 will bring me into balance on its own.

My results:

On 4th July my TSH reading was 0.01miu/L (range 0.3 - 4.2)

On 4th January my TSH was 0.02 miu/L (range 0.3-4.2)

These are lower than earlier readings.

When I look over earlier results, including one he insisted I do 15:10, it does seem to be higher in afternoon measurements.

Other July results:

Serum Free T4 is 11.9 pmol/L (9-23)

Serum free T3 is 4.6 pmol/L (2.5-5.7)

Other results

Serum Vitamin B12 519 ng/L (160-800)

Serum Ferritin 125 ng/ml (20-300)

Vitamin D 133.7 (70-150)

Serum Folate 9.8 ng.ml (greater than 2.7)

He wanted me to do further testing straight away but I have put it off. Now I have to see him on Monday so will do blood tests on Thursday.

Please advise how to prepare and whether early morning or late afternoon is better, and if fasting in the morning.

Much appreciated

[Angel_of_the_North]

No, it is lower. Early morning fasting is the best time for tests naturalmedicinejournal.com/... T3 also has a rhythm academic.oup.com/jcem/artic... Unless Dr Meeran is actually your endo and has seen you, GPs are not supposed to change or stop T3 prescriptions - tell GP to read article in Pulse magazine that specifies that.

[Fifteen in reply to Angel_of_the_North]

Thanks for these links.

I saw Prof Meeran once - once too often. He is not my endo - perhaps I should see my usual one again.

Prof Meeran was not impressed when I asked about his experience with the thyroid for, as far as I could see, all his research was on diabetes. I think there was one study with children in 1994 mentioned in his research list, and perhaps another, earlier, one. He did not handle that question well - I doubt he had ever had a patient do research on his background prior to an appointment. But we do it with other service people - plumbers, electricians, decorators - why not with someone who works with/on our bodies and minds.

[Hidden in reply to Fifteen]

Love your approach, I expect you were a bit of a shock!

[Fifteen in reply to Hidden]

The best way to be.

[SeasideSusie Remembering]

Fifteen

Daily rhythm of all thyroid hormones can be seen in the graphs in the first post of this thread

healthunlocked.com/thyroidu...

Early morning, 9am appears to be best time for high TSH (unless you can test between midnight and 4am )

Eating lowers TSH.

Coffee affects TSH.

**

Serum Vitamin B12 519 ng/L (160-800)

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Serum B12 isn't the best test as it's total B12 (bound and unbound/free). Active B12 is a better test as this measures the unbound/free B12 which is available to be taken up by the cells.

Serum Ferritin 125 ng/ml (20-300)

This is good, I've seen it said that 100-130 is good for females (I'm assuming you are female, it's 150 for males).

Vitamin D 133.7 (70-150)

This is good, assuming it's nmol/L.

The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).

Serum Folate 9.8 ng.ml (greater than 2.7)

Pretty good, over the low limit but I don't understand why there is no proper range any more. If you were 2.8 you'd be told it was fine, but at 2.6 you'd be deficient. I'd want mine in double figures so you're nearly there.

[Fifteen in reply to SeasideSusie]

Thank you for your very helpful reply.

I have been looking through my older blood results. While I was on Liothyronine my TSH was in an acceptable range. It is only since I have had to take a substitute that this very low TSH result has occurred.

Can you suggest why this may be the case?

[SeasideSusie Remembering in reply to Fifteen]

When taking Liothyronine it tends to lower, even suppress TSH, so it's unusual that you say your TSH was in a acceptable range then. When on T3 (liothyronie) it's the FT3 result that's important.

What is the substitute you are have been given?

[Fifteen in reply to SeasideSusie]

Interesting. I first saw Dr Mark Vanderpump in September 2015 and he put me on Liothyronine then. My TSH fell from around 2.27 (average). It varied in the following months/years eg 1.11, 0.98, 0.5, to 0.15 in June 2018.

Then I started on Thybon 20 Henning. By October 2018 it was 0.04, and now 0.01.

I buy Thybon 20 Henning from Germany. My GP agreed to write a prescription twice but has now refused because of the very low TSH.

I doubt he knows anything about the significance of the FT3 result. Dr Vanderpump said the TSH would drop and that was not a concern though my GP may not agree.

Since I told GP about Thybon 20 Henning, he has advised another patient about it. Evidently, in a quarter of a century, she and I are the only patients who have needed T3.

[shaws]

I think doctors who wish to remove T3 from patients who are well, should have their own thyroid glands removed and given levothyroxine at a low dose. They will then feel exactly what their patients are put through when they had expected the professionals to restore them to good health.

[Fifteen in reply to shaws]

I agree. Prof Meeran is the problem - he signed the edict. Actually, my Cardiologist (regarded as one of the top 3 in the UK) wrote to Prof Meeran to tell him I should stay on Liothyronine as it improved my quality of life (I have had cancer twice +++), my bone density is excellent, and he thought any other risks were absolutely minimal. His advice has been ignored.

[shaws in reply to Fifteen]

It is us - the patient - who knows what is best for us if we're allowed to trial variations. For instance, many of us on this forum don't improve on levothyroxine. Those who do will not be searching for information or help.

[Fifteen in reply to shaws]

It makes such a difference for me. The first time I had it was when a brilliant GP, then at a leading health resort in Arizona, prescribed a compounded version. I lost so much weight it was unbelievable, I had energy for the first time in years and, absolutely crucially, clarity of mind. I went back to Sydney and could not find a replacement, so back to illness. My GP here only gave in in 2015 and gave me a Private Referral to Dr Vanderpump. Then, last year, the battle returned.

What is it with these doctors? Arrogance, ignorance.....and fear?

[shaws]

You could also write to Lord O'Shaughnessy and this is a link for information:-

thyroiduk.org.uk/tuk/campai...

[Fifteen in reply to shaws]

Has not his submission been completed? If not, a good thought.

[shaws in reply to Fifteen]

Yes but you could still write as someone who is suffering. Re Dr Vanderpump - his method of treating does not suit many of us on this forum. This is an excerpt:-

"Thyroid hormone replacement is life-long and falls within the definition of the Equality Act 2010 as without thyroid hormone replacement the hypothyroidism is likely to recur. Hypothyroidism can be adequately replaced in the long term with Levothyroxine and hormone replacement is not associated with any significant increased morbidity or mortality provided that a therapeutic target is reached. Without thyroid hormone replacement the impact of the disability would substantially limit his ability to carry out normal day to day activities. However, adequate treatment should prevent any symptoms related to the disability from this point onwards.

markvanderpump.co.uk/blog/p...

[Fifteen in reply to shaws]

Interesting. He prescribed Liothyronine for me in 2015. His comment was that I seemed to one of a small number of people who benefited from it.

At my last consultation, when he spoke of the new 'edict', he told me about getting T3 from Europe - colleagues had mentioned this to him.

Can you let me know privately of Consultants who are more understanding of our illness? I will very much appreciate this.