Sleeping patterns and time of TSH test

[beam_me_up]

So just to give some context, my story is that I have almost all of the hypothyroid symptoms and have had blood work done which confirms a suspect pattern also associated with hypothyroid but a visit to the GP has revealed that in fact, I am perfectly healthy. No follow up in investigation needed.

High in range LDL cholestrol 3 mmol/L (0-3)

Low in range HDL cholestrol 1.36 (1.1 - 5.5)

High in range prolactin 293 mU/L (86 - 324)

Over range cortisol 516 nmol/L ( 166 - -506)

Over range DHEAS 12.8 umol/L (2.41 - 11.6)

TSH 3.86 mIU/L (0.27 - 4.2)

Both antibodies negative

Over range morning saliva cortisol 30.4 nmol/L (6-21) (~50% over top of range)

So my question is what effect will my sleeping patterns have on my TSH values, I generally wake at 9am to get to work for 10am, then work late and get to sleep around 1am.

The time of the blood test which gave the above results was around 10:30am but most recommendations on TSH testing is to get it done around 8:30am.

Due to my life style, should I force myself to get up early to get blood taken earlier or will it have made no difference as long as it was done quickly after waking?

Obviously I could just try an see what the values are but I see TSH values are highest in the night so I may then be kidding myself that my thyroid is the problem if the sample is taken in what is effectively my night time.

Many thanks.

[jimh111]

The odd hour will make little difference but it is the body clock that affects diurnal TSH levels and like me you live in a different time zone that is an hour or two behind other people. Although an elevated TSH (usually above 10.0) indicates a failing thyroid gland patients can be hypothyroid for other reasons and will a normal TSH. It would really help to have fT3 and fT4 measured as well as TSH. Ultimately, the only way to discover if you are hypothyroid is a trial of thyroid hormone, does it make you thyrotoxic (overactive) or does it resolve your symptoms?

Some of the symptoms you describe in your other post (e.g. dry skin) could indicate hypothyroidism but your blood test results suggest otherwise:

TSH 3.86 mIU/L (Range 0.27 - 4.2)

Free T3 5.91 pmol/L (Range 3.1 - 6.8)

Free Thyroxine 19.8pmol/L (Range 12 - 22)

These are slightly high thyroid hormone levels although TSH is not suppressed. Your antibody counts are low so these numbers will not be caused by autoimmune attacks causing irratic thyroidal secretion. In spite of the numbers the only definitive test is a trial of thyroid hormone, it will be very difficult to persuade a doctor to do this. I suspect there is a less than 50% chance you are hypothyroid but it's not impossible and should be ruled in or out with a trial of thyroid hormone. It would be stupid to miss the diagnosis just because the blood test results look good, mine were perfect and I was severely hypothyroid.

[beam_me_up in reply to jimh111]

Hi there,

Well the matter of TSH levels equating to thyroid dysfunction is under a lot of contention it seems, if I was living in the USA, Germany, Switzerland, Austria, Norway, Sweden or

Belgium there is a good chance I would have been diagnosed as hypothyroid if my TSH levels persisted as their standards range from TSH >2.5 to >3.2. The UK is very much the odd one out with levels needing to be >10 before they consider the thyroid failed and allow medication.

Unfortunately a trial is practically impossible, its not something the NHS would ever consider in the UK, at least I'm yet to hear of a trial with TSH levels similar to mine.

If I was to trial, I don't think it would be the case of do I become thyrotoxic or not as if the correct dose is given even in a euthyroid person it would simply replace the T4/T3 that the healthy thyroid was making and TSH would reduce to compensate. Only an overdosing of T4/T3 would cause thyrotoxicity caused by dosing too high to fast or by just too high a dose.

[Batty1 in reply to beam_me_up]

The US doctors think TSH is the golden test and the rest of the test are not really important. I was ignored for years by US doctors because my TSH was normal but my panic attacks from not being able to swallow were "all in my head" it took 5yrs one eye popping out of socket experience to get diagnoised with pap cancer, 3 yrs later no thyroid and TSH still rules my miserable life....same old same old...blah

[beam_me_up in reply to Batty1]

I'm sorry to hear that, what is your TSH value? I thought the US were working with the revised ranges now and had an upper range of 3?

[Batty1 in reply to beam_me_up]

Now without a thyroid <.014 ....hardly a blip

[McPammy]

My private Endocrinologist explained to me that anything above a TSH of 2.5 is hypothyroidism. The NHS ranges are too wide. This is to keep people off medication and away from Endocrinologists until it gets to a point of 10 when the patient is definitely suffering. All about money. Mine got to 36 before they’d believe me. We all try and get our TSH to 1.0. So in saying that your figure does look too high.

You really need your T4 and T3 levels also.

My cortisol levels are at their highest around 7.30am. The blood ranges for cortisol are usually 155-607. Mine got very low at 68 but since introducing T3 medication are now greatly improved at 466!!

[beam_me_up in reply to McPammy]

Yes its interesting that once you're diagnosed they try to get your TSH to the bottom of the range <1, if this is the correct place for it and they know that it needs to be here to relieve symptoms how come TSH4-10 is not an issue? Seems so weird.

Also they know that to avoid complications in pregnancy it needs to be <3 which is more evidence that >3 is not its natural state.

[shaws]

Was your blood draw at the very earliest? Fasting (you can drink water).

These links may be helpful:-

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

thyroiduk.org.uk/tuk/diagno...

[beam_me_up in reply to shaws]

It was drawn around 10:30am so not really at the earliest, I'm not sure how much difference it will make to the reading, I doubt it will be above 10 and enough to get some kind of help/diagnosis but if it goes over their magic >4 maybe they will at least take it more seriously, but probably not.

[HLAB35]

Your adrenals are functioning normally for someone who is a bit stressed. Any additional stressors could result in a plummeting in DHEA and then you'll really feel like you have hit a wall, so be careful as your thyroid is not going to make up for the shortfall if it is also becoming a little worn out.

drmyhill.co.uk/wiki/Adrenal...

Being an owl works quite well when you are younger, but I for one noticed a shift to early bird tendencies as I got older. I cannot preach much beyond hoping you are not relying on caffeine and carbs to cope with the late shift. Vitamin B5 is known to be very good for adrenal support and I have found Magnesium to be very helpful (with cofactors like p5p and zinc) also vitamin c with bioflavanoids. If you do 'hit a wall' of low blood sugar make sure to have lots of electrolytes or maybe just have some sea salt and some glucose tablets handy to put in some water. Dr Myhill's site is a really useful resource.

And, definitely get vitamin D optimal as it conducts the orchestra of other hormones... that is why Magnesium is important as it helps boost vitamin D levels which can be low if you are working indoors or asleep in daylight hours.

[beam_me_up in reply to HLAB35]

Actually I've had to remove caffeine pretty much entirely as it exacerbates my anxiety. At work I wait till around 4pm till I have a cup of tea an that is enough that it makes me jumpy but I can usually deal with it knowing that it wont be too long till I can go home, plus any meetings are usually out of the way.

I've been on magnesium support for quite a while with supplements and bath salts ect, probably the reason my adrenals have not died yet with all the extra work they have to do. I felt some good improvements when I started, much less anxiety and aches and pains in my neck disappeared. But yes I definitely need to keep an eye on them!

[Homer48 in reply to beam_me_up]

Good to see some people have sense with caffeine-cos is evil if u rely on it. My gf was in hospital to get off Diet Coke,and I got her off Red Bull! I've never touched Red Bull,rather just be slow than jittery,caffeine makes so many people overanxious-think it contributes to why so many teenagers are overanxious!

Unfortunately as work is all about how quick people are,and we've adopted the coffee shop every few metres like US,is difficult!