Is it better to be at the lower end or the upper end of the thyroid range?

[bmcentire]

Is it better to be at the lower end or the upper end of the thyroid range? ( As a side note..it took me 6 months of being on one dose to get in range..I stuck with it.. When I would test after 3 months I was out of range. Hopefully that made sense.) My numbers now are: TSH 3.160 (0.450-4.500 range) T4 1.44 (0.82-1.77 range) T3 3.2 (2.0-4.4 range). Thx so much

[Hidden]

Everyone is different. Some people needs high in range on both, some low, some ft4 lower than ft3 and the other way around, impossible to say. I know someone doing very well in low ranges. Myself, I'm learning, less is more. Depends also what you take a thyroid replacement

[bmcentire in reply to Hidden]

Thx so much. Im on Levo. But it looks like it a case by case basis. Thx

[Lalatoot]

It is best to be wherever you feel the most well in the range. We are individuals and need to alter our meds till we are as symptom free as we can be. You will read on here that most on levothyroxine need a tsh of 1 or under. Thereafter it is personal. Some manage with a low t4 high t3 others need both well through the range.

[bmcentire in reply to Lalatoot]

thank you so much. what u said helps.

[SlowDragon Administrator]

As you have had RAI it's likely you need very low TSH.....perhaps suppressed

If FT3 remains low despite high FT4 and low TSH, then like 20% of patients with zero thyroid function.....you may need addition of small dose of T3

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

Low vitamin levels are extremely common, especially after Graves

Are you on strictly gluten free diet? Helps many with a Graves or Hashimoto's

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

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 doctort

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many, note his comments on current inadequate treatment following thyroidectomy or RAI

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

Research shows 20% Patients with no thyroid can not regain full health on just Levothyroxine

ncbi.nlm.nih.gov/pmc/articl...

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

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

The most important results are FT3 followed by FT4. Vitamin levels need to be optimal

[bmcentire in reply to SlowDragon]

Thank you so much. Seriously. I really appreciate that info and it helps so much. Thx

[SlowDragon Administrator in reply to bmcentire]

Great article on why TSH is often irrelevant on replacement thyroid hormones

thyroidpatients.ca/rational...

[Gingernut44 in reply to SlowDragon]

Thanks for that very interesting link- me thinks another print and deliver to my GP is on the cards 😊

[san_ray70]

I have never thought to ask when I have a blood test and nobody volunteers any results.

[SilverAvocado in reply to san_ray70]

I dont think they ever do volunteer, it's often a fight to get hold of them!

[san_ray70 in reply to san_ray70]

I asked my doctor aboun brain fog and she said it happens when your medication is not right, apparently mine is ok.

[SilverAvocado]

Bmcentire, of the thyroid panel freeT3 is the most important number. This shows the amount of T3 available in the blood, this is the active hormone so most closely reflects symptoms. Most people will need this high in range, the top third or so, to feel well.

When taking Levothyroxine only, freeT4 is also important because Levo contains only T4. The body has to convert this into T3, so you need nice high levels of T4 to get enough T3.

Your freeT4 is currently a bit above halfway and freeT3 a bit below half. This suggests you need a bit of a raise of Levo, you can take it all the way to the top of the range of you need it based on symptoms.

As others say, symptoms are the most important thing. If you feel good on this doss you can stay there. Most people would probably need hormone a little higher to feel well.

[bmcentire in reply to SilverAvocado]

That is Extremely helpful. Thank you so much for letting me know that. It helps so much.