High TSH, dose titration: Hi, My TSH was around... - Thyroid UK

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High TSH, dose titration

LilLily profile image

Hi,

My TSH was around 151 a couple weeks ago. I've been on 50mcg for 2 weeks, then I go to 75mcg for 1 week, then 100mcg and then see my endo. Does this titration seem too quick?

I've heard there are two ways of thinking with this. Some say start at 100 straight away, while others say tritrate slowly from 25.

I think my endo wants me to go up as quickly as I can due to the high TSH and I have no thyroid. Just worried I'll get too anxious going up like that. Any advice?

Thank you

TSH (151) .450-4.50

T4 (2.7) 4.5-12

T3 Uptake (17) 24-39%

Free T4 (0.5) 1.2-4.9

T3 (43) 71-180

14 Replies

Should be perfectly fine. Even starting on 100 mcg you would just above a typical dose after two weeks due to the long half-life of thyroxine (7 days). If you did feel any adverse effects you could simply resume the 50 mcg dose and let your endo know. If you are OK after a week or so you are likely to be fine. Your levels were very low, borderline dangerous so getting them up is a good idea.

LilLily profile image
LilLily in reply to jimh111

Thank you! That sets my mind at ease.🙂

How are you feeling with a TSH that high? I could hardly function when mine was 9.

LilLily profile image
LilLily in reply to Lora7again

It's been tough. Not able to do much but shower, make my meals and watch TV.

shaws profile image
shawsAdministrator

Welcome to our forum LiLily and am sorry you have hypothyroidism.

Your dosing is correct, in that your TSH was so high it has to be brought down as quickly as possible.

The aim, eventually, is a TSH of 1 or lower but your endo knows what he's doing.

Gradually you will begin to feel much better.

I'd copy and paste some of your history above into your introductory page (you've only got your name in it) so that members, in future, can refer to it if they wish to know your background to being diagnosed as hypo and you don't need to repeat it.

Blood tests have to be at the earliest possible, fasting (you can drink water) and allow a gap of 24 hours between last dose and test and take afterwards. This helps keep TSH at its highest as it reduces during the day and may prevent doctor from increasing your dose if TSH is too low. We need a TSH of around 1 but many doctors seem to think that if it somewhere in the range (up to 5) is adequate. The aim is also for the Free T4 and Free T3 to be in the upper part of the ranges. (the latter two are rarely tested).

Also request doctor to check B12, Vit D, iron ferritin and folate as they should be in the upper part of the ranges.

Always get a print-out of your results, with the ranges, for your own records.

LilLily profile image
LilLily in reply to shaws

Thank you Shaws 🙂 All my other bloodwork is normal including cortisol, adrenaline, ferritin, iron, B12. I'm on every other week B12 injection and daily Vitamin D.

shaws profile image
shawsAdministrator in reply to LilLily

If your B12 was low, did they check you don't have pernicious anaemia.

LilLily profile image
LilLily in reply to shaws

Yes I do have that. I tried to add it to my history but it wouldn't let me enter what I take for it. I was in my early 20's and have given myself shots ever since and my B12 is in good range. Except for when I was first diagnosed, I've had no ill effects from it. My mother had it too. The thyroid issues are from my dad's side. 😏

shaws profile image
shawsAdministrator in reply to LilLily

My mother had P.A, and I, too have it. At least mine was diagnosed many years ago by a good doctor and have the usual injections. My mother's doctor told her that she needed no more injections as her bloods were now fine. My sister and I thought that was great. Little did we know what was coming along in the future as that doctor's decision to withdraw caused my mother to die before she should have.

LilLily profile image
LilLily in reply to shaws

I'm so sorry to hear that. That is unconscionable!

shaws profile image
shawsAdministrator in reply to LilLily

Thank goodness for the internet these days as we can at least double-check with various forums to get a 'more professional' opinion than the 'real' professionals . Not all professionals, of course, as many excellent ones had their licences removed for doing as they were trained (before blood tests were introduced).

When I was first diagnosed at 150 my GP put me on 50 Levo and to look at increasing after a 6 week blood test. This was way too slow and I pushed for an endo referral and increase sooner as I was so sick.

It sounds like you are being well looked after but this forum will help answer any queries and provide any reassurance you might need.

One thing I’ve learnt is to be prepared by being knowledgeable in the treatment of my disease so I can work with my doctors and get the best care available.

Listen to your body and rest. Avoid any stress and meditation has been key in calming my nervous system and helped my anxiety. I hope you begin to see an improvement very soon x

Thank you so much for your response and advice. Yes staying on 50 for 6 weeks does sound too long. I hope someone listened to you and didn't make you wait that long.

I'm in a weird place because I know I need to increase the dosages as soon as I can but at the same time I'm worried about it being too fast. I'm going through with it though and am following my endos guidelines exactly as he's planned them.🙂

I take 100mg of thyroxine and im ok .

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