Hello. I’m after some advice. My latest blood results taken on 23 October are
TSH <0.95 (9.39 -5.00)
T4 24.0 (11.00 - 22.00)
T3 6.8 (3.10 - 6.80)
I take 175 of Levo
My TSH has been suppressed despite my medication being put up and down over the last couple of years. The GP on Friday said if I am happy on this dose to continue - and I am. But I wanted to ask about the TSH. The GP says I have concerningly high bp and is arranging a 24 hour monitor and also concerned at 2 stone weight gain since last test - a raise in cholesterol to 5.6. I think I have read on here that the suppressed TSH could be to do with the pituitary or cortisol or adrenals. I’m not quite clear on what I have read but am wondering if anyone can see what I am vaguely thinking about with these results and symptoms. Could I suggest another test to my GP that will link these things - he is thinking I am stressed/anxious.
Thank you.
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annegal
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To be honest, your results are pretty strange. Your TSH isn't actually suppressed - suppressed would be 0.1, as far as a doctor is concerned, 0.01 as far as I'm concerned! lol And, it's surprising that it isn't suppressed with that high FT4/3. Oh, and by the way, I think you made a mistake with the TSH range, there.
You're obviously not a very good converter, in that you need your FT4 that high to get top of the range FT3. But, if it works for you, that's fine.
I think I have read on here that the suppressed TSH could be to do with the pituitary or cortisol or adrenals.
Not sure quite what you're thinking, here. The pituitary produces TSH, yes. And, as your FT3 is high it's not surprising that the pituitary has cut back on TSH production, because it senses that you have enough thyroid hormone in your blood. But, your TSH is not suppressed, as I said. Not sure that TSH has anything to do with cortisol/adrenals - certainly not directly. But, with that TSH, I don't know what you're worrying about, anyway. It's fine. And, even if it were suppressed, it would still be fine.
Just reread your post: what is surprising is that your cholesterol has risen. What was it before?
The weight gain and rise in blood pressure could be indirectly caused by stress, via your cortisol - have you had that tested? OR it could be that your FT3 is actually too high for you, and too high T3 can cause a rise in BP and weight gain. But, nothing to do with the TSH.
Thank you. It was the GPS terminology if suppressed. I think it was the pituitary process I was thinking of and the production of cortisol. Are they interconnected?
Well, GPs do like to be over-dramatic. lol I remember when I had my first cholesterol test, it was 0.1 point over-range, and he shouted at me that I was 'clogging up my arteries'! lol Idiot.
There is a link between the pituitary and cortisol, in that the pituitary secrets ACTH which stimulates the adrenals to make cortisol. Like the TSH stimulates the thyroid to make T4 and T3.
I’ve been reading through the posts to see if I can find out what a suppressed TSH really is and came across this reply. My endo has told me that my TSH is suppressed at 0.02 (0.27-4.2) and that I’m over replaced and that is an issue as there is a risk of osteoporosis and cardiac arrhythmias. My T4 is apparently ‘normal’ at 15.2 (12-22) and he has no t3 results for me yet. My Levo has been reduced by 25mcg (75 to 50mcgs) but he has left my t3 at 20mcgs. I’ll phone to see if I can get my t3 results tomorrow but am I at risk with my ‘suppressed’ TSH?
0.02 is suppressed, yes. But, most doctors consider the cut-off point to be 0.1! However, a suppressed TSH is not a risk of anything, because the TSH has nothing to do with hearts and bones. It is long-term well over-range FT3 that increases the risk of arrhythmias and osteoporosis. And, of course, if the FT3 is over-range, the TSH will be suppressed. So, with their usual practice of putting the cart before the horse, they have come to conclude that it is the TSH itself that has that effect. They really cannot see the wood for the trees!
Thank you. I knew at the appointment that I was going to have difficulties when he told me that he’d have to see what my TSH was before he could adjust my meds. My appointment was at 2.30pm so I expect that my TSH may have been a bit higher at a morning appointment but I didn’t feel I could challenge him on that at the time. He didn’t seem like a guy who would appreciate it. My t3 may well be high since the last endo I saw (have now seen 3 different endos in 3 appointments) increased my T4 and t3 together. I feel warmer and am sleeping much better I have been a bit shaky some days. (My pulse is still mid to high 60s, basal body temp averaging around 36 degrees). However I was quite surprised that my T4 was so low. I’ll wait to see what my t3 results are tomorrow.
You've made a typo in the lower part of the range, presumably it is 0.39? In that case your TSH is not necessarily suppressed, just low in the range. When it shows "<xx" that means that the test doesn't measure lower than that number. So your result is less than 0.95 but you don't know exactly what.
I have been diagnosed/treated for hypothyroidism for 45 years. I've been keeping a record of my results for 25 years. For all but 3 of those tests my TSH has been suppressed, when I was on Levo only and also now I am on Levo + T3.
TSH is a signal from the pituitary to tell the thyroid to make hormone if it detects there's not enough. Obviously your FT4/FT3 results are showing plenty of hormone so the pituitary doesn't need to send the signal so your TSH remains low.
As your FT4 is over range and your FT3 is at the very top of the range, it may be where you need your levels to be for your to feel well, but it may be that you are also slightly overmedicated. The fact that your BP is high could also suggest this. Did you get your BP measurement? Always a good idea to make a note so you can monitor it yourself. It might be an idea to just reduce your Levo slightly, say 12.5mcg, to see what effect this has on your levels and how you feel.
Weight gain and high cholesterol are often symptoms of hypothyroidism/undermedication but it doesn't seem that you are undermedicated.
If not done recently, I'd check your nutrient levels to see if they are optimal so I'd test:
Vit D
B12
Folate
Ferritin
If you want adrenals checked then your GP can probably only arrange a morning cortisol test at this stage. If you want to check them yourself you could do a 24 hour adrenal saliva test with either Regenerus or Genova Diagnostics:
I use Regenerus, they send you an email when your results are available, Genova send them to ThyroidUK who then send them on to you when they have received your consent.
I’ve reposted my TSH below I hit 9 instead of 0 on the result and range.
I haven’t worried about TSH before but was just concerned with the recent symptoms. I think it’s the cortisol production. I was thinking of. I have functional hypothyroidism not autoimmune so wondered if there’s a connection with low TSH/cortisol and the pituitary with my symptoms ? The results I’m happy with - just know you experts like the latest numbers to get the full picture. Thank you
So your TSH is classed as "suppressed" but it doesn't change what I said above that the pituitary doesn't need to send the signal TSH because it detects you have plenty of hormone.
I still think it's worth experimenting with a slight reduction of 12.5mcg Levo to see if it makes a difference.
Of course there could be other reasons for the high BP, and the weight gain is unusual, but we have to start somewhere when trying to fathom out the problems so I would consider doing those tests as a start.
Yes - I feel well on those results just trying to make sense of other symptoms arising and exploring the possibility of a thyroid / hormone connection.
When were vitamin D, folate, ferritin and B12 last tested?
What vitamin supplements do you currently take?
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Is this how you do your tests?
Ask GP to test vitamin levels or get tested privately
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
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
Thanks for your reply slowdragon. I did follow that advice, didn’t take my morning dose and had the test at 8.30 am
My vitamin D is now up to 84 from 40 over a year ago and I still taking 20,000 every fortnight. The other results were normal last time and I’ve been told they are this time but I haven’t picked up a copy yet.
Thank you for your advice knowing these things really helps.
I wonder how reliable your test results are? How close to a dose change, or a dose? And if you’ve changed weight that might affect it too. You could have a strange mix of symptoms that show both over and undertreatment at the same time. It might be easier to lose weight before you reduce the dose, if you want to, or if the dose is too high may be fuelling your appetite and causing weight gain. Your blood pressure could be high due to your weight increase.
I do agree that weight loss needs to be a priority for helping blood pressure. I’ve never easily been able to lose weight but if I do a total food replacement diet of 600 calories per day with a commercial ready made drink formula it seems to be the best way for me to do it. I suppose I will not know if the weight and BP are linked with the thyroid I just have to get fitter and healthier to see if it makes a difference first and look at other possibilities if the bp remains high.
Good luck annegal, weight loss is never easy, but if you’ve found a way that works for you... I find the new Weightwatchers is excellent and I can eat a range of food on that. You just have to be careful with dieting that T4 to T3 conversion isn’t impaired so I wonder if bursts of dieting then resuming normal eating before returning to diet is the way forward? There are arguments that TSH is not worth worrying about. Just as well really for me, mine has been undetectable for many years, but I’m well.
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