i am due a blood review and wondering what is the best action to ensure my TSH is at its highest, my Health Centre do not test T3 or T4 only TSH.
I appreciate that usually it is best to have a fasting test as early in the morning as possible to assist TSH being as high as possible 24 hrs after last dose, i normally take my medication at around 11pm at night, but i am wondering if there is any benefit in me missing a dose and leaving as long in to the following afternoon as possible before draw, ie
if Blood draw is on Thursday afternoon at 4pm, take medication at 11pm Tuesday night and have no medication at all on Wednesday evening and then have the blood draw Thursday afternoon so will have gone without medication for approx 41hrs, will this assist raising the TSH as high as possible or will that not work??
I would not be eating or drinking on the Thursday until draw,
Any advice or comments would be greatly appreciated,
Many thanks.
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If you are sure only TSH will be tested then it doesn't matter about your Levo. The timing of Levo affects FT4 result, not TSH. The timing of the test and fasting/water only is what affects TSH (no coffee, all eats and drinks other than water after the blood draw).
You would have to be on a lower dose of Levo, or leave it off for some time, to try and raise your TSH.
I would change the time of your test to no later than 9am. You will see from the first graph in this post that your TSH will be lower at 4pm than 9am:
many thanks for that, so if i take my medication at 11pm on the Tuesday evening, don't take medication on Wed evening and then have an early morning draw on Thursday, say 9am that would be 34hrs without medication, but it would still be higher in the morning?
My GP is in meltdown because my TSH is between 0.01 and 0.03 the last couple of tests, she doesn't seem to get that i have been feeling fine for years at that level, having a real battle with her at the moment about her wanting me to reduce my dose so the next test is crucial.
Do you happen to know if its possible to for me to sign a disclaimer absolving the Health Centre of any liability, i suppose if i refused to reduce she would threaten to stop prescribing??
many thanks for that, so if i take my medication at 11pm on the Tuesday evening, don't take medication on Wed evening and then have an early morning draw on Thursday, say 9am that would be 34hrs without medication, but it would still be higher in the morning?
As I said, the Levo will not affect your TSH, it's just timing of test and an overnight fast with water only before the test that can affect TSH. Take it, or don't take it, it's up to you, but it will only affect FT4 level which you said wont be tested.
My GP is in meltdown because my TSH is between 0.01 and 0.03 the last couple of tests, she doesn't seem to get that i have been feeling fine for years at that level, having a real battle with her at the moment about her wanting me to reduce my dose so the next test is crucial.
Do you have the article by Dr Toft? If not then send for it and show your GP:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
If your GP doesn't like your low TSH then invite her to get your FT4 and FT3 tested. Dosing purely by TSH is completely wrong. TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone).When there is not enough thyroid hormone (natural or replacement) TSH will be high.
If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
Your pituitary is satisfied so is not sending the TSH signal so it remains low.
Do you happen to know if its possible to for me to sign a disclaimer absolving the Health Centre of any liability,
I don't know if you can sign a disclaimer but I doubt it.
i suppose if i refused to reduce she would threaten to stop prescribing??
Just stick it out and refuse to reduce unless she tests FT4 and FT3. Tell her that if FT3 is over range and suggests overmedication then you will make a dose adjustment to get FT3 back into range, following Dr Toft's thinking above.
My TSH is always suppressed, has been for donkeys' years. My GP doesn't like it and we have this stupid argument every time. I now avoid her if I can as she brings it up whatever I go to see her about. Fortunately, the hospital lab which does my surgery's tests will do FT4 and FT3 if TSH is suppressed so I get mine done every time. When the Advanced Nurse Practioner brought this up about my suppressed TSH I pointed out exactly what I have written above about TSH being a pituitary hormone and FT4/FT3 being the thyroid hormones that tell us if we are overmedicated. He seemed quite surprised that I actually knew anything about it, checked my record and found that my suppressed TSH is historical and said it may never come back into range, so now as long as FT4 and FT3 are in range he is happy, and he is the only one I will now discuss my thyroid results with.
My NHS GP's lab will always do an FT4 automatically whenever they see a surpressed TSH, Seaside Susie says hers would automatically do FT3 and FT4. So it seems to vary.
In summary, patients on long-term T4 with either an increased serum TSH (>4 mU/liter) or a suppressed TSH (<0.03 mU/liter) have an increased risk of cardiovascular disease, dysrhythmias, and fractures when compared with patients with a TSH within the laboratory reference range. Patients with a low, but not suppressed, TSH (0.04–0.4 mU/liter) had no increased risk of these outcomes in this study.
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
Vitamin levels all good apart from Vit D, i am insufficient according to Medichecks test a couple of months ago, i bought a good quality supplement from Nutri but it did not have the K2, i was unaware how important it is to have it with K2 so have re ordered the Vit D plus K2 drops
You also need magnesium. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
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