Optimum TSH

[gigitheweegie]

I’ve seen it in many posts on here that if you are being treated for hypothyroidism, your TSH should ideally be at the bottom of the range, preferably below 1.

Can one of you wise people please tell me where I can find this written down/published somewhere please?

Currently gathering ammunition for a telephone appointment to “discuss my current dose”, (just in case I need it)

I had a funny feeling it was part of the nice guidelines but can I find it?!

Thanks in advance

[SlowDragon Administrator]

New NICE guidelines published last month

They don't mention TSH....but they are clear about dose by weight

nice.org.uk/guidance/ng145/...

1.3.6 Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Important to regularly retest vitamin D, folate, ferritin and B12, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by high thyroid antibodies

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

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)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

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...

[SeasideSusie Remembering]

gigitheweegie

Besides the information that SlowDragon has given you, although not "official" there is the article written by Dr Toft for Pulse magazine (the magazine for doctors) , leading endocrinologist and past president of the British Thyroid Association, which states:

"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

[e-mail]

print it and highlight question 6 to show your doctor.

[gigitheweegie]

Thank you both.

Happy on my dose of 125 but 25 of that has been a trial (at my request) as I was experiencing symptoms again after a trouble free summer where I had been on 100mcg. I really do feel less symptoms in the summer so must be heavily affected by vitamin d.

recent bloods done at docs showed TSH of 0.81 (0.55 - 4 range)

And t4 at 17

There was an asterisk next to the tsh apparently. I was told things were within range but I should make a telephone appointment to discuss.

Blood tests were at 11.50 in the day too as early appointments are saved for fasters. Not ideal but I wasn’t expecting it to be so close to the wire on the range.

I’m due to do a full blood test again soon (one that I have paid for) just to check vitamin levels)

Will have all details at the ready, just in case!!

Thanks again for all your time and help

[Wetsuiter]

well you re not under range.

when you have a thyroid test, you should be with the fasters (even though we dont actually mention that to the Dr