TSH levels following Thyroidectomy

[w6eva]

HI , I have no thyroid due to cancer and a total thyroidectomy 30years ago

my Tsh is 0.03 and my T4 free is 21.3- i have other health issues and lots of meds

but its the best I've felt for me in 5 years-my doctor has asked to speak to me and i suspect wants to lower my levothroxine.

any advice would be appreciated

[SeasideSusie Remembering]

w6eva

You haven't given the reference ranges for your results (they vary from lab to lab), TSH we know is suppressed but we have no idea if your FT4 is in range or over range.

Your GP is probably looking at TSH and may want to reduce your dose due to it being suppressed, but TSH is not a thyroid hormone, it's a signal from the pituitary to the thyroid to make hormone when it detects there's not enough. Once on thyroid hormone replacement the pituitary is usually satisfied anyway so doesn't send the signal (which would be a high TSH) but you don't have a thyroid so it's irrelevant in your case. It's the actual thyroid hormones that are important and tell us our thyroid status - FT4 and FT3.

Before agreeing to a reduction in your dose of Levo, ask for a Free T3 test to be done at the same time as TSH and FT4. It's FT3 that tells us if we're overmedicated, if it's in range then we're not. You can show the following to your GP which explains this:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional 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

[e-mail]

print it and highlight question 6 to show your doctor.

[w6eva in reply to SeasideSusie]

Thanks

It says -Serum free T4 level 21.3 (12.0-22.0)

Serum TSH level 0.03 (0.27-4.2)

[SeasideSusie Remembering in reply to w6eva]

w6eva

So your FT4 is high but it's still in range, in that case it's bound to be the suppressed TSH that your GP doesn't like. Definitely ask for FT3 to be tested before agreeing to any reduction in dose.

[w6eva in reply to SeasideSusie]

I’m going to and I will also want my consultant involved

Thank you again

[Marz in reply to w6eva]

Does your Endo test T3 ? Most Endos are diabetes specialists and know little about thyroid !

[w6eva]

Thank you for the support

That’s were I’m at , I feel more armed with the facts now

[SlowDragon Administrator]

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

Low vitamin levels are extremely common on levothyroxine

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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

academic.oup.com/jcem/artic...

Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.

[w6eva]

It’s my GP that’s phoning me 1st September to discuss

My consultant is great and I’m sure he will back me

[bantam12]

My TSH is also 0.03 and has been for years, my T4 is slightly over range and T3 almost top of the range, I have no thyroid and feel well with these results. Having had previous battles with GP's my current one accepts I'm fine where I am and she's happy with my results. You just have to convince them to leave well alone !!

[w6eva]

Than you - great info much appreciated

[w6eva]

My sentiments exactly, why interfere

When I feel fine