TT and TSH

[annnsandell]

I am curious to know about patients who have had a Total Thyroidectomy and whether it is actually ever likely to have a TSH test above .0 with normal doses of Levothyroxine. I know after Thyroid Cancer Consultultants like it to be below .0 but has anyone ever had it go above? This might well affect where patients have their T4 reduced to increase TSH and end up on too little because of it. Anyone on 100 mg or less T4 and unwell?

[helvella Administrator]

I think you might have a typo in your post.

TSH cannot be below .0

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[annnsandell in reply to helvella]

Yes it can. Mine is currently .02 mU/L (0.30-4.50) and always is as it is supposed to be to suppress cancer.

[helvella Administrator in reply to annnsandell]

But that isn't below .0!

Below zero would be negative.

I understand that the wisdom is TSH should be suppressed (which itself has various interpretations).

[annnsandell in reply to helvella]

Obviously a confusion here over negative numbers. Suppression is usually aimed at below 0.02.

[SlowDragon Administrator in reply to annnsandell]

To feel well the most important results are Ft3, followed by Ft4

Often TSH is below range when Ft3 is at good level

How do you feel?

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

Low vitamin levels are extremely common on just levothyroxine, especially if you have poor conversion of Ft4 to Ft3

Low vitamin levels tend to result in poor conversion of Ft4 to ft3

Ask GP to test vitamin levels

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 thyroid antibodies 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

Thriva also offer just vitamin testing

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...

[annnsandell in reply to SlowDragon]

Yes thank you, I know most of the principles and tests. I am thinking hyperthetically about whether it is actually possible with no Thyroid to raise TSH in range or will TSH never come in range? I don't actually want to achieve it. There must also be a Levothyroxine dose under which a person without a thyroid should not go. As you know many doctors swear by TSH without fully understanding the subject.

[2020kel in reply to annnsandell]

Hi there only just seen post you can increase TSH I had TT in 2017 been well and unwell since. Had a rough time this last 12 months

May TSH was 6.5 GP increased my thyroxine to 175mg

June TSH was down to 1.5

August still 1.5 leaving me on 175mg now.

So to answer your question it is possible to have a higher TSH with no thyroid

[annnsandell in reply to 2020kel]

Thank you, All interesting stuff. Wish you well.

[annnsandell]

Thanks JaneyJanuey