These are my latest blood results (I'm shocked my GP actually tested FT3 and FT4 without me asking). I'm taking 100mg / 125mg of Levo alternate days. They want me to retest in 6 weeks time as they don't like the TSH that low. Also my PTH is low, I had a short synacthen test last year which was normal & I supplement with calcium & vit D (amongst all the other vits & minerals). The consultant I saw said some people have low levels on blood tests but they are actually normal. I've never heard this before and I wanted to see if anyone else had an knowledge or information on Hypoparathyroidism or know what other tests I can do?
TSH - 0.25 (0.27 - 4.2)
FT4 - 17.6 (12 - 22)
FT3 - 4.6 (3.1 - 6.8)
Vit D - 75 (50-125)
PTH - 1.3 (1.6 - 6.9)
Calcium- 2.48 (2.20 - 2.60)
Thanks for your help.
Regards
Jo
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jostafford0
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They want me to retest in 6 weeks time as they don't like the TSH that low.
Ask your GP to look at the actual thyroid hormones - the FT4 and FT4 - rather than the pituitary hormone - TSH. It's the thyroid hormones that tell us what we need to know. Your FT4 is just 56% through range and your FT3 is only 40.54% through range, if anything you could do with an increase in your dose of Levo as the aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges if that is where you feel well.
Show your GP the following:
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
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Your Vit D level is in the "adequate" category but the Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
This paper shows that the reference range for TSH that applies to healthypeople does not apply to treated patients even if just on T4. I've included the abstract's summary of findings so you needn't download the whole article.
Thyroid 2017 Apr;27(4):484-490. doi: 10.1089/thy.2016.0426. Epub 2017 Feb 6.
Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy
Background: Some investigators reported that among athyreotic patients on levothyroxine (LT4) monotherapy following total thyroidectomy, the patients with normal serum thyrotropin (TSH) levels had mildly low serum free triiodothyronine (fT3) levels, whereas the patients with mildly suppressed serum TSH levels had normal serum fT3 levels, and the patients with strongly suppressed serum TSH had elevated serum fT3 levels. The objective of the present study was to clarify which of these three patient groups is closer to their preoperative euthyroid condition.
Methods: A total of 133 consecutive euthyroid patients with papillary thyroid carcinoma who underwent a total thyroidectomy were prospectively studied. The patients' serum levels of lipoproteins, sex hormone-binding globulin, and bone metabolic markers measured preoperatively were compared with the levels measured at postoperative LT4 therapy 12 months after the thyroidectomy.
Results: The postoperative serum sex hormone-binding globulin (p < 0.001) and bone alkaline phosphatase (p < 0.01) levels were significantly increased in the patients with strongly suppressed TSH levels (≤0.03 μIU/mL). The postoperative serum low-density lipoprotein cholesterol levels were significantly increased (p < 0.05), and the serum tartrate-resistant acid phosphatase-5b levels were significantly decreased (p < 0.05) in the patients with normal TSH (0.3 < TSH ≤5 μIU/mL). In the patients with mildly suppressed TSH (0.03 < TSH ≤0.3 μIU/mL) and fT3 levels equivalent to their preoperative levels, all metabolic markers remained equivalent to their preoperative levels.
Conclusions: The serum biochemical markers of thyroid function in patients on LT4 following total thyroidectomy suggest that the patients with mildly suppressed TSH levels were closest to euthyroid, whereas those with normal TSH levels were mildly hypothyroid and those with strongly suppressed TSH levels were mildly hyperthyroid. These data may provide novel information on the management of patients following total thyroidectomy for thyroid cancer or benign thyroid disease.
Most likely your doctor didn't request the fT3 and fT4 results - the computer did! Many hospitals now program their blood test equipment to measure TSH and then report fT3, fT4 is TSH is low. If TSH is high fT4 is reported.
Your fT3 and fT4 are very close to average levels and so we would expect TSH to be average also, i.e. 1.0 or 2.0 or similar. The issue is your TSH is not responding adequately to your hormone levels. Hopefully, it will pick up in time but they shouldn't use TSH as a marker for your thyroid status because the TSH dial is broken.
‘Intact’ PTH is broken down into several molecular fragments including: an N-terminal, a C-terminal, and a mid-region fragment. While each of these fragments can give the doctor information about calcium regulation, intact PTH is measured most frequently as it is the major biologically active form.
Drugs that may increase PTH concentrations include: phosphates, anticonvulsants, steroids, isoniazid, lithium, and rifampin.
Drugs that may decrease PTH include cimetidine and propranolol.
I was stuck on propranolol for 20 years.....took me ages to realise this was cause of hypo parathyroid issues
Propranolol also lowers magnesium too (Not good if also vitamin D deficient, as we often are)
Most medics seem completely unaware
Propranolol also significantly slows conversion and uptake of thyroid hormones at cellular level
Essential to reduce propranolol incredibly slowly. I found it possible to reduce by 5mg per day....then wait 3 weeks. Reduce by further 5mg etc. Last 5mcg by far hardest. Cutting to 2.5mg....then stop one day week. Then next week 2 days etc. Took about 6 months to stop......down from 4 x 10mg per day
Propranolol decreases plasma T3 and increases plasma rT3 in a dose-dependent manner due to a decreased production rate of T3 and a decreased metabolic clearance rate of rT3, respectively, caused by inhibition of the conversion of T4 into T3 and of rT3 into 3,3'-T2. This inhibition of 5'-deiodination is not secondary to inhibition of thyroid hormone transport across the plasma membrane. Propranolol and its major metabolite, 4-hydroxypropranolol, are not directly responsible for these effects, but an unidentified metabolite of propranolol might be involved
Thank you for all your really useful, informative and valuable messages. I feel I am in a constant battle with my GP practice just to feel well (which I never have even before diagnosis 14 years ago). I will take this information to show the GP next time I see one.
I currently take the following (as recommended by the new Functional Practitioner I am seeing after the Genova Diagnostics ONE Test & genetics report I had done this year)
Thorne - Riboflavin 5 Phosphate
Body Bio PC
Allergy Research Group - Lactobacillus
Nutri Advanced NADH
Allergy Research Group - Saccharomyces Boulardii
Bio Marine Plus EPA/DPA with B12 & Folic Acid
Biocare Nutrisorb B6
A Vogal - Liver & Gallbladder drops
Calci D
Selenium
I couldn't tolerate Propranolol so stopped it about a week after I started taking it.
I did a Blue Horizon sports performance test earlier in the year which showed I had low calcium and high magnesium. The GP comments recommended I take a PTH test which I did in July (couldn't get a blood test because of Coronavirus). It showed I had low PTH but normal Calcium (I had been supplementing). I had another blood test done in September after stopping the Calcium and it showed I still had low PTH but normal Calcium.
Could the low PTH be connected to why my TSH is not working properly?
I see the Functional Practitioner on 16th November but I really value everyone's advice on here as you guys know more than any professional I have seen.
I'm going to raise my Levo to 125mg per day to see if I start to feel any better. At the moment I wake up every day feeling dreadful with headaches.
I doubt your doctor will take notice of any links you show him.
Most are adament that if the TSH is 'within a range' that we're on a sufficient dose, instead of ensure that the TSH is 1 or lower and check that both Free T4 and Free T3 are in the upper part of the ranges.
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