NHS guidance on TSH please?

Having had bloods taken at 8:50 yesterday morning the results are back already.

TSH level - 2.35 miu/L [0.3 - 5]

GP has marked them "normal, no further action" ... Of course.

I've searched the site but could someone let me know where I can find the NHS guidance about a TSH around 1 please?

Full thyroid testing, vitamins, and iron panel being done via thriva. Results should arrive today.

[Lora7again]

I don't think there is a guidance by the NHS for the TSH to be around 1 I'm afraid. I believe a lot of NHS doctors won't treat until your TSH is 10. In my case my TSH means nothing and when it was 0.80 and my T4 and T3 were at the bottom of the range I felt dreadful. I sat infront of my GP with my hair dropping out and so tired I could hardly get out of bed and he refused to help. I had taken Levothyroxine in the past and even had an exemption card but he wasn't interested. He told me he would be struck off if he gave me Levothyroxine because my levels were within NHS guidelines. I then joined Thyroid UK and a kind lady told me where I could purchase Thyroid S and I did because I had no choice. You might have to do the same and self medicate like a lot of us have had to do.

Just to add I showed him my Medicheck results with my very high Thyroglobulin antibodies that were 4000. He brushed them aside and said he would only trust NHS labs which only test the TSH and sometimes the T4 if you are lucky.

[Hidden in reply to Lora7again]

I'm currently on 75mcg levo. 🙂 I have felt a huge improvement from when I was diagnosed - TSH at 9.37 and antibodies at about 900 (I think, from memory).

I still have to sleep 10+ hours though and an hour long walk yesterday meant I was good for nothing the rest of the day and had to go to bed at 8:30 so I'm far from optimally treated.

That's an absolute disgrace about your GP. I don't understand how they can see someone is clearly in ill health and effectively shrug their shoulders.

[Lora7again in reply to Hidden]

Sorry I should have read your previous post there is a article by Professor Toft about this that you can print off from Thyroid UK. 75mcg is not enough and you should have an increase of 25mcg but it sounds like your doctor is dosing by the TSH. Is there any chance you can change to a more enlightened GP?

I used to have a copy of it.

Here is a link that might be helpful.

drmyhill.co.uk/wiki/Thyroid...

[Hidden in reply to Lora7again]

I need to update my profile section - thanks for the reminder! 😁

I'm hoping to speak to her today, unfortunately it's the same GP who told me 2 weeks ago that "we've see you a lot lately" so I feel she's already marked me!

I'll find that article, thank you!

[Lora7again in reply to Hidden]

That really annoys me because my GP put "delusional" on my records when I had untreated Graves' for over 2 years because I kept going back. I would ask to see your records just incase they have put something on there if I was you.

[Zazbag in reply to Lora7again]

I would be furious!!

[SlowDragon Administrator]

gponline.com/endocrinology-...Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

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...

guidelines on dose levothyroxine by weight can help push for a dose increase

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on, or near full replacement dose

NICE guidelines on full replacement dose

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Obviously need to see your Thriva test results too