This is a last minute question about TSH. My appointment is today.
I was diagnosed with Hashimoto's Disease more than forty years ago. As soon as I began taking liothyronine, my life became normal. However, every time I go to a doctor, I get grief about the very low reading of the TSH. I read on this stream that TSH is not a measure of the thyroid but don't remember more than that.
What does the TSH reading measure? I want to go to the Dr with some ammunition so that he will just leave the prescription as is. I want for him to just behave himself and renew it. I am so worried that he will change things and make me suffer because of hs ignorance. Please educate me in a hurry. Thank you!
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jersey-jazz
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TSH is Thyroid Stimulating Hormone. It is produced by the pituitary and is a signal to the thyroid. If the pituitary detects there's not enough thyroid hormone it sends a signal - high TSH - to tell the thyroid to produce hormone. If the pituitary detects there is sufficient hormone (as in when you are taking your thyroid meds and you are optimally medicated) then there is no need to send the signal so TSH remains low.
Taking T3 tends to lower, even suppress, TSH, it's just what it does.
TSH is good for diagnosing hypothyroidism. Once we are on replacement thyroid hormone then it's not really much use, it's testing the actual thyroid hormones - FT4 and FT3 - that tell us our thyroid status and the FT3 is the most important one of all, particularly when taking T3. If FT3 is over range it usually suggests that we are overmedicated. If FT3 is within range we are not overmedicated.
How you feel is also important. If your FT3 is within range and you have no symptoms of hypothyroidism then there is no reason to change your dose.
Thank you for writing in a clear and concise fashion. There is so much I don't know but this is enough to get through the meeting with the doctor. He blackmails me by not okaying renewal of prescription unless I have an appointment with him. So, every three months, there I go so he gets his money for an office visit. I pay for good health insurance so he always gets paid. The Hashimoto's Disease diagnosed so many years ago has destroyed the gland. I have little or no thyroid gland left. To used the word popularized by the COVID, I have comorbidity; cancer to be exact. Therefor, I really don't want to always be worrying about how this doctor will handle my thyroid medication prescription. It should be the least of my worries.
Good luck with your doctor visit, I hope it goes well. So sorry to hear about your cancer, you certainly have enough on your plate without the worry about having your thyroid meds changed.
Thank you for your good luck wishes. I am recovering from the ordeal of the doctor's visit, until the next horrid visit when I will have to stand up to the doctor, again, to get my prescription filled as is.. It shouldn't be this way but that is the way it is.
Just testing TSH is completely inadequate especially when on any dose of T3
If Ft3 is not over range you are not over medicated ....regardless of how low TSH is
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 with Hashimoto’s
What vitamin supplements are you currently taking
When were vitamin levels last tested?
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)
If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
There is some concern that administering thyroxine in a dose which suppresses serum TSH may provoke significant cardiovascular problems, including abnormal ventricular diastolic relaxation, a reduced exercise capacity, an increase in mean basal heart rate, and atrial premature contractions.12 Apart from an increase in left ventricular mass index within the normal range, these observations have not been verified.13 Moreover, there is no evidence, despite the findings of the Framingham study, that a suppressed serum TSH concentration in a patient taking thyroxine in whom serum T3 is unequivocally normal is a risk factor for atrial fibrillation.
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.
20% Patients with no thyroid can not regain full health on just Levothyroxine
Dear Slow DragonWow! I was attempting to read all the articles that you so kindly forwarded to me but the day and my head is fading. I wanted to get back to you and thank you for all your conciencious support you have offered to me. It is so good to know that there is evidence that the way we feel is what the doctors should be following..The human body works sometimes in mysterious ways, ways that the doctors have not yet figured out. If only they would give us credit for knowing how we feel.
Doctors are under pressure to remove T3 prescriptions due to price of it at the moment. However if it was originally prescribed by an NHS endocrinologist, then they are not supposed to remove/reduce it without the involvement of an endocrinologist.
Your first point should be to insist on them doing an fT3 test (the active hormone) if they are suggesting that you are overmedicated.... as long as fT3 is within reference range you have good proof that you are not.
They will tell of risks to heart and bone if TSH is too low, but these risks are relative, and need to be viewed in relation to quality of life.
Emphasise your improved quality of life on T3, which will in itself be protective to heart and bone health ... ending up on the sofa for years is also proven to be harmful to heart and bone health.
This doctor received the results from the hospital where I go for my cancer treatments. They had only done a test on FreeT4 and on TSH, none on FreeT3. He started to talk about my extremely Low TSH and I blinded him with my recently acquired knowledge. I have been lectured on the subject of weakened bones and heart and, like you, say to myself, "What does that matter to me when my dosage of thyroid medication is keeping me alive, alert and vertical. Thank you for responding so quickly.
It's hard to stand up to these doctors when the time actually comes - and well done to the forum for their prompt replies. One extra thought, if they're lecturing you about bone density and the dangers of low TSH, you might ask if they can refer you for a dexa scan, so you can establish a benchmark for how your bones are now, and then in a few years time, hopefully prove that nothing has deteriorated
That should give both you and them some comfort (and it's what I've done - I had the dexa scan before getting NHS lio)
fuchsia-pink. Somewhere in the large amount of articles that Slow Dragon forwarded to me is an article disclaiming a connection between TSH and low bone density,. Interesting! I think that I read that right.
I don't doubt it :)But it's something that worries TSH-obsessed GPs, so getting a scan now and others later to show no deterioration will help defend your preferred level of medication and give them comfort that it isn't in fact the quick route to damnation and osteoporosis x
"TARGETING TSH? IT’S NOT AS SPECIFIC OR AS SENSITIVE AS PEOPLE CLAIM."
Good luck with informing your GP. Your T3 dose should not be changed on the basis of a TSH test, unfortunately your GP is like so many others; they lack essential knowledge about thyroid disease because it is poorly taught in med schools.
Dear DippyDame. Luck was on my side, this morning, but not without major stress levels registered in a very high blood pressure reading when I first got there. (It went down after a while.). I spoke knowledgeably about the Low TSH and, surprisingly, he listened like it was news to him. It probably was. He wants to see me in three months and, by then, I will know so much more and will hope to blind him with my knowledge. It does take a lot out of me though. Thank you for your help.
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