Central hypothyroidism?

[Bearo]

I just want to rule this out

Jan 2020 no meds TSH 4.98, T4 10 (12-22)

Oct 2020 50mcg Levo TSH 0.91, T4 14 - 22% through range

Dec 2020 75mcg Levo TSH 0.09

Jan 2021 75 mcg Levo TSH 0.14, T4 15.9 - 39% through range, T3 4.6 (3.1-6.8) 40.5% through range

[SeasideSusie Remembering]

Bearo

I think to consider whether or not it is Central Hypothyroidism, you need your test results for TSH and FT4, along with reference ranges, from before you were ever started on Levo, i.e. what were the results that gave you a diagnosis and prescription, and any results before that.

[Bearo in reply to SeasideSusie]

Thanks for getting back to me . The first test before Levo was in Jan 2020 with TSH 4.9 and T4 below range - 10 (12-22). There were about two annual well-woman tests including TSH before that but I never asked for the results. Was just told in 2020 I’d “been borderline for a while” and because I then kept pushing for another test I was given Levo “ just try a little bit”, then ignored.I expect a TSH of 4.9 at the start was too high for central hypo, but with all my results being low since I was looking for an explanation.

[SeasideSusie Remembering in reply to Bearo]

Bearo

I expect a TSH of 4.9 at the start was too high for central hypo,

No, not necessarily. With Central Hypo, TSH can be normal, low or minimally elevated. What is the reference range for TSH?

[Bearo in reply to SeasideSusie]

Sorry, the TSH range was 0.27-4.20mIU/L

[SeasideSusie Remembering in reply to Bearo]

So it's minimally elevated therefore it's could well be Central Hypothyroidism.

[Bearo in reply to SeasideSusie]

Oh, thanks, seasideSusie, I’d better do a bit more research

[Bearo in reply to SeasideSusie]

“Measurement of anti-thyroid autoantibodies may help in differentiating CH from primary hypothyroidism, as they will be undetectable in patients with CH.”Does this mean TPO antibodies? I had a measurement of 21, so not undetectable.

So would that rule it out?

I just need more Levo?

[SeasideSusie Remembering in reply to Bearo]

Bearo

I don't know what antibodies they mean.

I find it difficult to believe that anyone would have totally undetectable antibodies. We all have antibodies to some extent, often low enough not cause a problem. We see lots of results on here for TPO and TG antibodies that are below range mine are usually around 6 to 11, some are shown as <10 but I have never seen anyone post a result with "undetectable" or <0.00

[Bearo in reply to SeasideSusie]

Thanks, SeasideSusie. I’m trying to judge whether or not my quickly falling TSH means anything. My low in range T4 and T3 must surely reflect my low dose of Levo (75mcg) and probably still low B12 and not great ferritin. The question would be ‘how do I feel?’. So-so. Most of my ‘could be thyroid’ symptoms I’ve had for as long as I can remember. I’d say my current dose of Levo isn’t doing anything at all.....although I did feel more energetic the first 5 days of the increased dose. But I had to persuade the GP to give me that increase. I can’t see them agreeing to increase again.

[SeasideSusie Remembering in reply to Bearo]

Bearo

Your opening question in this thread was whether you could rule out Central Hypothyroidism. Your original results on diagnosis did not rule it out, as explained above.

To answer your next question, leaving Central Hypothyroidism out of the picture:

I’m trying to judge whether or not my quickly falling TSH means anything

Jan 2020 no meds TSH 4.98,

Oct 2020 50mcg Levo TSH 0.91,

Dec 2020 75mcg Levo TSH 0.09

Jan 2021 75 mcg Levo TSH 0.14,

Jan 2020 - no medication - elevated TSH

From October 2020 onwards you have been on Levo, of course your TSH is going to reduce, this means that Levo is doing it's job, it should reduce TSH and raise FT4. Compare your October 2020 and January 2021 FT4 level, it has risen, albeit only by a small amount

Oct 2020 50mcg Levo TSH 0.91, T4 14 - 22% through range

Jan 2021 75 mcg Levo TSH 0.14, T4 15.9 - 39% through range, T3 4.6 (3.1-6.8) 40.5% through range

*

My low in range T4 and T3 must surely reflect my low dose of Levo (75mcg)

Yes, you need an increase in dose.

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 to support your request for an increase in your dose of Levo.

[Bearo in reply to SeasideSusie]

Thank you for this. I’m panicking that I won’t get a dose increase before I’ve even asked. I’ve read many posts on here saying ignore TSH, go by T4 and T3, but I’m still a thyroid novice!As no one else replied to my post I’m very grateful to you for responding each time I’ve hit the panic button. I hope you are well, and I’ll be quiet, now!

[SeasideSusie Remembering in reply to Bearo]

Bearo

Make use of Dr Toft's article, they don't come much better qualified than him.

If you are experiencing symptoms, print off the list of signs/symptoms from ThyroidUK and mark those you are affected by:

thyroiduk.org/signs-symptom...

Emphasise to your GP that if you were optimally treated you would not be having these symptoms and as your FT4 and FT3 are so low in range ask for a trial of an increased dose.

Presumably your nutrient levels are all optimal (I haven't looked back at your previous posts)?

[Bearo in reply to SeasideSusie]

Thank you Seaside Susie.

I’m supplementing vit D, which was 95 in October and I’ve increased dosage since then.

My B12 was 348 in October and I’ve struggled taking 1000ug a day as that dose makes me feel dizzy and sick, but I take at least 500 b12 + Igennus B complex. I take another 500 b12 some days.

My ferritin was 72 in October so I have reintroduced a bit of meat to my diet.

Folate is ok, I think.in October it was 14.6 (2.40-17.50).

I also take magnesium glycinate.

Only a couple of days ago it occurred to me how frequently I have a mug of tea after a meal. Trying to leave a gap, now, in case it was decreasing absorption of everything.

[SeasideSusie Remembering in reply to Bearo]

Nutrients are pretty good, although B12 could be better as you realise

[Bearo in reply to SeasideSusie]

👍