I have posted a few times and am by no means a novice when it comes to all things thyroid and bloods and vits etc but my question is does anyone have any official guidlines regarding reaching a euthroid state on replacement.
In other words is there medical guidance that states top 3rd of range is best?
I have yet another endo appointment with a calcium specialist (also have hypoparathyroidism) last 4 appointments have been on the phone and today have a face to face, all bloods over last year have shown my t4 and t3 on on a downward trajectory in range. He says its fine because my tsh is staying below 1 and he would like it higher (i know its better low) but I'm bobbing on bottom of the range for t3 and t4...
T4 12.9(9-23) 27.86%
T3 3.5 (2.4-6) 30.56%
TSH 0.09
and of course feel like death, he says he doesnt think its due to thyroid and doesnt want me any higher as doesnt want to damage my heart etc and is going to write to gp as must be something else. I am beyond frustrated.
Anyway again the question is there any Nice Guidelines regarding patient wellness within range??
Thank you in advance.
Written by
Sweeneythyca
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Right. As i said I don't feel great, which he claims can't be due to thyroid levels which I don't agree with. Has been on a downward trend for the last year, at this rate it will be below range in the next 6 months. I told him i should be top 3rd of range which he said is ridiculous (i was there in first 6 months after removal of thyroid and had more energy than i do now.
" Each patient's thyroid function needs to be assessed on an individual basis with the entire clinical picture in mind." ex The Lancet
We are all different and have very different needs, aiming to treat/dose by tick box diagnoses is unlikely to be effective... patients all need to sit on different parts of the relevant ranges, but generally aiming for the top 3rd of the range is a start.
How the patient feels is far more important than aiming to satisfy a specific number, some feel better close to the top of the range others lower down
Your endo sounds clueless, I guess he is a diabetic rather than a thyroid specialist!
' He doesn't think it's due to thyroid"....well he isn't going to help improve your health!
Your miserably low lab numbers wave a red flag for hypothyroidism/undermedication and that should be clear to anyone with some knowledge of thyroid disease.
Forget about finding guidelines which you hope to stick under his nose to prove your point....instead, find a better informed endo!!
Or, find a GP who can analyse your labs, recognise undermedication and prescribe levothyroxine....you don't need an endo to do that.
As I said he specialises in parathyroid issues, I sacked off last endo (also surgeon that performed tt for cancer) for the obvious reasons. This guy is good as far as calcium issues go but isnt connecting dots.
Im on 100mcg which according to him is overmedicated (at 52kgs) he says we can afford to reduce dose 😏
My question was just about guidance about range as seen it alot on here about many people feeling best in top 3rd.
Yes do all the recommended things as stated on here ...I'm old hat at all this been on this rollercoaster for many years fast, don't take meds, supplement have had more blood tests in the last 10years than hot dinners, folders full of medical info, results etc been through countless docs blah blah.I did notice the nice guildlines regarding thyroid were supposed to be updated 2019/20 but due to the 'pandemic' still not done. Was hoping there would be some new updated guidance regarding treatment etc
Can't understand why all vits are good, but t4 and t3 keep sliding, aswell as ferritin despite being on iron supps. Will ask for a referal to hematologist for that as perhaps have a conversion issue or liver issue that is affecting conversion?
Not guidelines exactly , but does this help ?:-Copied from SlowDragon (admin) reply to someone else...
"Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"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)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
If i remember correctly Dr Toft was the Queen's Physician when she's in Scotland... and she's in Scotland A LOT... so if his advice is good enough for HRH the Queen, then it's good enough for me.
( Not 100% sure i've remembered this correctly, so don't quote me without checking )
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