I quote directly from an NHS Endocrinologist’s clinical letter to my mother’s GP, note they are based at an NHS hospital that prescribes a lot of Liothyronin/T3:
“One would use the TSH as a basis of judging adequate replacement rather than free hormone levels and the aim would be to keep TSH in the normal reference range.”
No wonder GPs are so ill-informed if this is what Endos are telling them!
I’m fuming as the Endo completely forgets the random fluctuations of TSH through Hashimoto’s and is now going to tell me a TSH of 0.15 is great despite FT4 being 14.4 (39% through range) and the patient suffering every textbook symptom.
Here’s my mother’s previous test results showing indadequate treatment:
Another example of mistreatment at the hands of an NHS robot. Shocking.If you email Dionne at ThyroidUk she can provide a list of more "genned up" endos.
This Endo works closely with 2 others on the Thyroid UK list in the same clinic. They are all consultants, so will ask to be switched to one of the other 2.
Is there any research that backs up the fact TSH is unreliable and fluctuates in Hashimoto’s?
Clearly there’s an issue here if T4 is low and so is TSH, either TSH is not reliable or there’s a signalling problem from the pituitary.
Thanks this is really useful. However sadly a lot of it is one person’s opinion and likely it will be dismissed by the endo. Perhaps I can print it, roll it up and smack him round the head with it!
I will of course forward it to his secretary and see what comes of it
my Doctor has the same approach as yours it would seem. Despite my Endocrinologist writing to him twice telling him ....quote-
'Please note the change in Thyroxine as we are looking at his free T4 levels and we would like to keep it around 12-15 if possible.
TSH is a useless test in Secondary Hypothyroidism.'
Surely he couldn't have put it any plainer than that but my Doctor still insists on using TSH to monitor my assess my Levo medication level . On my recent blood test results he wrote Serum TSH level 0.01 mu/l (ref range 0.34-5.60 mu/l ) dose should be reduced ?
TSH has a half-life of about an hour and can vary as much as 50% over a day. For clinical interpretation of laboratory results it is important to acknowledge that TSH is released in a pulsatile manner resulting in both circadian and ultradian rhythms of its serum concentrations.
Hoermann R, Midgley JE, Larisch R, Dietrich JW (20 November 2015). "Homeostatic Control of the Thyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment"
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Hmmmm..... results in - should I be pleased or not ??
TSH STILL 00.1 AFTER HALVING T3 DOSE TO CONCIEVE AND REPRODUCTIVE ENDOCRINOLOGIST RECOMMENDATIONS IN LONDON OR MANCHESTER PLEASE
Treatment will not change unless the use of TSH as the prime diagnostic target is realised to be inadequate
Labs in Western Sussex NHS instructed by CCG not to test FT4 unless TSH is out of range!
Downward trend of T4 and upward trend of TSH, but doctor reluctant to prescribe thyroxine 
