Can anyone give me a heads up what my GP may say when she phones me this week about my new blood results. I increased to 100 from 75/100 alternate days at the beginning of September.
TSH 0.01 (0.27-4.2)
T4 19.3 (12-22)
T3 5.4 (3.1-6.8)
I feel a lot better on this dose and have only had a couple of bad days, but these have been after a very busy few days, but still have swollen /puffy fingers.
This is the first time a dr has wanted to discuss a blood test , so was wondering what she is likely to advise me to do.
Thank you
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nat10
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Well depending on how well your doctor understands thyroid she might be concerned that your TSH is now suppressed and believe you are over medicated.
However you have both T3 and T4 bloods which show you in range and not over medicated.
Your T4 is around 70% and T3 at around 62% through the range and if you fell better here than where you were - stay put.
No thyroid hormone works well until ferritin, folate, B12 and vitamin D are optimal and see you have a diagnosis of Hashimoto's so hope you've healed your gut as this is another area that needs repair to help maintain optimal health and well being.
We generally feel at our best when our T4 is in/ towards the top quadrant of its range as this should convert to a higher level of T3 and it is T3 that gives you your wellness.
Too low a level of T3 for you and you will experience symptoms of hypothyroidism just as too high a level of T3 for you and you may experience symptoms of over medication commonly referred to as " hyper " which you are not, as once hypo you can't " go hyper " but may become over medicated especially when dealing with Hashimoto's AI disease.
Thank you for your reply. I am hopeful that she understands thyroid as she agreed to the increase when bloods before my TSH was 0.04, T4 17.7, T3. 4.9 so I did double check my appointment was with her and not the other drs I have spoken to in the past.
I agree with pennyannie, she wont like the TSH result being suppressed. But as your FT4 and FT3 are well within range there is no problem, you're only overmedicated when FT3 goes over range.
You may need to argue your case not to have dose reduced. You can use the following information to support this:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication 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 confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of this article from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
How can blood tests be used to manage thyroid disorders?
.....
Occasionally patients only feel well if the TSH is below normal or suppressed. This is usually not harmful as long as it is not completely undetectable and/or the FT3 is clearly normal.
There are also certain patients who only feel better if the TSH is just above the reference range. Within the limits described above, it is recommended that patients and their supervising doctors set individual targets that are right for their particular circumstances.
Hard to see how a GP can argue with the BTF really.
What was interesting - the whole talk or the part I referred to? The part I referred to is about patients on Levo only, not patients on combination hormone replacement.
Yes but he goes on to talk about if you’re taking both levo and lio. Was I still sleepy or did he say AF was a risk with suppressed tsh on combination therapy? Prob need to listen again but didn’t seem the news I wanted to hear.
It's so long ago since I listened to the whole talk that I can't remember it now, I just made a note of the important bit about suppressed TSH and high FT4 not being a problem if FT3 is within range, and where to find it.
If you can give me the time stamp of where to find that I'll have a listen
I'm taking levo and lio, and I'm sure he did say that AF is a risk with 'suppressed' TSH on combination therapy. I suppose it depends on what is meant by 'suppressed'. I have always assumed that it means "less than zero", so my current TSH of 0.04 is nothing to worry about. I hope the experts on here will correct me if I'm wrong!!
I hear different definitions of 'supressed' . depending on the writer/speaker.
Some writers do use it to mean 'anything below range'.
Other papers describe 'below range but above 0.03 ish' as 'low but not fully supressed' . and reserve 'fully supressed' for 'below what todays machines can measure' ie <0.001 or <0.05 etc (depending on the machine)
helvella explained somewhere that older TSH machines couldn't measure as low as later models . So they can now measure levels as low as 0.03/4/5/6 etc .. which wasn't previously possible.
When the lowest possible result was reported as "<0.1 " they they had to call anything below that supressed , because they didn't know if it was actually 0.09 , or 0.000
A lot of it just seems to be down to the preference of whoever is writing.. there's no universally accepted definition of 'supressed' that is used across the board in the research papers i've seen.... so you have to look closely at the methods section of individual research studies to see how they have defined the term .
This leads to problems .. eg. you do a study with 'supressed TSH is associated with so an so' in the Conclusion ....and people quoting it later, take 'supressed' to mean whatever they want it to .. even if you defined it as <0.001 in your Methods
i listened to the full talk a few weeks ago , and I got the impression Dr Toft was uncomfortable with going on record saying there no risk in 'low but not fully supressed TSH' in those taking T3+levo. But is less concerned if it's just on Levo. I don't remember him giving a clear explanation of why .. i will have to listen to it properly again. but i guess he has to be careful what he goes on record saying,
Doc is gonna wanna take your dose down. Do not let them! Remember your care is a collaboration. Neither FT4/3 are over range, you feel well and so don’t allow them to change your dose. Be prepared.
GP may well say "they are worried about your heart and / or bones" (atrial fibrilation /ostoeporosis) ~ due to the low TSH.
Make the GP do some of the work here .... say something like:
"as far as i am aware, a lot of the studies associating these risks with low TSH, include results from hyperthyroid patients where as well as the TSH being low , the fT3 and fT4 are also over range, but in those cases it's surely the very high fT3/4 levels that are responsible for the heart and bone problems., not the low TSH.
If you know of any research showing that a low TSH with 'in range' fT3/4 is a problem for heart and bones i'd be very happy to read it .
If you are concerned i'm currently overmedicated on this dose take my pulse /blood pressure.
I'm aware of the signs and symptoms of overmedication .. (fast heart rate , fine tremor in the fingers , feeling hot , sweating , over-frequent bowel movements , anxiety /irritability)... obviously i don't want to be overmedicated so i will keep an eye out for any of those, and i would of course let you know.
But since i feel so much improved on this dose i would like to continue on it for another few months to see if these improvements continue.
Perhaps we could try continuing at 100mcg for 6 months and then re-do bloods if you are still concerned ?"
Thank you for your reply, some very useful points and advice. I am hopeful that she will not be too concerned about TSH as she gave me the increase when my last bloods TSH 0.04
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