GP/Endo rant - help on TSH: Usual fun and games... - Thyroid UK

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GP/Endo rant - help on TSH

tzracer profile image
13 Replies

Usual fun and games after latest blood test results (see image).

Dr comments 'normal no action' for T4 & T3 and refers the abnormal TSH result to the Endo because I'm on Armour (I wish I could try it).

Endo reply in image.

So following previous pattern of reduction-worsening symptoms and dose increase. It seems Endo wants to make a change just because the Dr has written to him. I haven't spoken to either of them, they have no Idea of how the patient is feeling. I at least get to choose where the reduction comes from.

I'm going to write back when I calm down and ask why when T3 and T4 in range and TSH suppressed for years, do they feel the need to reduce my medication when it will have no effect on TSH but will only aggravate my symptoms. I would really like to include an explanation of why TSH is flawed but don't feel I can recall where I have seen a succinct explanation I could use (very probably something from diogenes ).

Thanks for any help

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tzracer
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13 Replies
shaws profile image
shawsAdministrator

It's no wonder, at times, that our blood pressure rises due to stupid comments by the 'supposed to be' professionals.

In theory we should not be on the internet at all searching for advice but, of necessity, we have to as the majority of 'experts' are not experts at all and don't seem to be aware of the difference between T3 or FT3.

Before blood tests were introduced (making lots of money for the suppliers) we were diagnosed upon our clinical symptoms alone (not numbers) and given a trial of NDTs (natural dessicated thyroid hormones).

NDTs saved thousands of lives from 1892 and still can today - if only they had not been removed from the NHS, quite a number of people might have found their symptoms resolved and health restored..

diogenes profile image
diogenesRemembering

TSH is not a driver of thyroid function, but a signal. Thyroid parameters (TSH, FT4, FT3) to gain optimal health on T4 in people with no thyroid are not the same as healthy people, This paper shows that the ideal range for patients on T4 is much lower than for healthy people, as demonstrated by biochemical markers that respond to thyroid output. However note that even the suppressed TSH is only a signal for possible MILD hyperthyroidism.

Thyroid. 2017 Apr;27(4):484-490. doi: 10.1089/thy.2016.0426. Epub 2017 Feb 6.

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy

Mitsuru Ito 1 , Akira Miyauchi 1 , Mako Hisakado 1 , Waka Yoshioka 1 , Akane Ide 1 , Takumi Kudo 1 , Eijun Nishihara 1 , Minoru Kihara 1 , Yasuhiro Ito 1 , Kaoru Kobayashi 1 , Akihiro Miya 1 , Shuji Fukata 1 , Mitsushige Nishikawa 1 , Hirotoshi Nakamura 1 , Nobuyuki Amino 1

PMID: 28056660 PMCID: PMC5385443 DOI: 10.1089/thy.2016.0426

Free PMC article

tzracer profile image
tzracer in reply to diogenes

Thank you for taking the time to reply, I probably should have included some background information as I haven't updated my profile. I'm currently taking Levothyroxine and Liothyronine. My TSH has been suppressed form the time I introduced the liothyronine around May 2017. While I saw a reduction in hypo symptoms, I had more energy, was able to exercise and had gradual weight loss. I am back to being fatigued combined with the other hypo symptoms I suffer.

DippyDame profile image
DippyDame

This might help...bmcendocrdisord.biomedcentr...

"Time for a reassessment of the treatment of hypothyroidism'

John E. M. Midgley, Anthony D. Toft, Rolf Larisch, Johannes W. Dietrich & Rudolf Hoerman

tzracer profile image
tzracer in reply to DippyDame

Thanks, I do remember reading that at some point, I'll include a link in my letter.

Lovecake profile image
Lovecake

It seems quite a few of us are getting TSH results of <0.01It is probably correct, but I’m beginning to feel that the labs are just not trying and putting that result (I know not true, but it just feels like we are being picked on).

I too am awaiting a reply from my endo on my most recent results (FT4 14.4 R11.2-20.2 and FT3 5.9 R3.2-6.8). I’ve only recently 2.5mcg T3 and a reduction would be awful for me.

Please let us know how you get on. I hope they leave your doses alone.

tzracer profile image
tzracer in reply to Lovecake

Thanks for replying, your results don't look too bad, hopefully the T3 will ease your symptoms. I have replied to the endo, but he's away until the 12th so will find out then. Take care.

playtime2 profile image
playtime2

Yes how you feel is very important to your dose, as long as your numbers are within an acceptable range, and you don't rely to much on just your TSH number. If you are feeling good on a dose and your numbers are in a decent place, just keep doing what you are doing and just smile at the Doctors. If your numbers are way off, then you can listen to the doctors suggestions.

tzracer profile image
tzracer in reply to playtime2

Unfortunately, those who prescribe the drugs don't care much for symptoms and they don't like their decisions questioned.

playtime2 profile image
playtime2 in reply to tzracer

I found two doctors NOT ENDOS who do care how I feel as much as they care about numbers. Do not use and endo to adjust your dose. You need someone to have you follow the protocols for monotering for cancer, and a different kind of doctor to help you futz with your T4 and T3.

serenfach profile image
serenfach

I got through to the GP who wanted to change my dose due to a low TSH by saying "if the car engine is running fine, and the dip stick says the levels are OK, do you add oil or take it out?

GP said he would leave it alone. Then he twigged.

If you can think of something similar, it may help, as the GPs dont seem to engage brain any more.

tzracer profile image
tzracer in reply to serenfach

Thanks, I like your analagy, I have been trying to think of a car related one as I'm a bit of a petrol head. Unfortunately my TSH is out of range and that's all they want to focus on.

serenfach profile image
serenfach

TSH is pulsar - changes every half hour - and can vary through the day by as much as 50%. Most GPs dont know this. The feedback to your pituitary gland due to your high in range T3 tells your thyroid not to produce anything (the TSH). Your engine is working, dont take oil out of the tank!

You could try the direct method - I feel well, you want me to be ill? They will then waffle on about heart and bone health, and this is when you shake your head and say you wish they would stay up to date with the research, and would you like to send them some. They hate this. I have been known to say "oh, that is not what McInnis and Splot found in their latest research", making up names on the spot as I know full well they will not even think of looking it up! Let us know how you got on, and sending a hug.

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