Hi, my daughter has just got TSH level at 0.08. Her GP wants to reduce her medication. I thought this level would indicate over active thyroid but she has symptoms of under active ie gaining weight. Has any one else had this issue. She goes to the gym everyday and is really strict with her calorie intake. She is so miserable. Can anyone help?
Many thanks
There are many posts and replies on here as to why TSH is not a good marker of hormone status once you are on replacement hormones. Your daughter needs to know what her ft4 and ft3 results are. These are the thyroid hormones. TSH is not a thyroid hormone. Going to the gym every day and restricting calorie intake are not beneficial if a person still has hypo symptoms. I would suggest gentler exercise. Her body is struggling to maintain all its functions (hence the hypo symptoms) so hard exercise just puts a further strain on the body.
You need calories to convert T4 (what is taken in form of levo or produced by thyroid normally) into T3 (hormone used by our cells). On a restricted calorie intake you can disrupt conversion resulting again in hypo symptoms. This can ironically lead to weight gain.
If you can get blood tests for TSH, ft4, ft3, ferritin, folate, vit D and B12 then those results will give a better picture of what is happening with your daughter. Post the results on here and you will get helpful advice.
Many of us have been in the same position.
Hi, her levels are THS 0.08T4 15.4 and Triiodothyronine 5.1.
Her vit D and B12 are ok. Don’t think she’s had ferritin and folate tested.
Is she already diagnosed as hypothyroid and on replacement thyroid hormones, eg levothyroxine
Assuming yes, how much levothyroxine is she currently taking
Does she always get same brand levothyroxine at each prescription
Just testing TSH is completely inadequate
As Lalatoot says…..over exercising will use up her (limited) levels of thyroid hormones if on levothyroxine
Restricting calories can slow conversion of Ft4 (levothyroxine) into Ft3 (active hormone)
ESSENTIAL To regularly retest vitamin D, folate, ferritin and B12 at least once a year
What vitamin supplements is she taking
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation she needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
On T3 or NDT - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last dose 8-12 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
Gluten intolerance is often a hidden issue too. Request coeliac blood test BEFORE considering trial on strictly gluten free diet
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Please add any other test results if have them
Or come back with new post once she has full results
Many thanks for your reply
Hi yes she is on levothyroxine. 150mgHer t4 is 15.4 and Triiodothyronine is 5.1
Her gp wants her to reduce to 125mg.
Thanks for any advice
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
ESSENTIAL to test vitamin D, folate, ferritin and B12
When were these last tested
What vitamin supplements is she currently taking
Has she had thyroid antibodies tested
The simple answer is that TSH is not enough to dose by. She needs to have her actual thyroid hormones tested too, to see how she is doing. Many of us have low (suppressed TSH) without also having an adequate level of free T4 and free T3 - and so need our meds increasing not reducing ... Remember you are ONLY over-medicated when free T3 is too high - not when free T4 is over-range or if TSH is under-range.
Most of us need free T4 and free T3 to be in the top third - or higher - to feel properly well - regardless of what that dose to TSH - and I for one can't lose weight unless they are.
It's also important that she checks key nutrients - ferritin, folate, vit D and B12 - at least once a year, and supplements any that are low. GPs don't know anything about nutrients, as it's not included in GP training, but I've had some success with mine by saying that these are the tests recommended by Thyroid UK
Finally, she may be making things worse if she exercises too much or restricts calorie intake too severely WHILE she is under-medicated. You need a certain number of calories to convert the inactive free T4 into the T3 that is needed in every cell in our bodies ...
Good luck x
Many thanks for your reply
I would like to thank you all for your knowledge and replies. What a great group x
These are her blood results
Hi All, do these levels seem ok?
Hello there :
New information generally requires a new post as once a post has been replied to it is seen as actioned :
Unless you reply to someone specific to draw their attention back to your post, you may not receive an answer, through no fault of anybody.
It's just how this rolling screen is, and suggest you start a new post with these results as we can all look back at the previous details if we need to refresh our memories.
Many thanks
I see you've now kick started this post - you should get picked up :
Thank you x
Ft4 is only 34% through range
Ft3 is 53% through range
Helpful calculator for working out percentage through range
Most people when adequately treated on just levothyroxine will have Ft3 between 50-70% through range. Usually Ft4 is a little higher
academic.oup.com/jcem/artic...
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
Hi thanks for your reply. I will get all her results and let you see them. I asked her about leaving 24hours since meds to blood test. She takes it in a morning so has been taking it before the blood test x
So if been taking levothyroxine before test this gives false high Ft4 result ….so likely Ft4 would be 12 or lower if left 24 hours between last dose levothyroxine and blood test
Ft4 almost certainly too low …ie needs dose INCREASE in levothyroxine
THS 0.08
Ft4 15.4 and
Triiodothyronine 5.1
It won’t affect TSH
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
Thank you so much x
Hi, her B12 level was 553 (197-771)Serum total 25-hydroxy bit D level 96.8
nmol/L
She hasn’t had folate or ferritin checked.
Do these results look ok ?
Many thanks
Yes both good …..does she supplement or is this natural levels?
Hi, no she doesn’t supplement
Hi, her GP has told her that taking her meds before test make no difference to results because of type of blood test it was. Makes no sense to me. Do you know if over medicating can lead to weight gain? X
just tagging SlowDragon so she sees your reply . her GP has told her that taking her meds before test make no difference to results because of type of blood test it was. Makes no sense to me
GP is only half correct :
The TSH test isn't affected by the time of last dose .
The fT4 test is affected.
But .... from GP's point of view , in this instance the TSH result of 0.08 is the one she's looking at when she's saying the dose need reducing.
We are looking at fT4 , we know that TSH0.08 is not an increased risk for anything, and we're taking symptoms into account too .
You may be able to argue the case for GP not to reduce the current dose if you show them the study slow dragon quoted above: academic.oup.com/jcem/artic...
" patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. .... our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter."
..... but realistically , with TSH at 0.08 it will be extremely unlikely they would consider an increase in Levo dose .. even if you could get them to understand about time of last dose levo /fT4 result. ( GP's aren't often taught about this , as they mostly just learn about TSH tests , but it's true )
Thank you for the tag. I’ll soon get the hang of this 😂Thanks for the info, it’s a struggle with the GP X
Get folate and ferritin tested
Never supplement iron without doing full iron panel test for anaemia first
Medichecks iron panel test
TSH LEVEL
Increased TSH level.
Polymyalgia
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TSH level
