Elevated TSH

[ChrissyS1]

So I have Hashis and take levo 100 mg daily. I've been chugging along ok until a few months back and I'm having muscle stiffness all over. I'm also getting headaches, problems sleeping and horrendous period pains in back and pelvic area. I had my bloods done and was told T3 and T4 are normal but TSH is 4.8 can anyone explain what is going on. My doc us emailing my Endocrinologist but I think I'm gonna have to wait months to see her. Any advice would be appreciated.

[greygoose]

What's going on is that your doctor doesn't understand about ranges. He thinks that anything within the range has to be 'normal', but it isn't. If your FT4/3 are at the bottom of the range, it's 'normal' that your TSH is high because they are too low. Do you have the actual numbers: results and ranges?

[ChrissyS1 in reply to greygoose]

I will contact her today to get full ranges.

[greygoose in reply to ChrissyS1]

Might be better to ask at reception for a print-out. Doctors do not like giving exact numbers - they either would prefer you don't know, or think you're too stupid to understand! And, results/ranges given verbally can easily contain mistakes. It is your legal right to have a printed copy, to ask for one at reception.

[ChrissyS1 in reply to greygoose]

Oh she did say my T3 and and T4 we're also bang in the middle if you know what that means..

[greygoose in reply to ChrissyS1]

I more or less do, but that is not good! Doctors tend to think that anything 'bang in the middle' of the range just has to be good. But, when you are taking thyroid hormone replacement, FT4/3 are often better up in the top third of the range. Obviously your pituitary thinks your levels are too low, because it's raised the TSH.

But, how do you feel, anyway?

[ChrissyS1 in reply to greygoose]

I feel bloody awful at the moment I have no energy and very weak muscles..

[greygoose in reply to ChrissyS1]

Well, it certainly sounds as if you're under-medicated.

How much levo are you taking? And, how long was the gap between your last dose of levo and the blood draw?

[ChrissyS1 in reply to greygoose]

I'm taking 100mcg levo and I took levo in the morning and had my bloods taken at 12 noon..

[greygoose in reply to ChrissyS1]

OK, so you have a false 'high' FT4. Normally, one leaves a gap of 24 hours between the last dose of levo and the blood draw, to get the normal circulating level of FT4. Had you done that, your FT4 would be much lower.

TSH is highest early morning. We usually recommend getting it tested before 9 am. At 12 noon, your TSH would have been at its lowest.

So, what that means is, you are a lot more hypo than you think (false 'high' FT4, false 'low' TSH) and very under-medicated.

Unfortunately, doctors do not understand about the fluctuations of the TSH, nor the importance of the timing of the last dose of levo - there are so very many things they do not understand! So, they wouldn't question it. But, if I were you, I would be strongely requesting an increase in dose.

(I think your doctor probably made it up about your FT3 being mid-range, because I doubt they even tested it. They rarely do.)

[ChrissyS1 in reply to greygoose]

Thanks for your advice. They said they'd retest in 6 weeks so I'll make sure it's an early appointment and I won't take my levo till after. It's like a constant battle to get treated properly and I must admit the ranges confuse the life out of me.

[greygoose in reply to ChrissyS1]

Why do the ranges confuse you?

[ChrissyS1]

They couldn't give me a print out at reception last time and it's difficult to actually get into the surgery as it's all phone consultations where we are.

[greygoose in reply to ChrissyS1]

OK, but you're still better off speaking to reception about your results, than the doctor.

[fuchsia-pink in reply to ChrissyS1]

Can you register for on-line access and get your results that way?

[ChrissyS1 in reply to fuchsia-pink]

I spoke to the doctor and she's leaving a print out at reception for me to collect..

[ChrissyS1]

I've been worrying that there's something wrong with my pituitary gland.

[greygoose in reply to ChrissyS1]

No, don't think so. Just bad testing methods. But, even if there is something wrong with your pituitary gland, it's nothing to worry about. The main problem would be getting your doctor to understand something that is totally alien to him!

[Lulu2607]

Hi. I was told at the Drs that once on levo you should adjust medication until TSH is under 2 and T4 at the top of the range. Your surgery probably thinks as your results are in range you're fine, but different rules apply once you're diagnosed with a thyroid problem and treated with levo. I was also told that symptoms should be taken into account. Therefore, based on your info and your symptoms it sounds as if your Dr should try an increase in your levo and see if it helps, although it would take a few weeks before you felt a difference.

[SlowDragon Administrator]

You’re almost certainly under medicated

On levothyroxine dose is increased slowly upwards in 25mcg steps until TSH is always below 2…..often will be lower

Essential to regularly retest vitamin D, folate, ferritin and B12 as well, especially if under medicated as this frequently causes low stomach acid, leading to poor nutrient absorption and low vitamin levels as direct result

ALWAYS test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

No other medications or supplements within 2 hours

Some should be minimum 4 hours away

What vitamin supplements are you currently taking

Dose levothyroxine is increased slowly upwards in 25mcg steps

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine