TSH LEVEL

[Kemali]

I would like some advice please my doctor has told me my blood tests results were satisfactory my tsh level was 4.93 is this normal?

[SlowDragon Administrator]

Presumably you are still on 50mcg levothyroxine

This is only standard starter dose

Request/insist on next 25mcg dose increase in levothyroxine

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

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

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...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

[SlowDragon Administrator]

Have you had thyroid antibodies tested or vitamins

For full Thyroid evaluation you need 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) usually diagnosed by high thyroid antibodies

About 90% of primary hypothyroidism is autoimmune thyroid disease

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 early morning, ideally before 9am last dose levothyroxine 24 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 and money off codes

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...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

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.

If you have autoimmune thyroid disease…….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...

[Kemali in reply to SlowDragon]

Thankyou very much I will have a read through everything you mentioned. I asked to be put on thyroid meds but have only had blood test twice in 2 years.

[SlowDragon Administrator in reply to Kemali]

Thyroid levels should be retested 6-8 weeks after each dose increase in levothyroxine and again after that until levels are stable

TSH is far too high for someone on levothyroxine

Dose levothyroxine should be increased by 25mcg

Then bloods retested 6-8 weeks later

If TSH is still over 2 you will need further 25mcg dose increase

Come back with new post once you have seen GP

If GP refuses to increase dose you will need to see thyroid specialist endocrinologist

[McPammy]

A TSH over 2.5 is too high. A healthy persons thyroid is around 1.00. My private only Endocrinologist explained this to me. He also said the NHS set their ranges too wide. You will probably be feeling some symptoms of being under medicated. I was under medicated for years by my GP on Levothyroxine. I have Hashimotos and I’m a very poor converter of T4 Levothyroxine to the much needed T3. Without adequate levels of T4 and T3 you will struggle. I’m now on combined Levothyroxine plus Liothyronine T3 medications. My TSH is now around 1.00. I get it checked every 3 months along with vitamins which help converting T4 to T3 also. I also get my T4 and T3 levels checked they are usually mid way in the range without taking medications that morning. I think your GP is wrong but they are only looking at their ranges and yours probably falls inside it even though it’s too high. Can you go private? If you’d like my private Endocrinologist details please message me. The NHS will never agree they just look at figures they set which are inadequate.

[suex11]

Hi

I had the same, my results were 4.93. I was told this was within range.

I think in range/normal doesn't necessarily mean optimal for YOU. Its all about how you feel.

I still felt ill and very tired so called my doctor and said how I was still feeling ill. I too had seen that when on thyroid medication most people feel better at the lower end of the range - ie 0.5 - 2.0. Doctor increased my Thyroxin by 25mg. Reading now 0.2 and I feel so much better. So I would advise discussing with your doctor if you still don't feel well.

Good luck

Sue xx