Recent levels

[Pjd94]

Hello,

When I got my diagnoses my levels were

TSH 0.01 (0.3-4.2)

T4 24.7 (9–19)

I’ve been on 20mg of Carbimazole a day since then and new levels are

TSH 0.01 (0.3-4.2)

T4 16.4 (9-19)

My doctor has asked me now to increase my Carbimazole to 25mg a day and also asked me to take an iron supplement as that is now low.

My question is why hasn’t my TSH budged but my T4 has? Is this common? I do feel a million times better, but I’m just concerned as to why the TSH is the same.

Thank you in advance

[pennyannie]

Hello again :

The TSH is a very unreliable measure of anything and with Graves Disease your antibodies are likely ' sitting on ' your TSH receptors, and driving up your thyroid hormone production and you can't really do much about the antibodies during this first phase of this disease.

There a 2 main sets of antibodies - TSI (stimulating ) and TR ab ( blocking ) and there is also a middle ground when the blocking and stimulating antibodies off set each other and you may be feeling relatively normal.

However the anti thyroid drug is working as you T4 has dropped back down into range so would have thought a dose reduction in Carbimazole more logical.

But where are your T3 results and ranges - it is essential that T3 is tested when on AT medication :

[Pjd94 in reply to pennyannie]

Hi 👋🏽

I did get t3 the first time

11 (3-5.4)

I also found it a little odd it wasn’t on this result this time. I have messaged my GP. I feel great and really don’t want to drive myself hypo with an increase in meds if my TSH will take a while to respond. I have endo appt not until July 28!

Thank you for your explanation as to what it means, much more clearer to understand!

[PurpleNails Administrator]

TSH takes time to respond even in healthy individuals. TSH is unreliable - especially when levels have been abnormal.

I had prolonged hyper (mildly, but over 4 years) My TSH never recovered as remains undetectable now, even when euthyroid since taking carbimazole for over 3 years. This is quite common and caused by the disruption to the HPT axis (Hypothalamic-Pituitary-Thyroid) which becomes down regulated. Doctors are taught to focus in TSH alone, which is wrong.

Your FT4 is now in range, I suggest it be adjusted downward slightly (as still higher in range) to prevent your FT4 going hypothyroid not increased.

You have no FT3 result to go by so unless that is tested and shown to be high your doctor is going by TSH alone.

Have you been prescribed iron supplements or just advised to buy a supplement? How much iron dose? Was an iron panel tested?

[Pjd94 in reply to PurpleNails]

Thank you for your reply. I am not sure if she has done them and not put them for me to see but I’ll send her a message because I thought that was odd too!

I’ve added my resent results below:

Results

[PurpleNails Administrator in reply to Pjd94]

No it doesn’t seem FT3 has been tested. The lab may automatically be set up to not test if FT4 in range.

If stated on blood request form “patient takes carbimazole & please include FT3” then lab may be able over ride & test, but it has to be specified on form.

Many arrange private testing as difficult to obtain full testing and important nutrients.

No iron panel or ferritin on here. Haemoglobin looks ok, why has doctor said to take iron supplements?

[SlowDragon Administrator]

You also need vitamin D, folate and B12 levels tested if not been tested yet