TSH upon waking

[Lavender-Blue]

Hello All!

Can anyone say if there is a recommended / ideal TSH upon waking?

Thank you in advance!

[SeasideSusie Remembering]

Lavender-Blue

Everyone is different so there can't be a recommended level.

Healthy people with no thyroid disease have varying levels of TSH, see graph here:

healthunlocked.com/thyroidu...

Healthy people are likely to have a different TSH level than someone with diagnosed thyroid disease and on thyroid hormone replacement.

Can I ask what exactly it is you are asking and why?

[Lavender-Blue in reply to SeasideSusie]

Here's my latest results done a few weeks ago by Monitor my Health:

TRIODOTHYRONINE

23/05/2022

3.8 pmol/L

FT3 levels normal (normal range 3.1 - 6.8 pmol/L)

THYROXINE

23/05/2022

11.2 pmol/L

FT4 levels low (normal range 12 - 22 pmol/L)

THYROID STIMULATING HORMONE

23/05/2022

6.09 mu/L

TSH levels high (normal range 0.27 - 4.2 mU/L)

I know I am under medicated from these results and I have increased my NDT by 1/4 grain.

I am just wandering what I may be aiming for upon waking.

Thanks for your reply!

[SeasideSusie Remembering in reply to Lavender-Blue]

Lavender-Blue

I am just wandering what I may be aiming for upon waking.

It's not a case of what TSH you should aim for when you are waking, it's what levels of thyroid hormones - FT4 and FT3 (with FT3 being the most important) that makes you feel well.

When on NDT this tends to lower, maybe even suppress TSH, and this is not a marker of your thyroid health.

When on NDT it tends to lower FT4 and FT3 generally would be in the upper part of it's range when you are optimally medicated.

So your results:

TSH: 6.09 (0.27-4.20)

FT4: 11.2 (12-22)

FT3: 3.8 (3.1-6.8)

show that you are very, very undermedicated.

When did you take your last dose of NDT before the test. Last dose should be 8-12 hours before the test and dose should be split into 2 or 3 the day before and time adjusted if necessary.

You are looking at getting your TSH down to around 1 and probably lower when optimally medicated, FT3 in the upper part of it's range and probably around 5.7 (or maybe higher, depends on the individual), and FT4 wherever you need it to feel well.

With NDT having a fixed ratio of T4 to T3 at 4 to 1, this doesn't suit everyone. Some of us need Levo and T3 so that we can tweak the dose of each hormone to suit our own individual needs. Some are fine with low FT4 as long as FT3 is in upper part of range, some of us need FT4 and FT3 reasonably well balanced over half way through range.

Have your recently swapped to NDT?

Is this self medicating or prescribed?

How much NDT are you taking?

Are your key nutrients - Vit d, B12, Folate and Ferritin - all at optimal levels, which they need to be for any thyroid hormone to work well. If you have results for these tests perhaps you can post them with their reference ranges and tell us if you take any supplements.

[Lavender-Blue]

I have upped my dose from 1.5g(when bloods were taken) to 1.75g (increased 23/5/22 ).

However, one and a half weeks in with the extra 1/4 and still feel no better, but I am scared of being over medicated.

That said, I have just taken an extra 1/4 grain because I feel so dreadful.

Do you feel I should stay on the 1.75g, do you think that amount will bring my levels down or shall I add the extra 1/4g tomorrow (like I have just done) taking me to 2g?

I see Endo privately.

I take Thorne Selenium and 1000mg Vitamin D.

Eat gluten free, Mediterranean Diet with plenty of olive oil!

Thanks for advising me, I really don't know what to do for the best. I have in the past been overmedicated and that is just as bad as being under medicated!

I hope this makes sense!

[SeasideSusie Remembering in reply to Lavender-Blue]

Lavender-Blue

I didn't get notification of your reply, for a notification to be sent you need to reply in the box directly below the message you are replying to and it will say "Reply to xxxxxxx".

You are on a very low dose of NDT, many people are on 3 grains.

You didn't answer the question as to when you took your last dose of NDT before your test but assuming that you took your last dose as I mentioned above then your results show that you are nowhere near overmedication, your TSH is way over range, your FT4 is below range and your FT3 is only 18.92% through range. One would expect your TSH to be at the bottom end of it's range and your FT3 in the upper part of it's range when optimally medicated. You have a long way to go.

Here is the calculator to show percentage through range: thyroid.dopiaza.org/

I see Endo privately.

Is endo prescribing the NDT? Presumably the endo is guiding you with initiation and titration of your NDT?

You didn't answer the question about whether you have recently swapped to NDT; however, the normal protocol is generally:

Starting dose: 1/4 grain (15mgs) in the morning and quarter of a grain in the afternoon and stay on this for 7 days. If no adverse effects:

Week 2: increase your dose by another 1/2 grain (30mgs) a day. Take half a grain in the morning and half a grain in the afternoon (total 1 grain daily) and stay on this dose for at least 3 weeks. If no adverse effects:

Week 5-6: increase by another 1/2 grain and take 1 grain (60mgs) in the morning and 1/2 grain (30mg) in the afternoon (total 1 and 1/2 grains daily). Stay on this dose for 3 weeks and again, if no adverse effects:

Week 8-9: increase by another half grain and take one grain in the morning and one grain in the afternoon and stay on this for another 3 weeks (total 2 grains daily).

This may or may not be enough. If you are still symptomatic, increase by 1/4 grain (15mg) every 3 weeks. If you feel overmedicated then drop back to the previous dose.

IF CHANGING FROM LEVO TO NDT

For many people they can stop taking Levo one day and start NDT the next day.

Many people split their NDT dose, taking half the dose in the morning and the second half later in the day.

I take Thorne Selenium and 1000mg Vitamin D.

How much selenium? Did you test before starting it?

* What is your Vit D level?

I don't think you'll be taking 1,000mg (milligrams) Vit D, I think you mean 1,000iu (international units).

100mcg (micrograms) Vit = 4,000iu

1mg = 1,000mcg so 1,000mg would be 1,000,000mcg and there's no way you could take that amount of Vit D.

1,000iu Vit D is just about a maintenance dose for someone with a good level already, so if your level is low then that dose isn't going to be much help in raising it.

* What about B12, Folate and Ferritin - all vitally important to have good levels for thyroid hormone to work, ferritin in particular. What are your levels?

[Lavender-Blue in reply to SeasideSusie]

I hope this has arrived with a notification?

Yes, I am seeing Endo privately.

I did the blood test after a 24 hour hour period. I take all the meds at once. I was initially on Nature Thyroid but due to withdrawal switches to Levo which was horrendous.

Been back on NDT since end of last year.

Yes, you are right Vit D is 1000 iu, I think a 3000 is is available in the Vitabiotics brand, is this a recommended brand?

I take one Thorne Selenium 200mg I think is the dose in the tablet, I didn't get a test due to costs.

I had B12, Ferritin and Foltate done a while ago, they were OK but I am uncertain where the printout is for this.

I thought I was "nearly there"! I hope 2g is enough as it is so costly with private Endo appointments and private prescriptions but to get a prescription is cheaper than buying it from a well known pharmacy recommended on here which is where I used to get it from until Nature Throid was recalled.

[SeasideSusie Remembering in reply to Lavender-Blue]

Lavender-Blue

Yes, thank you, I got notification this time

I did the blood test after a 24 hour hour period. I take all the meds at once.

OK, so by leaving 24 hours since last dose of NDT you have a false low FT3 result. Because NDT contains T3, and T3 has a short half life, we should only leave 8-12 hours between last dose and blood draw. When you take NDT in one daily dose then for the day before the test it should be split into 2 or 3 and the last part of the dose taken 8-12 hours before the test.

Yes, you are right Vit D is 1000 iu, I think a 3000 is is available in the Vitabiotics brand, is this a recommended brand?

I personally don't rate that brand, there are much, much better brands available. For a start it's a tablet which is the least absorbable form. Vit D is a fat soluble vitamin so it needs fat to be absorbed, either in the form of some kind of fat being in the supplement (eg an oil based softgel or oil based drops) or taking the supplement with dietary fat (eg cheese, full fat yogurt, etc). It's also chock full of nasty additives.

My suggestion for a Vit D supplement is Doctor's Best D3 softgels which are a clean supplement with no added ingredients, just D3 and extra virgin olive oil for absorption.

It's impossible to say what dose you would need until you get a current Vit D level.

When taking D3 there are important cofactors also needed.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

K2 is also fat soluble so should be taken with the fattiest meal of the day or buy an oil based supplement.

We should take D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid. Both are imported German brands and sometimes available on Amazon or Ebay, they can also be purchase direct from the producers' websites.

If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form

natureprovides.com/products...

It may also be available on Amazon

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

I take one Thorne Selenium 200mg I think is the dose in the tablet, I didn't get a test due to costs.

Supplementing selenium - 100-200mcg (mcg not mg) is said to be a safe amount to take but some people have found 200mcg to be too much for them.

Recommended forms of selenium are selenium l-methionine or a yeast bound selenium, ones to avoid are selenite and selenate forms.

I hope 2g is enough

Only time will tell. With those results on 1.5 grains, even allowing for a false low FT3, your TSH is so high that you could very well need more and your FT3 will probably need to be at least half way through it's range, if not higher, maybe around 70%. However, next test follow the advice we always give:

* Test no later than 9am

* Water only before test (certain foods and drinks can affect TSH)

* Last dose of NDT 8-12 hours before test, splitting dose and adjusting times the day before to give this time gap

* No biotin, B Complex or any supplement containing biotin for 3-7 days before the test as biotin can give false results

[Lavender-Blue in reply to SeasideSusie]

Wow!

Thank you for your time. I will take a look into your suggestions.

I am going to stay on the 2g now until next blood test.

I am curious what my results would have been had I taken in two or three doses; do you think I would have had a lower TSH doing it that way?

[SeasideSusie Remembering in reply to Lavender-Blue]

I am curious what my results would have been had I taken in two or three doses; do you think I would have had a lower TSH doing it that way?

No, I don't. It would have given you a slightly higher FT3. Your TSH is high because there is not enough thyroid hormone.

[Lavender-Blue in reply to SeasideSusie]

OK Susie thank you, it's all very complex and confusing.

Thank you for your time in reaching out! 😊