TSH LEVELS

[Artless]

My thyroxine was upped from 50 to 100 daily as my TSH was higher than the range given. This brought my TSH down to 1.5mu/L I felt ok on this but had very loose poos so meds dropped to 75micrograms a day. Just had a blood taken for other purposes and had to ask that they include a thyroid check due to recent change in dosage. They only appear to have done the TSH level which came back as 4.5mu/L (range is 0.4 - 4.9) not sure if i have done the right thing but sent message to docs asking if my levothyroxin should be put back up to 100micrograms. The test was not early morning as suggested as you get fitted in when possible.

[SeasideSusie Remembering]

Artless

The test was not early morning as suggested as you get fitted in when possible.

To get an accurate measure of your TSH you really need to do your test no later than 9am and have nothing but water beforehand, even if it means waiting for an appropriate time slot. Then stick to this time for subsequent tests so that they can be compared. Dosing by inaccurate testing means you will be forever chopping and changing your dose based on inaccurate results.

Dosing by TSH is wrong anyway, it's a pituitary hormone not a thyroid hormone, you should dose by how you feel and the FT4 and, more importantly, the FT3 results.

Regarding dose change, it does not have to be by 25mcg increments, it can be 12.5mcg, even 6.25mcg, or whatever is needed. Very gradual changes and fine tweaking is often the answer. My Levo dose is actually 107mcg which I to achieve by taking 5 x 100mcg and 2 x 112.5mcg per week.

[PurpleNails Administrator]

Most feel well with TSH around 1.  But the TSH can be unreliable.  

Focus should be on FT4 and FT3 & where you feel well in range with these.  FT3 is rarely tested by NHS, was FT4 not tested either?

 A 50mcg to 100mcg jump is too great.  Steps are usually 25mcg a day. So that might be why a 75mcg wasn’t well tolerated, after a time you become ready for another increase.  You don’t say when & time scales of altered doses. 

 Usually doses shouldn’t be changed too often. It takes around 6 weeks for a new dose to settle.  After 6 weeks you need to recheck levels.  

[Artless in reply to PurpleNails]

thanks for the quick responses. GPs really not interested in checking more than the basics. Really fed up with doctors. Thyroid meds seems really low in the grand scheme of things. Why do we not have a proper clinic dedicated to thyroid problems. Think i will just have to see how things pan out or go private.

[jimh111]

TSH is a very good marker for most people, it reflects the combined levels of fT3 and fT4. However, for a minority of patients it is unreliable. It's not a case of TSH always being reliable or always of no use. In your case your TSH does seem to reflect your thyroid status and so is useful.

TSH levels have a diurnal cycle and are higher early morning. if you have the blood taken later in the day just make a mental adjustment to note you would have got a higher figure at e.g. 8 am. Of course, if you get up earlier to have an early blood test it will give a similar result to having the blood taken later in the day. TSH works according to the body clock, not the clock on the wall.

TSH is very useful, it saves many babies from cretinism but the point to remember is it is not reliable in every case and we should consider symptoms also.

It is a good idea to try 100 mcg, it's not good to have an elevated TSH. If you find it a little too much just try reducing your dose by e.g. half a tablet every few days. You should be able to settle on a happy medium in a month or two.

[SlowDragon Administrator]

which brand of levothyroxine was 50mcg

Which brand of levothyroxine is 100mcg

Which brand of levothyroxine is 75mcg

Many people find different brands are not interchangeable

Teva is only brand that makes 75mcg tablets and Teva upsets many people

GP should not have increased levothyroxine from 50mcg to 100mcg in one go

Increasing too quickly is counterproductive

We nearly always need to increase at maximum of 25mcg …..retest is 6-8 weeks after each dose increase

Then, if TSH too high, Ft4 and Ft3 too low, increase again

You’re now under medicated and ready for next increase in dose levothyroxine

Perhaps initially increase to 75mcg and 100mcg alternate days….wait few weeks before increasing to 100mcg daily

Suggest you request GP test vitamin D, folate, ferritin and B12 plus thyroid antibodies for autoimmune thyroid disease

Or test privately

Details in replies on your previous posts