Here we go again. Was texted to get yearly thyroid test.

[Gillybabe48]

Yearly test was texted through. Had it 24 hour fasting and early in the morning. TSH came back 0.02 T4 18.6 and T3 5. Ranges were TSH 0.35-4.00 T4 7.70 - 20 T3 3.68-6. I received a text to drop 25 mgs due to TSH no consultation. I did this before and T4 went down and I had to increase again. The text also did not say test again in six weeks. I feel they are panicking everything they see TSH suppressed. Fed up with them playing Russian roulette with my health. I emailed the surgery and no reply. Has anyone else had this experience with doctor and TSH 0.02.

[humanbean]

Yearly test was texted through. Had it 24 hour fasting and early in the morning.

You've misunderstood the instructions on preparing for thyroid function tests.

You don't have to fast for 24 hours before testing. You have to fast overnight before the test - so, don't eat or drink anything other than water from roughly 10pm the night before the blood is drawn.

It is suggested that you don't take Levo for 24 hours before blood is drawn though.

[Gillybabe48 in reply to humanbean]

That's where I went wrong then took levothyroxine at 6 am. Would that affect TSH.

[humanbean in reply to Gillybabe48]

No, taking Levo at 6am just before a test probably won't affect TSH that much. The biggest factor for TSH is time of day, which is why we suggest testing at roughly 8am - 9am when TSH is at its highest during "office" hours. (It's higher in the middle of the night but people can't get blood tests done in the middle of the night.)

healthunlocked.com/thyroidu...

Taking Levo close to a blood draw would have raised your Free T4, possibly a lot.

It may have affected your Free T3 a little bit too but I can never remember the details on that.

[SlowDragon Administrator]

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

Refuse to reduce dose

Ft4 and Ft3 are well within range

Instead request that GP test vitamin D, folate, ferritin and B12

[Gillybabe48]

Thanks. I will although always find it difficult to challenge doctors but will quote the above guidelines. Thank you for that.

[tattybogle]

there is evidence i use with GP's that shows TSH between 0.04 - 0.4 (on Levo) , does not have any increased risks..... unfortunately you can't use that because yours is 0.02, and the same study shows risks did increase quite sharply for the group of patients below 0.04 .

But i'll put it here anyway , in case it comes in useful for you in the future if TSH raises to the dizzying height s of 0.04/ 0.05 healthunlocked.com/thyroidu.... some other useful stuff on there too for use when discussing heart/ bone risks with GP's

pragmatically ,your best option at the moment is probably to negotiate a smaller reduction than 25mcg ... (based on your past experience that 25mcg proved too big a reduction , and "according to that study your TSH only needs to raise a teeny bit to 0.05 ish , to put you in the 'no extra risk' category "

Very fine dose adjustments of 12.5mcg are commonly prescribed (using standard cheap 25mcg tablets ~ 12.5mcg tablets do exist , but only TEVA brand and the price is ridiculous) .

eg.

I am prescribed 112.5mcg (100 was not enough, 125 was a bit too much) .

it can either be prescribed as 'alternate dosing' 100mcg one day/ 125mcg the next etc.

or if preferred , 25mcg tablets can be halved to get the same dose each day .

(some GP's say 'you can't cut them as it's not accurate enough' , but my NHS prescription from the senior GP partner says "25mcg tablets, Half to be taken each day"

Even Smaller adjustments than 12.5mcg can also be prescribed very easily :

eg. if previous dose was 100mcg /day.... then GP could prescribe ;

6 days 100mcg / 1 day 75mcg (effective dose 96.5 mcg/day)

or 5 days 100mcg /2 days 75mcg (effective dose 92.8mcg / day)

etc.

etc.