Analogy for using TSH to monitor T3/T4?

[Dadof5]

Hi all

Does anyone have a decent analogy similar to comparing shoe size to test results range for the above situation? Seeing a new doctor on Tuesday and best I can think of is just because I’m holding up five fingers on my right hand doesn’t mean I’m holding up five fingers on my left hand(I’m not I’m holding up three!)

I just want to try and get across how annoyed I am that the NHS is so rubbish at treating this problem.

[tattybogle]

mechanical speedo on car ( before the days of GPS and black boxes)

if you change the size of the wheel, the speedo will read a bit wrong.

A larger tire has a higher circumference and fewer rotations as you roll along the road. Because the tires rotate slower, the speedometer reads this as a lower speed. The faster your drive, the more your speedometer reading will be off.

TSH is your speedo, and changing your ratio of T4:T3 by using Levo instead of your own thyroid changes your wheel size.

On levo you have relatively more T4 , relatively less T3 and relatively lower TSH than you had when you were healthy . healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

Charlie-Farley has one too >> if you want to know how a person is , why ask their neighbour , when you could knock on their door and just ask the person themselves .... their neighbour might be deaf , or blind , or have been asleep for a week.

[helvella Administrator Thyroid UK in reply to tattybogle]

Not in any way disagreeing but I often use the rev counter of a car as an example. Imagine trying to use that to keep your speed steady.

Because to get your speed, you have to take that and use a factor to convert RPM to MPH.

But, on top of that basic fact, you need to know what gear you are in!

And even then, you have all the inaccuracies of an actual speedometer (tyre diamater, temperature, etc.)

And if you start going up a hill, you have to change down a gear, which changes the ratio...

You will notice that the rich consultants (not all are!) very often have expensive cars which will almost all have rev counters. But I bet they hardly ever look at the rev counter at all - and certainly not to see their speed. It would be silly...!!!

[tattybogle in reply to helvella]

yes .

i once asked my GP if he'd be happy to let me remotely adjust the speed of his car on the way home without being able to see what he could see out of his windscreen ,in the same way he wanted to adjust my thyroid hormone dose ( by text) without asking how i felt first.

serenfach has this brilliant one about getting TSH 'anywhere in range' , rather than 'optimal'

Does your GP play golf? ...ask him if he'd be happy with his ball 'in the range', or if he'd prefer it in the hole.

[helvella Administrator Thyroid UK in reply to tattybogle]

If the ball isn't visible, perhaps you got a hole in one? But you can't tell whether the ball is actually in the hole - or at the bottom of a lake, or buried under sand in a bunker.

(Unless you saw where it landed.)

[tattybogle in reply to helvella]

lol ,

When i was little i was looking out my bedroom window one sunday morning watching my dad practicing golf on the huge playing fields at the back of our house.

while the nuns from the convent took their morning walk.... in single file... 5 feet apart.... heads bowed.

swing of golf club..... wait ..... last nun in the line fell over ..... dad came in ..... didn't play golf again for a few weeks ... i couldn't see the ball, too far away , and he said he didn't remember anything about any nuns. Mmmmm.

[SlowDragon Administrator]

Looking at previous post

Your vitamin levels are terrible and presumably you are now working on improving

Have you got TSH, Ft4 and Ft3 tested privately yet

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

NHS England Liothyronine guidelines July 2019

 

sps.nhs.uk/wp-content/uploa...

Page 9 

Test for Deficiency of any of the following: Vitamin B12, Folate,  Vitamin D, Iron

See page 13 

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

LEVO DOSE SHOULD NOT BE DETERMINED BY TSH

Diogenes/Toft paper:

bmcendocrdisord.biomedcentr...

healthunlocked.com/thyroidu...

The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:

[Dadof5]

Thanks all

There are some great analogies here. Seeing a new doctor tomorrow so good to have some of these in the locker so to say!

[arTistapple]

Not exactly an analogy but just heard Dr. Paul Jenkins (Thyroid Trust YouTube) describe hypothyroidism as attempting to drive a car without using the choke and hyperthyroidism as driving with the choke on all the time. However most highly paid doctors probably have cars that do not use a manual choke (T3) so they would not necessarily understand the explanation. Clearly hypothyroids don’t need chokes if their endo has a super duper car.