LOW TSH: I'm extremely angry. I spoke with my... - Thyroid UK

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LOW TSH

Jules2194 profile image
16 Replies

I'm extremely angry. I spoke with my endocrine nurse about 2 months ago as I was feeling tired. She refused to do bloods as I'd had them done early March and all was fine.( Full thyroidectomy 10 years ago). I argued the toss with her but she flatly refused. Told me to see gp.I left it for a while to see if was all in my head, but gradually the tiredness has become worse. I'm sleeping but waking like I've not had an ounce of sleep. Falling asleep all over the place. I did a private blood test for vitamin D came back normal. Bought high strength vit B12. I went to GP last week had full bloods done. Was thinking yesterday b12 not working. That usually takes effect in 2 days. Went online this morning. All OK apart from TSH 0.09😡

To say I'm angry is an overstatement. The result is useless on its own. Gp won't test T4 or T3. Shows I'm down for a call from pharmacist. That'll be an interesting call. I've now put a message to endocrine nurse again. Let's see what she has to say!!! More time feeling rubbish waiting for her to get back to me.

Rant over!!!

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Jules2194
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16 Replies
pennyannie profile image
pennyannie

Hey there again Jules:

Looking back I see you contemplating seeing a certain lady from the Thyroid UK list - did anything come of this ?

Are you still on T4 monotherapy ?

A TSH seen in isolation, especially when there is no thyroid is a very unreliable measure of anything and depending on your cancer diagnosis you may need to keep the TSH low suppressed any way :

But yes, you must be dosed and monitored on your Free T3 and Free T4 readings and we generally feel better when the T4 is on the top quadrant with a T3 tracing behind at around 60% through it's range.

Have you stopped the Propranolol as that is known to down regulate T4 to T3 conversion ?

What can we help you with - other than suggesting you get private blood tests run and we advise you on the results ?

I know it goes against the grain and not what we expect from the NHS - but what is one meant to do when so unwell and it appears there is no help nor understanding.

SlowDragon profile image
SlowDragonAdministrator

Thousands upon thousands of U.K. thyroid patients forced to test privately to make progress

You need full thyroid and vitamin testing BEFORE booking any consultation

What was reason for thyroidectomy

For full Thyroid evaluation you need TSH, FT4 and FT3 tested 

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Recommended that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

Tips on how to do DIY finger prick test 

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

Looking at post from 2 years ago

healthunlocked.com/thyroidu...

Are you still taking propranolol. This significantly slows uptake and conversion of Ft4 to Ft3. if yes…..how much per day ……You must NOT stop propranolol suddenly…..has to be weened off incredibly slowly

Jules2194 profile image
Jules2194

Thanks for your replies. I had cancer. Its 10 years next month and still battling with levels. I don't take propranolol anymore. I take 5mcg T3 twice a day and then alternate days levo 75mcg and 100mcg.I just wish they'd listen. Looks like I'm going to have tovresort to my own private testing like suggested . I'll see if I get a response from the endocrine and take it from there.

I did see a functional medicine lady in thyroid uk list. Got absolutely nowhere after spending a fortune.

SlowDragon profile image
SlowDragonAdministrator in reply toJules2194

Test early Monday or Tuesday morning

Last dose levothyroxine 24 hours before test

Day before test split T3 as 5mcg waking, 2.5mcg mid afternoon and 2.5mcg Approx 8-12 hours before test

TSH is almost inevitably going to be very low or suppressed on any dose of T3

Essential to test vitamin levels too

which brand of levothyroxine are you taking and do you always get same brand at each prescription

Which brand of T3

Is T3 prescribed on NHS?

In theory if prescribed T3 on NHS we should get TSH, Ft4 and Ft3 tested as standard……in practice….just doesn’t happen …lab over rules GP request

Jules2194 profile image
Jules2194 in reply toSlowDragon

Hi thank you for this.

Levo is Teva for 75mcg and Accord for 100mcg and then T3 is Vatris which is NHS prescribed.

SlowDragon profile image
SlowDragonAdministrator in reply toJules2194

Teva upsets many people

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz 

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots, 

 Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet. 

So if avoiding Teva for 75mcg dose ask for

50mcg tablets to take……50mcg plus half a 50mcg cut in half to get 25mcg

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. 

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Discussed here too

healthunlocked.com/thyroidu...

Jules2194 profile image
Jules2194 in reply toSlowDragon

Thank you so much. This is really interesting. I'll have to keep an eye out when I get my next lot of tablets

SlowDragon profile image
SlowDragonAdministrator in reply toJules2194

then T3 is Vatris which is NHS prescribed.

Vatris?

NHS brands are

Teva - 20mcg only

Mercury Pharma - 20mcg only

Morningside - 5mcg, 10mcg and 20mcg

Occasionally

Sigma Pharma - 5mcg

Regenallotment profile image
RegenallotmentAmbassador in reply toSlowDragon

I found Viatris T4 lactose free on this thyroid UK document … not listed as T3 here.  helvella might know (top of page 8) thyroiduk.org/wp-content/up...

Edit found discontinued Viatris T3 listed here services.nhsbsa.nhs.uk/dmd-...

TiggerMe profile image
TiggerMeAmbassador in reply toRegenallotment

No ✅ which suggests it is still available added 15th Nov 2022... American make 🍄 will know 😉

Brightness14 profile image
Brightness14

You are only taking 87.5 levo daily is that right plus 10 mcg T3. I too had my thyroid removed for the same reason as you 8 years ago. I have worked out that I require approx 53 of T3 per day. Converted either from Levo and T3 or NDT. This is what keeps me well.

It's hard to work out what you require but it sound to little to me. It depends if you have anything else wrong with you too. Low vitamins and minerals, perhaps.

When reading the instructions on my new Levo it states that people without a thyroid require 150 levo. I work that out at around 60 T3 per day but I know that it's too much for me. My conversion is around 40% per 100 Levo.

Jules2194 profile image
Jules2194 in reply toBrightness14

Its 75mcg one day levo and then 100mcg next day and each day 5mcg t3 morning and then 5mcg 6 hours later.

All sounds complicated. After all this time I still don't know what I really need. I was doing ok but then it's just gone pear shaped. This keeps happening but endo not interested

Jules2194 profile image
Jules2194 in reply toBrightness14

How did you work it out. I haven't got a clue

Brightness14 profile image
Brightness14

Yours works out at 87.5 not daily I typed the wrong thing. You are still not taking much for someone without a thyroid. Just 10 T3 is a very small amount to. It's not complicated at all but it does depend on the conversion. I have no gut problems but people with it usually do not convert the same. When you say ok what do you mean exactly. I just treat myself but I live in France and can get Levo and T3 easily here.

Jules2194 profile image
Jules2194 in reply toBrightness14

I have been feeling fine on the dosage so not sure what's happened

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