'Abnormal' TSH result

[Kacey12]

Just received online results of my recent annual blood test. I have Hashimoto's (16 years) and on levothyroxine.

Serum Free T4 14pmol/L [9-23]

Serum Free T3 4.3pmol/L [2.4-6]

TSH 0.18 [0.3 - 4.2] - with a note of 'abnormal - need to speak to doctor.

I know they will be pressing for me to lower my dose of levo (75mcg), when, if anything, I think a rise would help! I weigh 62kg which according to NICE guidelines of 1.6mcg per kg body weight would be 100mcg. I cannot lose weight despite a very healthy low carb diet and good level of exercise. I feel well enough now (though have suffered other hypo symptoms in the past including severe depression when I was on a lower dose). A previous doctor at the Practice allowed my TSH to be this low - and actually took into account how I was feeling - but unfortunately she has since left.

Can anyone advise me what to say other than T3 and T4 are normal (if anything, T4 on the lowish side)?

[SlowDragon Administrator]

Was test done early morning, ideally just before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

FT4: 14 pmol/l (Range 9 - 23)

Ft4 is only 35.71% through range

FT3: 4.3 pmol/l (Range 2.4 - 6)

Ft3 is 52.78% through range

much much better and your results a year ago

Are you taking any T3

What vitamin supplements are you taking

When were vitamin D, folate, ferritin and B12 last tested

Request GP test these if not tested in last 6-9 months

Looking at previous posts

You have Hashimoto’s

Have you had coeliac blood test

Or are you already on strictly gluten free diet and/or dairy free diet

[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. "

[Kacey12 in reply to SlowDragon]

Thank you for your swift and useful response. I am on Teva 75mcg. The blood test was done with perfect timing (thanks to info on this site!). I have not had coeliac test but do not have any symptoms and eat a pretty much gf diet (low carb). Vit D was tested (63.6) and ferritin was low in range 33ng/ml [20-300] but I have recently donated blood.

I have just been watching a very good youtube video by Dr Toft in which he goes into the history of how the TSH range came about, and dismissing it's impotance if T3 and T4 are okay - which is what I've read on here many times. I'll have to show that to the GP!

[tattybogle]

recent consensus statement ... written by some of the most influential endocrinologists in the country... says the following ( i relation to making sure the patient has been tried on the optimal dose of levothyroxine before considering a trial of T3):

british-thyroid-association...

" In those with established overt hypothyroidism, levothyroxine doses should be

optimised aiming for a TSH in the 0.3–2.0 mU/L range for 3 to 6 months before a

therapeutic response can be assessed. In some patients, it may be acceptable to have

serum TSH below reference range (e.g. 0.1–0.3 mU/L)statement but not fully suppressed in

the long term."

Revised: 18 May 2023

Rupa Ahluwalia | Stephanie E. Baldeweg | Kristien Boelaert |Krishna Chatterjee |

Colin Dayan | Onyebuchi Okosieme |Julia Priestley | Peter Taylor | Bijay Vaidya |

Nicola Zammitt |Simon H. Pearce

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

You will find useful evidence in these two posts showing low but not supressed TSH can be ok long as fT4 and fT3 are in range :

healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk

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.