Spoke to GP

[Dawney63]

I spoke to my GP today about the results I posted in here 2 days ago.He has agreed to put the levo up by another 25mg to 100mg.

He has also agree to let me have a coeliac blood test.

What he did mention was ranges, I said my TSH was 3.14 and had been in thyroid UK and they recommeded to have TSH 1 or below, he said something about being in range as symptoms for under active and overactive can be the same, I had a overactive thyroid 38 years agon which I took beta blockers for 4 years.

How will I know if my thyroid would be going underactive ? Or staying under active

Bit confused about it

Thanks

[HealthStarDust]

Listening carefully to your body and with full TFT tests.

[greygoose]

If your TSH is 3.14, you're under-active. If you weren't underactive you wouldn't have been put on levo in the first place.

Or did you mean over-active? Well, that's a physical impossibility because your thyroid cannot regenerate and suddenly start making too much hormone. You could be over-medicated, but with a TSH of over 3, you're a long way off that.

Your doctor doesn't understand the difference between being in-range, euthyroid, and optimally medicated with thyroid hormone replacement.

- the ranges are too wide

- a euthyroid TSH is around one, never over two, and certainly not over three

- hypos on exogenous thyroid hormone usually need higher levels of thyroid hormone than someone who is euthyroid. So, whilst a euthyroid FT4 is around mid-range, hypos usually need it around 75% through the range, meaning that the TSH drops low, often below-range.

However, once a TSH drops below 1, it is a very bad indicator of thyroid status, so should not be used to dose by. Your doctor should be looking at the FT4 and FT3. But, by the sound of it, he wouldn't understand them, anyway. Although he is correct in saying that under and over-medication symptoms can be the same - which is why we need blood tests, to back-up our symptoms.

So, to answer your question: you know you're over-medicated when the FT3 is well over-range. And, to know that, you'd have to test it.

[Dawney63 in reply to greygoose]

Thank you, I will have the blood tests again in 6 weeks, my GP is doing all the tests so I think I'm lucky there as I've read on here some don't get the FT 3 test

[greygoose in reply to Dawney63]

That is indeed true. A lot of them won't do it!

[tattybogle]

So your thyroid itself won't be going underactive ( or overactive) ... it 's already underactive which is why you now take replacement thyroid hormone.

Once you take a full dose of replacement thyroid hormones ( ie. enough to get your TSH down to about 1 ish , give or take a bit) , you have effectively send your thyroid gland on holiday .. it's not doing much of anything anymore .. you are directly controlling how much thyroid hormone you have via the dose you take.

The thing that will happen is either becoming undermedicated (or overmedicated) ... or being on the right dose.

( however just for added confusion . the thyroid does not always stay inert while 'on holiday' ~ people who have autoimmune hypothyroidism can have random/ temporary periods where the thyroid dumps some T4 / T3 into the blood stream because it is being damaged by the immune system .. this can have the same effect in practice as if you had had a temporary dose increase)

Knowing whether you are actually undermedicated ( or overmedicated ) is a combination of looking at changes in symptoms and changes in blood results .

There is not an absolute level of TSH that always indicates overmedication in everyone... some people need doses of Levo that take TSH lower than others .. so some people will feel best with their TSH slightly under range , but some others would feel overmedicated at that TSH level. So you can't say 'TSH in range is always ok , and TSH below range is always overmedicated ( GP's often do say this , but that is because they are no using their own brains properly )

So you have to look at changes in TSH level rather than look for any specific number for TSH.:

eg. if someone who usually felt ok on a dose that gave them a TSH of 1 , then started to feel symptoms that could fit with over medication, and found their TSH was now 0.04 ,.....then that would be a good clue that the dose was currently too high for some reason , and needed lowering a bit .

(ideally they would also be looking at changes in the fT4 and fT3 level for clues, because looking at TSH alone is "not having all the information and therefore, doing half a job" )

but for someone else , who usually feels ok on a dose that gave TSH 0.04 .... if they felt symptoms that could be undermedication and found TSH was now 1 .. then that is a good clue the dose needed increasing a bit.

some symptoms can indeed be confusing , especially if the over / undermedication is only slight ....some of them feel similar /but subtly different when overmediated / undermedicated ........ once under/ over medication is more severe, the symptom picture tends to become a bit more obvious. but it can still be easily misinterpreted / missed if GP/ or patient is not experienced in all the variations of presentations in different individuals .

...... but as very 'general' guide~ overmedication will include things like over frequent bowel movements / feeling hotter/ loosing weight/ faster pulse / some sorts of pain/ tight , stiff muscles tendons / 'over reactive' reflexes/ plus fatigue / feeling a bit wired / stressy, unable to relax mentally./ problems with word finding and brain fog

undermedication will include things like constipation/ feeling colder / slower pulse / gaining weight / slower less reactive reflexes / plus fatigue and muscle aches/ problems with bursitis Carpel tunnel syndrome returning / anxiety (but a slightly different sort of anxiety) / problems with word finding and brain fog / feeling like a zombie

however there is a huge cross over in individuals ... especially with fatigue.

[Dawney63 in reply to tattybogle]

Thank you