meaning of a note after blood test?!

[Greenytea]

Does anyone know what euthyroid or adequate replacement means? I have recently had a blood test and there is a note that says this under the serum tsh level result. TIA

[Hidden]

Euthyroid means normal thyroid function, so that note is saying that either your thyroid is functioning normally (if you're not taking thyroid medication) or the thyroid medication you're taking is an appropriate dose.

All is well, in other words.

[Greenytea in reply to Hidden]

Thank you!

[waveylines]

It means your TSH is in range so they consider that you are on a sufficient level of thyroid hormone treatment. Euthyroid means normal level. However the TSH range is very wide.It would be better to add your results with the ranges on (figures in bracket)

I don't suppose they tested your Ft4 & Ft3 levels.... the actual thyroid hormones?

[SlowDragon Administrator]

Just testing TSH is completely inadequate

Are you on replacement thyroid hormone

If yes…..what exactly

Always test thyroid early morning, ideally just before 9am, only drink water between waking and test and last dose Levothyroxine 24, hours before test

What vitamin supplements are you taking

[greygoose]

euthyroid or adequate replacement means

Taking the two together, I'm guessing that you're on levo, and they've only tested your TSH, which is somewhere within the range, so they are claiming that your level is euthyroid and that means that you're on the right dose of levo.

However, there are many things wrong with that assumption:

- the range is too wide, so most of it isn't euthyroid at all. A euthyroid TSH - i.e. the TSH of someone with not thyroid problems at all - is around 1, never over 2, and at 3 you are hypo. But, the range usually goes up to about 4.5 - I've even seen one go up to 6! So, unless your TSH is around 1, it isn't euthyroid. But doctors don't know that.

- euthyroid means, as I said above, that the person has no thyroid problems. But, you are taking levo (I assume) so you do have a thyroid problem: you are hypo. And hypos usually need lower TSH than a euthyroid person, because they need their thyroid hormone levels higher, which causes the TSH to drop.

- TSH is a very poor guide to thyroid status. Especially once it gets to around 1. Just because your TSH is euthyroid, doesn't mean that your FT4 and FT3 is. Just relying on the TSH to judge your thyroid status is assuming that the pituitary always works perfectly. Which it doesn't. After all, if the thyroid can go wonky, what shouldn't the pituitary? It's only a gland, after all.

And, for those three reasons, just testing the TSH does not tell you you are euthyroid, nor that you are on an adequate dose of levo. But, it does make life easier for the doctor. So, draw your own conclusions.

[Greenytea in reply to greygoose]

Thank you for your reply, I have all the symptoms of thyroid problems so was tested for tsh levels, excuse my ignorance but I have no idea about it all and am so desperate to have an idea of what to do because am feeling so unwell I can tick off every thyroid symptom so came on here to see if I can find any information as my doctor has been really unhelpful so far, I think they’re just too busy to help me. I can’t get an appointment to discuss the results. They told me over the phone that everything is ‘normal’ so I don’t need to worry, I then got the transcript of the results just in case and saw this note.

The serum tsh level was 0.94 I don’t know what that means either. I hope it’s ok to post on here not knowing if I have a thyroid issue but I really believe I have and am trying to work it out.

The test was in the afternoon and I carried on as normal before it if that makes any difference.

I really appreciate any help.

[greygoose in reply to Greenytea]

Yes, of course it's ok to post here not knowing that. We're here to help in any way we can.

So, it looks like the lab just assumed that you were taking levo - i.e. thyroid hormone replacement.

The test was in the afternoon and I carried on as normal before it if that makes any difference.

It can make a huge difference, yes, because TSH has a circadian rhythm. It's highest around midnight, and lowest around midday. So, for practicality, we always suggest that you have the blood draw before 9 am. 0.94 would be euthyroid for a TSH in general, but would have been higher before 9 am. How much higher is just impossible to say, I'm afraid. It depends on so many things. Such as whether you've eaten or not. Whether you've drunk coffee, or if you have some sort of bug. But, that's just another one of those things that doctors don't know about - or claim not to know.

I think they’re just too busy to help me. I can’t get an appointment to discuss the results.

You wouldn't get much help from them, anyway, with that TSH. They'd just say there's nothing wrong with you, go away - or words to that effect. But, as I said before, the TSH is not the whole story. You need full thyroid testing before anyone can come to any sort of conclusion:

TSH

FT4

FT3

TPO antibodies

Tg antibodies

vit D

vit B12

folate

ferritin

But, you're unlikely to get all of those on the NHS, I'm afraid. Would it be possible for you to test privately?

List of companies doing private tests:

thyroiduk.org/help-and-supp...

TSH - Thyroid Stimulating Hormone - is not even a thyroid hormone. It's a pituitary hormone. The pituitary tells the thyroid when to make more hormone by secreting TSH.

The thyroid hormones are T4 (storage hormone) and T3 (active hormone).

The antibodies, if they're high, will tell you if you have an autoimmune thyroid condition - aka Hashi's - it's important to know that, although the antibodies themselves aren't important.

And testing nutrients is important because they are often deficient if you are hypo, and need supplementing. Also, low B12 causes symptoms similar to hypo symptoms. So that could also be a cause of you not feeling well.

If you can get all those tests done, and then post the results and ranges on here, we'll be better able to advise you of the next steps to take.

[FoggyThinker in reply to Greenytea]

Hi Greenytea I think many of us joined not knowing very much about our thyroids. Reading around the forum is a great way to learn more; also there are some good books available. My favourite is Dr. Durant-Peatfield's "Your thyroid and how to keep it healthy".

[tattybogle]

TSH ( Thyroid Stimulating Hormone) is a message from the pituitary gland ( brain ) to the thyroid asking it to make more / or less thyroid hormones .

The thyroid hormones are T4 and T3.

When the thyroid Hormones are too, low the TSH level rises ~ to stimulate the thyroid to make more T4/T3 .

When the thyroid hormones are sufficient for the body's needs the TSH level goes down again .

in most people the TSH level usually sits around 1 or 2 ish , but anything from about 0.4 -4.5 ish is considered 'normal'. although most of us would say anything over about 3 is suspicious.

When there is a problem with the thyroid gland meaning the gland itself is unable to make enough T4/T3 (primary hypothyroidism), the TSH will usually rise and eventually go over range and stay there, getting higher.

When hyperthyroidism is a problem (too much thyroid hormone) the TSH will become supressed .. go far below range and stay there.

So the usual method of diagnosing hypothyroidism / or hyperthyroidism is to just test the TSH at first .. if it is over /or under range ,they then test T4 ..... and then re-test TSH / T4 again in a few weeks / months to see if it has gone back to normal , or not .

You TSH is not over range , so they have assumed your thyroid hormone levels are ok (euthyroid)

However there is a problem with NHS only testing TSH at first .... it is sometimes possible that thyroid hormones are too low but the TSH doesn't rise appropriately (due to a problem with the pituitary /or the hypothalamus ~the hypothalamus tells the pituitary how much TSH to make) ........ this is called Central or Secondary hypothyroidism ...... if this is the case , a 'normal' TSH result does not rule out hypothyroidism.

. The NHS believe central / secondary problem is very rare .

The only way to rule it out is to get the actual thyroid hormones tested , T4 and preferably T3 ...... the tests you need for this are called fT4 and fT3 (FreeT4 / FreeT3)