Relevance of TSH vs T3/T4: My TSH varies... - Thyroid UK

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Relevance of TSH vs T3/T4

Jasper79 profile image
9 Replies

My TSH varies considerably: 1.5 to 3.1 in a number of NHS test but my T4 has been more consistent between 17.4 to 19.1.

In two Blue Horizon tests:TSH 1.29 and 4.7 with T4 15 and 14.5 and T3 4.2 and 4.21.

So fairly constant T3 and T4 but wildly varying TSH.

These results all for 75mcg dose over almost 4 years (I am now on 100mcg).

Everything I read, research papers etc., argues that TSH is the best guide for diagnosis and for determining levothyroxine dosage. But, on the basis of my results, this is unworkable.

Can anyone point to any relevant papers please?

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Jasper79
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greygoose profile image
greygoose

Are the blood draws for all these tests done at the same time of day? Because TSH varies throughout the day, being higher before 9 am and at it's lowest around midday.

TSH is actually a terrible indicator of thyroid status - we patients know this - and should never be used to dose by. Have a look at some of the papers linked to on diogenes profile:

healthunlocked.com/user/dio...

Jasper79 profile image
Jasper79 in reply togreygoose

The low BH one was at 7am as I had to book phlebotomist to visit and that was only time available. NHS ones were all around 10am or so.

Thanks - will follow up on your link.

greygoose profile image
greygoose in reply toJasper79

You're welcome. :)

SlowDragon profile image
SlowDragonAdministrator

TSH is highly unreliable on replacement thyroid hormones

It also has pronounced circadian variation so it’s important to always test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

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

You need to retest thyroid and vitamin levels 8-10 weeks after increase in dose (or after any change in brand of levothyroxine)

is your hypothyroidism autoimmune

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

Also both TPO and TG thyroid antibodies tested at least once

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

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

See detailed reply by SeasideSusie

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Forestgarden profile image
Forestgarden

thyroidpatients.ca/2020/07/... paper has some interesting graphs

Griffo_ profile image
Griffo_ in reply toForestgarden

This link didn’t work for me - could you check it? Could be because I’m on mobile maybe?

Forestgarden profile image
Forestgarden in reply toGriffo_

thyroidpatients.ca/2020/07/... the link doesn't work google 'Circadian rhythms of TSH, Free T4 and Free T3 in thyroid health'

Griffo_ profile image
Griffo_ in reply toForestgarden

That works - I see what has happened. Where you were meant to put "This paper" it has added "This" to the URL.

Forestgarden profile image
Forestgarden

thyroidresearchjournal.biom... Not sure, but this might help

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