Extremely upset

[Dryski]

Has anyone ever been told they can't have a levothyroxine increase until their tsh is over a five. I'm currently at a tsh of 1.77 with a range of 0.36 to 3.74. My free t4 is 1.01 Rage is 0.76 to 1.46. Feeling exhausted with the low free t4 but being refused even a boost from 125mcg to 137. Any reasons why. Explanation I got was increased risk of stroke and osteoporosis. I think things will be worse staying this low.

[jimh111]

Log (ln) TSH varies inversely with fT4 and fT3, so your TSH is quite high in the reference interval. I’d be tempted to tell this doctor to go back to school and learn logarithms.

There is absolutely no evidence to suggest there is an increased risk of osteoporosis and stroke with these levels. Not sure wha5 you can do - educate the doctor or find another one.

[SovietSong]

My GP won’t do anything unless tsh is over 10!!Was your T3 tested?Your t4 is only around 35% through range so t3 likely low also.

[helvella Administrator Thyroid UK]

Maybe hand them a copy of this paper?

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

helvella.blogspot.com/p/the...

[Charlie-Farley]

Yet another poorly trained doctor - not a clue. see the links below 😉

Courtesy of   humanbean links they provided in another post. (Thank you HB)

These are from thyroid Canada - and reference their sources thankfully

Still no proof that low TSH causes harm to bones.

thyroidpatients.ca/2019/07/...

The LOW T3 effect on the cardiovascular system

thyroidpatients.ca/2018/07/...

ALSO - just in case these are not in either body (cant remember off the top of my head....

bmcendocrdisord.biomedcentr...

frontiersin.org/articles/10...

Do you think you will write them a lesson plan? 😂😂😂😂😂

[SlowDragon Administrator]

Go over GP’s head and see endocrinologist

How much levothyroxine are you currently taking

Approximately how much do you weigh in kilo

Do you have autoimmune thyroid disease (hashimoto’s)

FT4: 1.01 pmol/l (Range 0.76 - 1.46)

Ft4 only 35.71% through range

But BEFORE booking consultation get FULL thyroid and vitamin testing

What vitamin supplements are you taking

Recommended that all thyroid blood tests 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)

is this how you did this test?

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

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

support.medichecks.com/hc/e...

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

[tattybogle]

Waiting until TSH is 5 before agreeing to trial an increase in dose is going against the advice given to GP's in the current NICE Thyroid guidelines ( 2019)

nice.org.uk/guidance/ng145/...

1.4 Follow-up and monitoring of primary hypothyroidism

Tests for follow-up and monitoring of primary hypothyroidism

1.4.1Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis

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

and is also against all these other recommendations~ which all recommend GP's to keep TSH below 2/ 2.5ish in all patients on levo:

healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range-

[Lovecake]

I saw a NHS endo at the start of my treatment. He said once on levothyroxine they like the TSH to be around 1 but usually just under.

If my TSH went over 0.6 I felt rough so I’d definitely be struggling with your level.

Make sure you have your blood test done 1st thing with having just water and take thyroid medication after. (If you can drag yourself out that early). Then I’d try and see a different doctor and tell them you have too many symptoms and can’t function.

Thyroid UK have a list you can print out. Tick your symptoms and give it to the doctor and ask them how you are supposed to live like this….

[HealthStarDust]

My TSH is currently under range and my GP still agreed to a small increase.

Luckily, I’ve only experienced one very very poor GP indeed when it comes to my thyroid treatment at my practice.

It was a delight to read that patient has made informed decision and is aware of blood test results and risks on my consultation notes.

In fact 2 GPs agreed the increased albeit somewhat reluctantly as I had to talk to another GP the following day to get brand issues for the increase sorted.

I mostly feel very blessed with my treatment and the control I have over it with my practice. Not always and not often enough but I try and count my blessings in this horrible thyroid health journey.