TSH level when on levothyroxine

[HashiSiren]

Hi all, very quick question ahead of a GP appointment (first one since prescribed levothyroxine 2 years ago - initially 50 then moved up to 75). Thyroid blood tests then revealed although levels just in ranges, high antibodies so diagnosed Hashimoto’s. Had gone in to GP thinking was menopausal (age 51 but apparently not there yet) with symptoms of tiredness, joint pain, feeling cold and also quite down (unusual for me). Recent full bloods did not assess for thyroid apart from TSH of 3.6. All blood results normal except slightly elevated cholesterol and kidney creatinine. Am I right in thinking that if my body is trying to produce more thyroxine, then my dose could be too low? Will have fresh thyroid blood test in 4 weeks but seeing GP ahead of this.

[greygoose]

Am I right in thinking that if my body is trying to produce more thyroxine, then my dose could be too low?

Getting a bit technical here, but your body is not trying to produce more thyroxine. What is happening is that your pituitary has noticed that there is not enough thyroid hormone - T4 and T3 - in the blood, so your pituitary is making more TSH to try and stimulate your thyroid to make more hormone. You pituitary doesn't know, cannot know, that your hormone is now coming from an outside source and the thyroid itself now has nothing to do with it. But, over-all, you are right, if your TSH is over 1 then your dose is more than likely too low.

Another indication that you're under-medicated is the high cholesterol. High cholesterol is usually a sign that the T3 is too low. You need an increase in dose.

[HashiSiren in reply to greygoose]

ok thanks for that, very helpful. Good to be prepared as my stats look a little borderline based on the recommended ranges.

[greygoose in reply to HashiSiren]

Well, that's the whole point, isn't it. They aren't 'recommended ranges'. Doctors just think they are because they are so poorly educated. Ranges are just rough guides to what is found in the population at large. That doesn't mean that they are 'normal' all the way through, nor that any one number within that 'range' is going to be right for you. Sometimes, some people need their levels quite a bit over-range to feel well. Some people are happy at mid-range. Although it's rare to find people who feel well lower than mid-range. But doctors have this weird, illogical idea that anywhere within the range just has to be good, because it's within the range. I don't suppose any of them know how the ranges are arrived at. As for borderline - borderline what? - that's just medical mumbo-jumbo to intimidate patients because they take us all for idiots!

Look at it another way: The TSH of a person with no thyroid problems (euthyroid) is around 1. At 2 you know the thyroid is struggling. At 3 you are technically hypo. Further more, for reasons I know nothing about, a person who is hypo need their FT4/3 levels higher than euthyroid, which means that their TSH is going to be lower than 1 - how much lower depends on the person - sometimes so low that it is immeasurable. But that's because the pituitary has decided that there is enough thyroid hormone in the blood, so you don't need TSH anymore. But, doctors just cannot understand all that.

[helvella Administrator Thyroid UK in reply to HashiSiren]

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...

[serenfach]

My new to me GP was freaking out about my TSH at 0.02. I said I have had Hashis for so long, I doubt there is anything left of my thyroid, so the TSH would be low. He agreed. I know this is not how it works, but he did not, so hopefully from now on he wont be bothered by my low TSH! He also said myTSH and my T4 were the same thing. I think he skipped the hour on thyroid they have in training...

[tattybogle in reply to serenfach]

lol .... loving your new management strategy ..... "baffle them with their own ignorance"

[tattybogle]

See these 2 posts:

references advising GP's to keep TSH between 0.4/0.5 and 2/2.5 in all patients on levo , useful to support request for dose increase.

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

and also some simple explanations (for use on simple GP's lol ) ie. the shoe size analogy / and the golf analogy :

healthunlocked.com/thyroidu... explanation-of-what-*high-tsh-is-telling-us-when-our-ft4-level-is-normal-on-levothyroxine-the-shoe-size-analogy.-*-over-2.5-3-ish

[Kingsway1]

Hi Hashisiren

Sorry to hear of your symptoms more than likely you are premenopausal and experiencing symptoms as a result of this too!!

Your TSH is too high at 3.6 most of us feel better with a TSH nearer to 1 Your GP needs to consider increasing your Levothyroxine as dose is low at 75 Your GP needs to gradually increase your dose over a number of weeks/months until you are asymptomatic Also need T3 testing and Vit D would be good both usually available on NHS if you ask in my experience but not routinely done. There are other tests which you can perhaps consider privately if you have no improvement with dose increase.

Some of us myself included need T3 Liothyrononine in addition to T4 Levothyroxine. Availability depends on your where you live and in my area Hampshire is only given if prescribed by an endocrinologist. Initially try increasing Levothyroxine and get TSH down see how you feel and then reassess.

Are you gluten free as many with hashis also have symptoms until they completely cut out gluten. ?

Hope you feel better soon x

[Judthepud]

Hi there, when I was first diagnosed, I was told by someone from the British Thyroid Foundation that, as a rule of thumb, your TSH should be 1 or below. I've found that when my TSH is above that I develop symptoms of hypothyroidism like the ones you describe. I sometimes have my bloods checked privately by Monitor My Health or Medichecks. It's very easy to do and costs around £30. Don't be put off my the finger prickers, they're really easy to use and initially you feel like your never going to get enough blood but it builds up surprisingly quickly (if you're having trouble soak your hand in hot water and let your hand dangle downward between each squeeze!!). Good Luck.