Reading lots of posts here and learnin alot.
One thing that conflicts…is advice here to take a full replacement dose for subclincal?
Are they any links to more information/research papers on this please? Anything I’ve found online state that a full replacement dose isn’t neccesary for sub. hypo. and could potentially do more harm than good.
Thanx
A lot of people on here are in the 10 to 15% who struggle and treatment is more complex ... my point is most are a lot simpler.
A home blood test that measures free t3 and t4 and antibodies is about £40. These tell more than just TSH. If your frees are low then it is sign your struggling.
How are you feeling?
So do some just take/get on well with a small/lower dose?
Levothyroxine doesn't top up your own hormones it replaces it, so you need a full dose if you take any at all.
Once you start taking Levo this shuts down your own hormone production.
Do quote where you have read you dont need a full dose.
Do you have recent blood results to share with us?
When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins.
Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...
There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...
Only do private tests on a Monday or Tuesday to avoid postal delays.
But I am just asking for links/sources on this topic ‘that it completely replaces and doesn’t top up’ I can’t find any information about it. Are there any studies etc confirming this?
ncbi.nlm.nih.gov/books/NBK5... This report says ‘Patients with subclinical hypothyroidism do not need a full dose of levothyroxine replacement.’
Another one says that you don’t need a full replacement dose unless you have autoimmune thyroiditis and thyroid function is expected to continue to decline.
all my vitamins and minerals are top off range and optimal.
Here:
It does say that, and then goes on to say that people on 50mcg Levo didnt notice any benefit from their treatment. This is likely because it was too lower dose to be of benefit.
There are many papers on hypothyroidism, not all of them will agree with the next paper and it depends on whos writing it and what they want to prove.
Obviously this is very confusing for people looking for information but asking thyroid patients is about as good as you'll get for many questions as we experience issues first hand.
So there no research papers to support ‘thyroxine replaces not top up hormone’ ?
I just not understand because subclinical ft4 can be mid-high in range and just TSH high?
For diagnosis purposes TSH is often (not always) a good indicator of thyroid status.
There may be papers stating what you are looking for but other than typing search terms into Google I dont know how to access them.
What is the situation with your thyroid health?
I search ‘thyroxine replaces not tops up’ but couldn’t find anything.
TSH raised subclincal and t4/t3 50-60% through range so this why I worry to take full replacement dose.
Tsh still indicating a problem I think…been raised for years
You wouldnt start on a full replacement dose though.
You start on a low dose of 50mcgs (sometimes only 25mcgs), take for 6-8 weeks then retest and assess how you feel and look at the blood results and see if you need more. This is repeated until you arrive eventually on the full replacement dose.
Increases are usually in steps of 25mcgs, sometimes 12.5mcgs. Its all done in a step wise fashion.
How do you feel?
I just not understand because subclinical ft4 can be mid-high in range and just TSH high?
'Subclinical' is not really 'a thing'. It's an NHS get-out to avoid diagnosing as many people as possible.
A euthyroid TSH - i.e. the TSH of someone with no thyroid problems - is usually around 1, with Frees around mid-range - FT3 slightly lower than the FT4.
A TSH over 2 means that your thyroid is struggling.
And when it goes over 3 you are technically hypo.
TSH - Thyroid Stimulating Hormone - is a pituitary hormone. When the pituitary senses that the level of thyroid hormones - T4 and T3 - in the blood is too low, it makes more TSH to stimulate the thyroid to make more thyroid hormone.
The thyroid cannot make thyroid hormone without that stimulation.
So, if you have high TSH, and euthyroid FT4 (around mid-range), the FT4 is at that level only because of the high TSH. Because the ailing thyroid needs more stimulation than average to make an average amount of T4.
Hypothyroidism is like pregnancy: either you are or you aren't. You can't be sub-clinically pregnant, can you?
So, if you define hypothyroidism by a high TSH and start taking thyroid hormone replacement - levo - your pituitary will sense the increase in thyroid hormone levels in the blood and reduce the out-put of TSH. As the TSH lowers, so does the thyroid's out-put of thyroid hormone, until you reach a point where the drop in thyroid-produced hormone is greater than the thyroid hormone replacement you're taking, meaning that you have in fact suffered a reduction in your total serum FT4, and therefore FT3. This will show up in your next blood test, if they are tested, and your TSH might even start to rise again, but not enough to stimulate the thyroid, as the thyroid now needs extra stimulus. So, the dose of levo is raised and the TSH goes down again, and the thyroid stops making hormone altogether.
So, it wasn't 'just' a high TSH. You cannot take one isolated result out of the three thyroid tests and come to any conclusions. The three results should be interpreted in conjunction with each other. And the fact that most doctors only test the TSH, and dose accordingly, is one of the reasons some people fail to improve on levo mono-therapy. The TSH does not tell doctors 'all they need to know', as they claim. Once it gets below 1, it tells them next to nothing. And claiming that the TSH 'tells them all they need to know' is assuming that everyone has a perfectly functioning pituitary. They don't.
And, even if the FT4 and TSH are tested together, as in the above quote, there is still two pieces of the puzzle missing: FT3 and antibodies.
It is perfectly possible to have a euthyroid FT4, but a low FT3. That would make you hypo. T3 is the active hormone - T4 is basically a storage hormone that doesn't do much until it's converted into T3. So, even though the FT4 is euthyroid, the low FT3 would cause the TSH to rise. The pituitary does not distinguish between the two.
Also, if the antibodies are high you have Hashi's/Ord's, which can make levels of thyroid hormones fluctuate. The TSH will follow but at a much slower rate. In which case, seeing a high TSH and a euthyroid FT4 won't prove anything. It won't tell you your FT3 level and it won't tell you if you have Hashi's.
Therefore, talking about and 'diagnosing' 'sub-clinical' hypothyroidism is simplistic in the extreme, and ignores all the complexities of thyroid function that all ought to be taken into consideration when examining thyroid status. So, even if doctors were capable of doing that - which they aren't - the NHS wouldn't like it because it would lead to a lot more people being diagnosed hypo. And that is exactly what they are trying to avoid by using the classification of 'sub-clinical'.
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