Advice please - re tsh results

[tasha54321]

Hi

Ive now been diagnosed with hashimotos thyroiditis & joint hypermobility syndrome plus other issues. I take 200mcg as had underactive thyroid for 11 years. My gp has done my 6 monthly thyroid/blood check even though endo have tested me every 2 months and the results are serum tsh 0.08 range 0.10-4.00 . What does this mean? Im on too much thyroxine? When I had blood done in dec the endo doc said I wasnt on enough but didnt give me the result. I havent felt well for years and have fought with docs and got progressively worse now having early stages of osteoarthritis and coeliac disease plus umpteen infections and afanoids grown back 3 times. Having grommits in in march and adanoids out as now 90% deaf in right ear .im at the hosp to see endo tomorrow and am going to ask what happens next but im feeling so poorly im sick of fighting a losing battle xx

[shaws Administrator]

Hi Tasha

I am not medically qualified but according to your TSH result, it would seem you are on enough meds. If you are having symptoms you are not on too much thyroxine and I am surprised the Endo did not communicate with your GP to give you an increase. Some GP's get nervous if we have a low TSH as I think they were taught to keep us within range - but this is not the case we should have a TSH 1 or below.

If you need an increase in your thyroxine as suggested by the Endo it is o.k. for you to have a suppressed TSH or maybe your GP would consider an addition of some T3 to your T4. This is an excerpt from Dr Toft in an article in Pulse Online and if you would like a copy of the whole article to give to your GP email [e-mail]:-

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

While taking both hormones it is important serum TSH is normal and not suppressed.

[tasha54321 in reply to shaws]

Thank you I will see what my endo says tomorrow. Its all very confusing and I just want to have some health back that I can cope with. Thank you xx

[tasha54321 in reply to tasha54321]

Oh I meant to say too that my notes have come up at the docs as "abnormal" because its outside of the "range" figures