is there a certain time of day when the TSH is higher?

[dgmootry]

I haven't had my FT3 or FT4 and TSH for quite a few months, the last time I had them tested I wanted my doc to up my meds another 15mg of Armour because I was still having problems like water retention and now slow thinking and dark bags at night, and some nights I get a urge to stretch my legs like restless legs. what I'd like to know is, is there a time of day when the tsh might be a bit higher? I was thinking of not taking my meds in the morning and take my blood test a little later in the day so maybe my ft4 would be lower and my tsh would be higher, is that possible? I know its sneaky but its hard to get these doc to get beyond this tsh thanks deb

[dgmootry]

I was just wondering that article said that Ft3 correlates with symptoms but not ft4 or TSH I can understand TSH wouldn't correlate but wouldn't the Ft4 say if you are real low on Ft4 as I am, my Ft3 from my last test is almost where it should be, with some room but my Ft4 is like 1 point from the bottom level, I still have symptoms like water retention slow brain thinking not quite foggy like before, very extreme nail problem, still a bit slow digestion and heavy legs a bit, and constipation, these symptom aren't bad like before but there still there but less severe.

[dgmootry]

i made sure not to take them this morning prior to my blood test, thank you

[Super_sally888]

Do not take  your thyroid meds on the morning before your blood test - the oral meds will be only just absorbed and naturally will give you much higher level than your normal daily reading.

Take your thyroid meds after the blood test.

[dgmootry]

I'll get this copied before I go in, thank you  

[dgmootry]

from what I gathered TSH taken in the morning will be higher, so I will try for very early morning, thank you

[gimel]

You might have more success with your doctor by explaining that trying to dose a hypo patient based on TSH only doesn't work.  As evidence of that, following are scientific studies, with conclusions immediately following each.  

http://www.ncbi.nlm.nih.gov/pubmed/3687325

"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."

http://www.ncbi.nlm.nih.gov/pubmed/12481949

"Suppression of TSH by thyroid replacement to levels below 0.1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p < 0.0001). In conclusion, in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus, insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment."


http://www.bmj.com/content/326/7384/311


"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 "


In addition, you can make the doctor aware of this scientific study that concluded that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

http://informahealthcare.com/doi/abs/10.1080/13590840050043521



You might give a copy of these studies to the doctor and try to get her to understand that medicating hypo patients based on TSH only does not work.  That hypo patients taking adequate doses of thyroid med necessary for symptom relief often find that their TSH becomes suppressed below range.  That doesn't mean that you are hyperthyroid, unless you also have hyper symptoms, due to excessive levels of Free T3 and Free T4.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can also get some good insight from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

[Red_Star]

"Endocr Res. 2013;38(1):24-31. doi: 10.3109/07435800.2012.710696. Epub 2012 Aug 2.

Clinical significance of TSH circadian variability in patients with hypothyroidism.

Sviridonova MA1, Fadeyev VV, Sych YP, Melnichenko GA.

Abstract

OBJECTIVE:
To investigate the clinical significance of thyroid-stimulating hormone (TSH) circadian variability in patients with hypothyroidism.

DESIGN:
A total of 20 women with subclinical hypothyroidism and 22 patients taking L-thyroxine replacement therapy for hypothyroidism were enrolled in the study. Measurements of serum TSH levels were done twice a day from 08.00 to 09.00 a.m. and from 2.00 to 4.00 p.m.

RESULTS:
The morning median TSH value in the patients with subclinical hypothyroidism was 5.83 mU/L; in the afternoon, it was 3.79 mU/L. The range of TSH circadian variability reached the level of 73%. According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.

The morning median TSH value in the patients taking l-thyroxine was 3.27 mU/L; it decreased to the value of 2.18 mU/L in the afternoon. The range of TSH circadian variability reached the level of 64.7%. Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples (p < 0.05).

CONCLUSION:
The time of blood sampling has an important role in the interpretation of TSH levels. Moreover, the high TSH circadian variability should be considered in discussions about the narrowing of its reference range.

PMID: 22857384 [PubMed - indexed for MEDLINE]"