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Results from regulating Tsh
I am a 74 year old male who recently had my Thyroid removed by an ENT / Surgeon. Communicating with him has been tough so I have put the regulation back to my Primary Md. At 1.25 mg Levo., my tsh was0.37. A previous test at 1 mg was 2.03. My Primary has taken me back to 1 mg and a test after 30 days..
I am wondering if I shoud expect any improvements in physical stamina when the "right " level has been attained?
Also the limits presented by the lab we have used are 0.4 to 4. I have read somewhere that there may be new ones at 0.3 to 2.5. And your take on generic as opposed to Synthroid..
Thanks for any help
This discussion is related to Regulating Levothyroxine/TSH levels for better quality of life?.
I am wondering if I shoud expect any improvements in physical stamina when the "right " level has been attained?
Also the limits presented by the lab we have used are 0.4 to 4. I have read somewhere that there may be new ones at 0.3 to 2.5. And your take on generic as opposed to Synthroid..
Thanks for any help
This discussion is related to Regulating Levothyroxine/TSH levels for better quality of life?.
The half life of T4 is one week, so if your calculate the numbers (I have), it comes out that after 4 weeks, the T4 level should be at 93 % of the max level it will reach with that dose. It takes 6 weeks to get up to 98%. So that is the reason that lots of doctors suggest that patients wait for 6-8 weeks before returning for testing.
If you want some ammunition to use in your discussion with your doctor, here is a copy of an email that I have sent to the Amer. Thyroid Assn. twice, with now response. LOL
After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined. After removing some suspect hypo patients' data, and recalculating the range, they recommended it be lowered and narrowed to .3-3.0. Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range? Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated. Is the ATA doing anything to encourage the medical community to change this practice? If so, why is it taking so long?
My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status. Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested? Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions? From studies I have seen and much personal experience, TSH does not even correlate very well at all with hypo symptoms. The test that has been shown to correlate best with hypo symptoms is free T3. Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.
When FT3 and FT4 are tested, the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range. As a result they are also told they are "normal" and receive no treatment. Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients? If this were done, these ranges would likewise be raised and narrowed, comparable to the new range for TSH. I'm sure that some would say that the range is just a reference range, that as you approach the lower end of the range, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable. I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results within the reference range as "normal" and don't want to go any further. As a result of all the above misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.
Is the ATA doing anything to raise the awareness of these problems among the medical community so that we hypo patients can look forward to some positive changes? If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.
If you want some ammunition to use in your discussion with your doctor, here is a copy of an email that I have sent to the Amer. Thyroid Assn. twice, with now response. LOL
After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined. After removing some suspect hypo patients' data, and recalculating the range, they recommended it be lowered and narrowed to .3-3.0. Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range? Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated. Is the ATA doing anything to encourage the medical community to change this practice? If so, why is it taking so long?
My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status. Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested? Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions? From studies I have seen and much personal experience, TSH does not even correlate very well at all with hypo symptoms. The test that has been shown to correlate best with hypo symptoms is free T3. Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.
When FT3 and FT4 are tested, the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range. As a result they are also told they are "normal" and receive no treatment. Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients? If this were done, these ranges would likewise be raised and narrowed, comparable to the new range for TSH. I'm sure that some would say that the range is just a reference range, that as you approach the lower end of the range, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable. I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results within the reference range as "normal" and don't want to go any further. As a result of all the above misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.
Is the ATA doing anything to raise the awareness of these problems among the medical community so that we hypo patients can look forward to some positive changes? If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.
Thank you much for your input. As I just responded to Barb, I am new at this. After posting my first post I looked up some of yours and thay are very impressive. I feel as you do that they are all generics and I have been on several, including synthroid and notice no real difference.
The info on FT3 and FT4 may be priceless and I will enter into discussions with my GP.about this.
In you opinion, do you have to be on the new amount 30 days to get a good blood test reading? Thank you again
The info on FT3 and FT4 may be priceless and I will enter into discussions with my GP.about this.
In you opinion, do you have to be on the new amount 30 days to get a good blood test reading? Thank you again
Thank's for your reply. I am new at these discussion groups, so I am am amazed at the quick response. i have been on Synthroid for about 8 years, and never quite understood how that was diagnosed. But I have been a very energetic worker most of my life and i have felt even before I had the gland removed, seemed to have lost strengh and stamina. It was removed because of a large nodule on the left a smaller one on the right. The biopsy came back "suspicious", and all that I read said that the only difference woul be the size of the med.So I went for it. I think basically it has possibly been an improvement overall, but I still have to take many rest breaks. Also, I have worked out on weights and treadmill and swimming and seem to get more pain than gain. I only had this done Aug 18th, and at my age I am looking for the right info.....Quik. Side note to any that might read this, far all of my life I have been a small venue saxophone player and singer. I mentioned this to my ENT guy who thought that it would not interfere. I am sure he did a good job avoiding the vocal cords, but there is an interaction off of the Thyroid that changes your performanc. In my case , it's not too big a deal, but someone in a budding carreer would want to make sure he or she knows what might be in store.. Thanks for your feed.
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What symptoms do you have and what "improvements" in stamina would you like to see? I have to keep reminding myself that I'm 60 yrs old and should not expect to look/act like a 40 yr old.
When my symptoms began getting better, I noticed that the joint/muscle pain eased considerably and I was less fatigued so I had energy to do more.
When my symptoms began getting better, I noticed that the joint/muscle pain eased considerably and I was less fatigued so I had energy to do more.
Regulating a patient's meds by using the TSH level is the wrong approach. TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn. TSH does not correlate very well at all with hypo symptoms.
In my opinion the best way to treat a thyroid patient is to test and adjust the actual, biologically active thyroid hormones, which are free T3 and free T4 (FT3 and FT4), with whatever meds are required to alleviate symptoms. Symptoms relief should be all important.
Of the two actual thyroid hormones, FT3 is actually the most important because it is four times as active as FT4, and FT3 largely regulates metabolism and many other body functions. The most difficult part of having thyroid problems is finding a good thyroid doctor that will treat your symptoms by adjusting FT3 and FT4 levels, without being constrained by resultant TSH level.
My take on the T4 meds is that they are all synthetic T4, with different filler material. I have the impression that the incidence is not very high, but some people have reported having reactions to some of these and not from others. I have never had a problem with either.
In my opinion the best way to treat a thyroid patient is to test and adjust the actual, biologically active thyroid hormones, which are free T3 and free T4 (FT3 and FT4), with whatever meds are required to alleviate symptoms. Symptoms relief should be all important.
Of the two actual thyroid hormones, FT3 is actually the most important because it is four times as active as FT4, and FT3 largely regulates metabolism and many other body functions. The most difficult part of having thyroid problems is finding a good thyroid doctor that will treat your symptoms by adjusting FT3 and FT4 levels, without being constrained by resultant TSH level.
My take on the T4 meds is that they are all synthetic T4, with different filler material. I have the impression that the incidence is not very high, but some people have reported having reactions to some of these and not from others. I have never had a problem with either.
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