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TSH
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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TSH

My TSH is 0.10 Low normal range is 0.40-5.50)
Does this mean I'm taking too much Synthroid? or I need more? This always confuses me. I never get it right. Thanks.
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Avatar_f_tn
Before resusing your Synthroid request a FT-4 and FT-3 test to see if they are in range.  My TSH runs low range or just below range with a FT-4 mid range and FT-3 low range so I constantly have to tell my GP that I refuse to reduce my replacment meds.

Also, if you took your replacement brfore your blood was drawn it could reflect in a lower TSH.  Most doctors disagree but I have proved it by taking my meds before a blood draw.
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Avatar_f_tn
Thanks for the information. I will make an appointment with an Endocrinologist instead of my GP for this.
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Avatar_f_tn
Your GP should be able to handle it.  I have not seen a Endo in 2 years as they never listened to my concerns.

Did you hve Graves disease?  The antibodies that cause Graves can also cause a supressed TSH.
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Avatar_f_tn
To me according to your Labs reference range your TSH is out to the hyper side i.e. you are med. induced hyper. You would need to lower med. to the next lower dose and see if that corrects it, if it doesn't then keep lowering to the next lower dose until you reach the level you and doc wants.
The FTs will follow appropriable, unless something else is going on with your thyroid.  But right now as it is, your TSH is showing med. induced hyperthyroidism - not good!  Next thyroid test get the FTs with Labs reference range, to see how they relate to each other.

Its ok to take medication before Labs, you want to know if pill/medication is working for you.  Plus the medication is a accumulation of days.  Today's test not reflect in today's test, but will reflect yesterdays and 5 days thereafter - pills last in our body's for up to 6 days. Adders on the other hand,  want to know how the thyroid/levels is doing without meds. So that they know if they are in remission and can go off the meds if thyroid is functioning at Labs reference range.
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Avatar_f_tn
Correction:  

ATDers on the other hand....

Todays pills will not reflect in todays test.

Sorry about that - even with spell check I goof.
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Avatar_f_tn
Hi,
No I do not have graves disease.
I'm on treatment for hepatitis C. So my thyroid gets ignored.
Thanks for all the comments.
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Avatar_f_tn
Ibeg your pardon!

The new super, sensitive TSH assay is thought to be 99.8% accurate. This will miss occasional problems, but for clinical purposes is an amazing test.

The TSH test is a reflection of thyroid balance. It is accurate in most  with auto-immune thyroid disease - including "hashitoxicosis", and  is considered to be more accurate than the tests for the individual thyroid hormones. It can detect teenier amounts of the hormone. As a result,  doctors tend to rely on the TSH reading, rather than the actual T3, T4 readings from our blood tests.

TSH is not "skewed" by antibodies unless there are anti-TSH antibodies that interfere with the assay (blood test). The anti-TSH antibodies  are rare ones that interfere with the assay.
TSH is like a running average, giving a general idea of where  levels have been for the past few months, but T4 is a more current reading
Adjusting meds using only TSH as a guideline can work well as long as Labs are done at least six weeks between changing doses.
T3 is a transient figure it can change throughout the day or even  hourly depending on our immediate needs for thyroid hormone, but it can provide valuable information if our F/T-3 is chronically low as well as how it relates to F/T-4.

Unless there is an abnormal thyroid, TSH influences or  controls the FTs.  When TSH goes down the FTs go up and when TSH goes up the FTs goes down.  In other words The FTs go in the opposite direction as the TSH.  Likewise, whatever the FTs do the TSH go to the opposite direction (actually its a tit for tat!).  If TSH goes hyper the FTs will go hyper - if TSH goes hypo FTs will go hypo, unless there is a thyroid dysfunction.

Shame on you!


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Avatar_f_tn
People taking thyroid replacement should NEVER dose according to TSH, shame on you.
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Avatar_f_tn
TSH varies with me up to .50 with every test run on me so as I said before dosing by TSH is not a good idea (for me anyway).

If GrandmaA has the same fluxuations then reducing her Synthroid based only on TSH would be a mistake ie. .10 + .50 would = .60 therefore in range. Also, a .10 is only slightly out of range and should be re-tested before dose reduction, especially since she has not listed any hyper symptoms.

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Avatar_f_tn
Correction:

My Labs do not indicate adrenal fatigue with TSH low and FTs high.  I didn't really think so for my symptoms are more on the thyroid side of the list then adrenal side.

Now I am back to my original thought as of a hyperfunctioning autonomous nodules - Marine-Lenhart syndrome.

Good Luck with your adrenal(s)!
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Avatar_n_tn
I wish I could agree but I don't trust these blood tests well certainly not for me anyway. At the end of the day that is exactly what they are.......... 'blood tests' and although I'm sure the TSH and the Frees relate to each other 'tit for tat' they certainly do not and cannot show you what's going on at the cellular level. I have weak adrenals, very low TSH and high frees (before being treated with hydrocortisone). This is because the thyroid is floating in my blood and not making it into my cells. I know other people have weak adrenals and as adrenals must work better in some people than others then surely you can't fit a 'range' around an individual? It certainly doesn't work for me so I'm dosing on how I feel. I'm not criticising by the way I am still learning myself and am interested in others views...?
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Avatar_f_tn
Here's proof that dosing by TSH does not work (for me anyway)and probably more than just me.

2/06 lab draw
TSH .164  (.34-5.6)

FT-4 1.10 (.6-1.64)

FT-3 2.8  (2.3-4.2)-same lab

What would you or your doctor do?  Reduce replacement based on TSH based on what you're saying.  My doctor agreed to leave me at the same dosage and retest in 6 weeks. Oops I forgot and went back 7 months later.

What did I do?  I increased my replacement by breaking my 125mcg pill and adding 1/4 tablet twice weekly in an effort to get my FT's to rise, especially my FT-3.

What happened?
9/06 lab draw

TSH .717  (.35-5.5) TSH increased with more replacement.

FT-4 1.2  (.8-1.8)

FT-3 2.6  (2.3-4.2)-same lab and went down with more replacement.

What did my doctor do?  She gave me a prescription for 150mcg pills to be "official" and I have since added to 3X per week but in reality the increase is marginal from my own little test.

The last lab with taking the 150mcg 3X per week along with my 125mcg dosage.

11/06
TSH .342  (.34-5.6)

FT-4 1.31 (.6-1.64)

FT-3 2.9  (2.3-4.2)-same lab

TSH is NOT a reliable way to dose replacment meds.  FT's are also needed as TSH is unreliable.  In the last 2 years my TSH has varied between .164-.958 all while being on the same dosage.

TSH is a screening tool for thyroid issues.  If TSH was used to dose me I would be in a state of hypo.








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Avatar_f_tn
Once diagnosed as thyroid issue, treated and placed on meds., it is alright to take into consideration symptoms in dose adjustments.  I have done this myself.
But being diagnosed by symptoms alone when there are so many other health conditions that share some of the same symptoms of thyroid is not correct and all should be ruled out before thyroid treatrment or dosing.

Low TSH and high Frees in which I have also, is indicative of hyperthyroid and perhaps Graves, depending on how your Frees relate to each other. However, Adrenal my not be directly related to Graves', but it does related to the thyroid therefore thyroid diseases. Adrenals and thyroid is so close together in symptoms, hard to ditinguish between the two by symptoms alone.
Correction of low adrenal is similar to correction of low thyroid. And of course you know, increasing thyroid meds when the adrenals are fatigued can make thre symptoms worse.
You say ( low TSH) high F/Ts, which is indictive of high cortisol but yet you state taking hydrocortisone which is indictive to low cortisol. Correction of low adrenal is similar to correction of low thyroid.  How is your conversion?
Increased levels of cortisol are found in Cushing's syndrome, excess thyroid (hyperthyroidism), obesity, ACTH-producing tumors, and high levels of stress.
Decreased levels of cortisol are found in Addison's disease, conditions of low thyroid, and hypopituitarism, in which pituitary activity is diminished. The symptoms of all these should be taken into consideration as well.  Have you been tested.
Adequate sleep, gentle exercise, naps, meditation, proper diet (adequate protein), natural progesterone, adrenal extracts, and nutritional (vitamins C and B5)  some of the natural ways to help support adrenal function.

Well I don't know all that much, but I am courious now as to my own thyroid issue and levels.

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Avatar_f_tn
With a non-problematic thyroid, if TSH would have been brought up with lowered med. dose, the FTs  should go down and you had plenty of room for them to do so.  As it is, they all moved just slightly, therefore shouldn't have made that big of deal  (difference)to go by TSH. I would have used the TSH and watched the FTs.  Sometimes when TSH is adjusted, no matter how crazy the FTs, they will adjust themselves accordingly. But I think you have something else going on....just my opinion, I am not a doctor.

Do you have adrenal fatigue, allergies, hormonal imbalance, yeast, or low pituitary function?  How is your temperature pattern? Also, did you do thyroid surgery (for)and what was your original diagnose???

If you think yours is crazy, mine is worse but at the opposite end of the spectrum/Labs. I am suspecting two issues to check into next doctors appointment.

Not everyone has a problematic (unusual) thyroid. So telling someone to ignore the TSH and go by the FTs is a little irresponsible in my theory.


We are all individuals and one shoe dose not fit all.
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Avatar_f_tn
Are you doing it right?  I am sure you know all the ends and outs of thyroid - I know where you are coming from!

There are many reason for TSH to fluctuate and so does the FTs  and this is normal and I am sure doctors take this into consideration (mine dose), that is why it is suggest to have Labs done approx the same time of day with every test.  If TSH moves then so does the FTs. If not, perhaps something else is going on (with you).  What are your Labs anyway?

Yes .10 + .50 is .60 and would bring her closer into Labs range.  And yes, I advocate that Labs are redone 6 to 12 weeks after each med dose change.

If 0.1 is slightly out of Labs range, I'd like to see your Labs reference range.   A 0.1 is low enough to cause some damage if kept there for too long.  I would agree if it were in the case of cancer.

TSH is fine to diagnose, monitor thyroid and change med. dose!  For you maybe not, I doubt it though.  I also advocate for the FTs to be done as well, because all three relates to the whole thyroid story.




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Avatar_f_tn
Total thyroidectomy 12/04 after 4 1/2 years of ATD's (Tapazole)Symptoms were mostly hyper but not to the extremes that most people have.

DX after surgery was hashitoxicosis.

Never been tested for adrenal issues as most symptoms are not present.

Don't take temperatures.

Currently being treated with iron supplements for low Ferritin levels which should be in normal range by February.

Most likely in perimonopause as mother was thru monopause at age 43 and I'm currently 43.

My TSH and FT's are much different (lower on all counts) than they were on ATD's.  This is not a real concern to me as I feel quite well except for some of the low ferritin symptoms which should resolve soon.

My point is still that anyone taking replacement meds should never dose solely on TSH.
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Avatar_f_tn
I believe once diagnosed, treated  and placed on medication then all aspects should be considered; TSH, FTs (after all that is why they are tested) and symptoms. However, dosage by TSH is the norm and better of the three.  But like I said before telling a person to ignore the TSH before being diagnosed is irresponsible.  Not every one has a problematic thyroid, what I mean is a problem beyond the normal thyroid disease(s).  

Your levels right now are not normal. Having all three levels low is not normal and suggest that something else is going. If you find this something else and correct it, you'll probably find that your levels will correct themselves and adjusting by TSH will not be a problem.  Right now your are trying to correct another issue by FTs and its not (totally) working for you or your levels.


This is just my conception, I am not diagnosing or treating, just suggesting.
You might want to do more research on your thyroid issue/levels and other health conditions that reflect in thyroid levels.

Good Health!




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Avatar_f_tn
Excuse me!  I didn't mean to up set you so.

Happy Health!

(K)(K)(K)
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Avatar_f_tn
You say...
"Your levels right now are not normal. Having all three levels low is not normal and suggest that something else is going. If you find this something else and correct it, you'll probably find that your levels will correct themselves and adjusting by TSH will not be a problem. Right now your are trying to correct another issue by FTs and its not (totally) working for you or your levels."

My levels are just fine for me.  All 3 of my levels are not low, just the FT-3 is a bit on the lower side.  It had been raised at one time with Cytomel to 3.2 but that made me feel hyper and I discontinued it.  The FT-4 remained the same during this trial.

The only thing I am attempting to correct is trying to see if getting my FT-4 up would result in more conversion to FT-3. The real reason for even trying this is the fact that while on ATD's my FT-3 was always at a much higher number.  The real issue is a GP who is terrified with the whole darn TSH issue and afraid to increase my replacement dosage for fear of the unkown of having a low range TSH.  Antiodies my dear... it's simply antibodies.  They don't just go away and may always be present in the body as it's not only the thyroid that produces them.

Your comments appear to be slanted to the point of if someone is not in a range you think they should be in then something is wrong.  I don't remember asking your opinion, I was simply sharing iformation that you asked for to prove my point that dosing by TSH only is a huge mistake.
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I was told today that I have Hypothyroidism.  I went to the doctor because I lost 32 pounds 8 weeks.  Anyway, my numbers were:     TSH O.013  and T4 1.92

He wants me to see an Endoronologist and said they can kill the thyroid and put me on medication.  I do NOT like the sounds of this.  Should I get a second opinion?

He's still not sure why I lost so much weight so fast.  
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