Thyroid Disorders Community
help please have to start lower does meds asap want to know why.
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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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help please have to start lower does meds asap want to know why.

my dr. said my tsh level was too high and they have to reduce my meds to a lower # this is the first time i've been able to loose wt in4 yrs. what does the tsh 0.035 mean i am hypothyroid
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1809109_tn?1331807377
TSH is a hormone that goes to the thyroid telling it to go on or stop. So a person with hypothyroidism usually has a higher level of TSH because the gland is telling the thyroid to get it's butt in gear. If the TSH is a really really low number that may mean that a person might have Hyperthyroidism, and the TSH is trying to make the thyroid turn off by not being around so much. However don't go by just this-Did your doctor do Free T readings too? Those can be a much better indicator at what your thyroid is actually doing that using TSH alone. Ask your doctor to do a free T3 and T4 to see what your thyroid is really doing. Are you experiencing any negative symptoms?
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649848_tn?1357751184
When TSH is high, medication should be increased,  when TSH is low, medication is decreased.  

TSH is a pituitary hormone and does not indicate actual thyroid status.  Have you had Free T3 and Free T4 tested?  Those are the actual thyroid hormones, and those along with symptoms will determine whether or not you are really hyper and need to decrease your medication.

Many doctors believe that TSH levels tell reflect actual thyroid hormone levels, when it does not.  Your TSH is very low in the range, so it's probably safe to say that your doctor is assuming that your thyroid hormone levels are too high, causing you to be hyper.

Do you have results for Free T3 and Free T4?  Do you have symptoms of being hyper?
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Avatar_m_tn
  actually it wasn't my dr. at all the idioits said i wasn't on the schduel to see him and i was schdueled 6 months ago  for this appointment anyway he was too busy so they "squeezed me into his nurse practioner" i said i didn't want her and they said its her or re schduel i couldn't take another day off of work for this so like a dummy i took it with the nurse practioner. all she did was talk to me and ask how i was feeling and say ok were gonna  get a tsh test paper for you and your all set that was it. i just went the next day and got the blood test that was it.i have been hypothyroid for 4 yrs now changed my meds i think 5 times doses mainley 'i'm really disturbed by this i'm supposto start my meds today but i don't want to until i know whats going on here. i'm supposto get back and take another blood test in 1 month on these lower dose meds so they can see wwhat my tsh levels are. here are my tsh levels so far o.270, 4.200 this was the one before the new one, and 0.035 this is the most recent one she said i was pretty normal at last itme which i'm guessing was the 4.200 then what the h-- is 0.035 isn't that lower than 4.2 wouldn't you hhigher my does rather than lower it? i'm on 125 levoxyl now and she wants me to take 112 levoxthride please explain to me whats going on i've called there you get the nurse NEVER THE DR OR HER NEVER or you get voice mail for the general and they get back to you its the nurst and she really doesn't explain it too good depending on who you get please help i'm just loosing it over this
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Avatar_f_tn
Well, first of all, if I were you, I'd start my meds at the reduced dose.  They probably shouldn't be reducing your meds, but 112 mcg a day is better than nothing until you sort this whole thing out.

TSH is counterintuitive.  When TSH goes up, your thyroid function is more hypo (lower), and when it goes down, your thyroid function is more hyper (higher).  So, according to your TSH, they are doing the right thing.  However, as both ducky and Barb pointed out, FT3 and FT4 are much more important than TSH.  If you stay with a doctor who uses TSH only to adjust your meds, you will most likely be on an increase/decrease rollercoaster for a very long time.  Between the fact that they only test TSH and their lack of response to your phone calls, etc., it looks like you really need a new doctor.

Just for your information...the currently recommended range for TSH is 0.3-3.0, so your 4.2 was hypo, not "normal".  Many labs and doctors still use the obsolete ranges.
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Avatar_m_tn
no, the only test they did was ablood test right now i'm so frustrated with all of it i wish iwas rich i'd find an all natural dr. to work with me. anyway i feel ok not hyperactive or anything i,ve finially been loosing wt. i've lost 12 lbs since jan 2010 i think thats great . what is the free t3 and free t4 test like i mean what is it a blood test they have never mentioned it to me ever please help.
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Avatar_f_tn
FT3 and FT4 are blood tests.  They usually draw a vial of blood and test FT3, FT4 and TSH at the same time.  T3 and T4 are the actual thyroud hormones.  They tell what your thyroid status really is.  TSH can be influenced by many things (just the fact that you're taking thyroid meds for one).  So, you have to test FT3 and FT4 to make sure.

Be sure to ask for FREE T3 and FREE T4.  There are other tests called total T3 and total T4.  Those are obsolete, and you want the "frees" not the "totals".

If you're not feeling hyper, then your meds probably should NOT be lowered.  

You don't have to be rich.  You just have to spend some time doing some research on the doctors in your area who might be more attuned to proper thyroid treatment.  
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Avatar_m_tn
hi thanks for the info my tsh they just did as i said is at 0.035 call me stupid or what not but isn't that lower than the 0.3 or 3.0 and if so doesn't that mean that its actually low and not high ? does that make any sense? i'm so confused right now .
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798555_tn?1292791151
Welcome to the club.

Per above comments, you are now aware that you need your Free t3 and Free T4 tested.

High TSH # indicates low thyroid (hypo), low # indicates hyper. Because TSH is the amount of SIGNAL required to get the thyroid to make hormone - energy for you to 'go'.. This confuses some people. I'll make the assumption you understand how a gas car works and use that for comparison.

TSH tells the thyroid what to do. ***TSH is like a gas pedal in a modern car***  Which now-days a gas pedal is usually an electric signal, telling the engine to go slow or fast.  T4 is fuel supply, T3 is usable gas, and your body is the engine. This analogy might help you or confuse you more (sorry)!

If your going to fast (hyper), you back off the gas (less TSH, lower #) to signal the need to use less gas- slow down the engine. If your going to slow (hypo) you increase the gas pedal (like more TSH, higher #) to signal the need for more gas and speed up the engine.  But still, TSH is not a good indicator of thyroid health. As it may not accurately regulate the thyroid hormone T3, T4 in some people. TSH, just like gas pedals, can be out of adjustment in some cases - just the way it is.

To further explain the thyroid hormones: T3 (active hormone) is what your cells actually consume and must be converted from T4 (storage hormone). So T3 is actually like the converted combustible mixture of air and gas in the engine, and T4 is like the pure fuel supply in your cars gas tank (which is less combustible, less useful).

If you have had free T3 / Free T4 tested in the past, and know where these levels were at a time that you felt symptom relief, this is what you need to monitor.

Apparently (not positively with everyone) the longer you are on thyroid med the more likely for TSH to drop more even if the T3 / T4 levels do not change.

.035 will look like the beginning of hyper on paper, your med pushed this tsh number down to this point - how docs gauge it. But do you feel hyper, anxious, fast bowels, shaking? If not, your not hyper.

I almost look hyper per TSH. But in reality, I'm not hyper, this is my where my TSH is in correlation to my T3/T4 "comfort zone".

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Avatar_m_tn
what do thery do for the free t3 and freet4 test it is blood samples skin scrapes ?
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798555_tn?1292791151
blood draw, like TSH testing
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Avatar_m_tn
i kinda knew about the t3 and t4 but no-one really explained the tsh # to me they just kept saying well that means bla bla bla everytime until my meds were uped to 125 then i felt kinda normal not fylly but a lot better than i had in yrs.  so correct me if i get this wrong so what your saying is because my tsh # is 0.35 its considered inhyper action so thats why they want to lower it? i havent felt gittery or shakey (shaky) or anything like that i definately have more energy than i usto i'm not as slugish as i was i feel pretty good infact. now i still have my 125 mgs i just got the script 1 week before they did the test and told them that . then they go and tell well take this for i month and then go get another blood test
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Avatar_m_tn
i kinda knew about the t3 and t4 but no-one really explained the tsh # to me they just kept saying well that means bla bla bla everytime until my meds were uped to 125 then i felt kinda normal not fylly but a lot better than i had in yrs.  so correct me if i get this wrong so what your saying is because my tsh # is 0.35 its considered inhyper action so thats why they want to lower it? i havent felt gittery or shakey (shaky) or anything like that i definately have more energy than i usto i'm not as slugish as i was i feel pretty good infact. now i still have my 125 mgs i just got the script 1 week before they did the test and told them that . then they go and tell well take this for i month and then go get another blood test sorry my tsh # is .035 not .35 i was just reading over stuff now i have no problem with the new free t3&freet4 test
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Avatar_m_tn
Excuse me, but this is why I hate duplicate posts.  You end up with people trying to answer on both posts and many times information and replies get overlooked.  So I'm pasting my reply to your other post here as well.  It explains a lot about the TSH question and gives some references for info you can look up.



gimel

2 hours
To: orangepens
Many doctors are not aware that when taking thyroid meds, TSH is often suppressed below the reference range.  This does not mean that you are automatically hyperthyroid, unless you also have hyper symptoms due to excessive levels of Free T3 and Free T4.   For example my TSH has been about .05 for well over 25 years without ever having hyper symptoms.  In fact I continued to have hypo symptoms until learning about the importance of Free T3 here on the Forum.  I got my Free T3 tested and confirmed as low in the range.  After a switch to a combo T4/T3 med, and some tweaking of dosage, I now feel best ever.  

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.  Symptom relief should be all important, not just test results.    You can get some good info from this letter written by a good thyroid doctor for patients he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Among lots of good info in the above link, you will find this.

" The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only
to determine the cause."

There are many related references, and this is one from the British Medical Journal.

http://sz0102.ev.mail.comcast.net/service/home/~/FraserNoTesting.pdf?auth=co&loc=en_US&id=135523&part=3

In the information in this link you will see this.

'We consider that biochemical tests of thyroid function are of
little, if any, value clinically in patients receiving thyroxine
replacement. Most patients are rendered euthyroid by a daily dose
of 100 or 150 ,mcg of thyroxine. Further adjustments to the dose
should be made according to the patient's clinical response."

I think you are going to have to give copies of this information to your doctor and tell him you want to be treated clinically, rather than by TSH.  If he is not willing to treat you clinically, then you will have to find a good thyroid doctor that will do so.
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798555_tn?1292791151
What myself and gimel are saying is there is a gray area with using TSH as a guideline and you should look more at the fee T numbers WITH your symptoms / how you feel..  .35 or .035 its about how you feel. Both of those TSH #'s are so close that they can inter change daily. TSH fluctuates more than the free T's do.

So dont look at the TSH range like its concrete evidence of being hyper or hypo.  Partially disregard the way TSH is presented, its a good guide, but the free T's are what you use for accuracy. That how simple this is. A majority of doctors do not know this.

The difference between hyper and hypo and in the middle is not black and white per TSH. It's not like a light switch - on or off.  Again, the TSH level and its accuracy differs person to person. Free T''s are more accurate- and you must find where you feel best in those two ranges. The way it is.
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Avatar_m_tn
thanksfor the info on that sorry sbout the duplicate post i didn't think it di dthat. if my dr. won't do the freet3 and freet4 i'm most definately getting a new dr. its been 4 yrs of yo yo and i finially feel ok and now this enough is enough with me.thankyou for all your help
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Avatar_m_tn
thanks for all the info i know i di question my dr. last year about my meds and the blood test i can't remember what he said but i went along with it what a dummy i was dummy no more now.
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Avatar_m_tn
  thank you to allof you who really gave me info i never knew about i did go to thyroid sites but they didn't inform me like you guys did. so much new info i have now my dr.s pretty straight forward so i thought maybe he doesn't know about the free t3 and free t4 thing. he will when i call them in ine month and tell them to change the paper work for my blood test if they don't i'll try to get in to see him i hate dealing with his nurse practioner she knows what she's doing its just that she's new to his practice and doesn't know me at all sure on file and records but that doesn't really tell you about the person . if he won't do it he's history in my book.
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649848_tn?1357751184
Don't discount the nurse practitioner too quickly.  I've found that once they get to know me, many NP's are more sympathetic and reasonable than the doctors are.

That said, as long as you are feeling poorly, I don't think I'd wait a month to call and/or get new blood work.  Since you only have a TSH to go by, and you need the Free's, waiting a month is only going to set you back that much further.  Plus, you don't know if your doctor will be willing to order the FT3 and FT4, therefore, if you have to find a doctor that will, it will take you that much longer to back on the road to recovery.  
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Avatar_m_tn
i really wasn't discounting the np its just that she has no idea who i was or why i was there or whats been going on with me the past 4 yrs. my dr. has been trying to get my thyroid back to normal all this time and other stuff he was concerned about and instead of the dr. they gave me to her . i clled first thing this morning and left a message i wanted the free t3 and 4 done not the tsh and i haven;t got a vall back yet . its been 2 days now since i've been on them and i know if i go back they will go "it hasn"t been long enough" they do have walkins through out the week i'll give it till the end of the week and see how i'm doing i just might go to the walk in but then again theres no guarentee i'd be able to see him then either . if i  don't i'll probably call them
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