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You are suggesting another poster is wandering off-topic to the original poster, and yet you are doing the same. If you want to claim "off-topic" then keep in ON topic yourself.
"Mild" hypothyroidism as a diagnosis is BS and an artificial categorization that makes diagnosis so cut and dried that any computer program could prescribe "proper" treatment for all.
I had undiagnosed hypothyroidism (it runs in the family) even as a child. When you live in a cold climate and have to soak in a hot tub for an hour to get warm after running a paper route, let me tell you SYMPTOMS MATTER. Yeah, yeah, doesn't relate to the OP... Again, neither are your responses, other than an admonition against "doctor shopping."
It took my having a personal consult with Richard L. Shames, MD (not a lab tech) for me to understand that the purpose of treatment is NOT to get perfect lab results, but to treat symptoms for an increased quality of life.
As for patients "self-diagnosing?" It happens all the time when idiots with degrees deny reality. Not my problem or yours. It just so happens that my doc has recognized that I know how to self-titrate so that my labs come back about center range - even with wide variations of how much generic synthroid I take.
Lab techs are not doctors. Doctors are not gods. Each individual knows more about their own body (in some fashion) than any doctor ever could. Most enlightened docs understand this now.
I've had bad doctors before. I fired them. Not every doc graduates in the top half of the class. You don't need to apologize for them -or claim knowledge of a pt that you do not have.
The question was with regards to the interpretation of the TSH result. It wasn't with regards to anything else. The OP is more than able to ask her doctor that question. This is a discussion forum and from my point of view being evidence based I pointed out that one should stay with reliable medical websites for the proper interpretation of the TSH that she was asking for. I cited the practice guidelines for endocrine societies that gave their proper use of the TSH as follows
"Measurement of serum TSH is the primary screening test for thyroid dysfunction, for evaluation of thyroid hormone replacement in patients with primary hypothyroidism, and for assessment of suppressive therapy in patients with follicular cell–derived thyroid cancer. TSH levels vary diurnally by up to approximately 50% of mean values (78), with more recent reports indicating up to 40% variation on specimens performed serially during the same time of day (79). Values tend to be lowest in the late afternoon and highest around the hour of sleep. In light of this, variations of serum TSH values within the normal range of up to 40%–50% do not necessarily reflect a change in thyroid status.
TSH secretion is exquisitely sensitive to both minor increases and decreases in serum free T4, and abnormal TSH levels occur during developing hypothyroidism and hyperthyroidism before free T4 abnormalities are detectable (80). According to NHANES III (11), a disease-free population, which excludes those who self-reported thyroid disease or goiter or who were taking thyroid medications, the upper normal of serum TSH levels is 4.5 mIU/L. A “reference population” taken from the disease-free population composed of those who were not pregnant, did not have laboratory evidence of hyperthyroidism or hypothyroidism, did not have detectable TgAb or TPOAb, and were not taking estrogens, androgens, or lithium had an upper normal TSH value of 4.12 mIU/L. This was further supported by the Hanford Thyroid Disease Study, which analyzed a cohort without evidence of thyroid disease, were seronegative for thyroid autoantibodies, were not on thyroid medications, and had normal thyroid ultrasound examinations (which did not disclose nodularity or evidence of thyroiditis) (81). This upper normal value, however, may not apply to iodine insufficient regions even after becoming iodine sufficient for 20 years (82,83)."
The reference that the other poster made has their interpretation of the TSH as follows,
"Why is the TSH test not enough?
The Thyroid Stimulating Hormone (TSH) test is often considered the diagnostic 'gold standard' of thyroid hormone imbalance. A TSH level above or below the "normal" range is required by some medical professionals before initiating a treatment plan with the goal of keeping the TSH level within this range. However, the TSH test does not reveal cellular hormone status, rather, it measures pituitary gland function. Research continues to demonstrate that the TSH test is not a sufficient measure of overall thyroid function and can be unreliable [1-6, 23]. Therefore, patients with a thyroid hormone imbalance, clear symptoms, and an "in-range" TSH level may not be properly diagnosed or treated if a medical professional relies on the TSH lab test exclusively."
One statement is evidence based on the other is not. Those two statements are completely opposite. The endocrine societies published their guidelines on hypothyroidism and change them and review them periodically on the published research.
I am not a lab tech. I am a Clinical Laboratory Scientist and if you don't know the difference that would be off topic.
I suggest the OP stick to conventional medical sites and guidelines established by endocrinologists.
This is the first time my THS stayed under 5 for a while. I should be able to lose weight with the below results right? Or should my TSH be lower?
I take Levothyroxine everyday
Mon Wed Fri and Sat - 150 mcg.
Tues and Thurs - 100 mcg
Sunday - 200 mcg
My TSH - 3.742 range 0.45 to 5.5
Free T4 - 1.68 range 0.60 to 1.81
Total, T3 - 0.89 range 0.75 to 2.00
It always seems to go up and I have to increase my meds.
I am also hypothyroid. It’s very hard to lose weight, and worse than that it’s that old joke I gained 5 pounds by walking past a cake. I gain weight VERY easily.
What has worked for me and I have lost 80 pounds and I still have more to lose, is the diabetic diet. Which is great because I’m also diabetic. You want to be low carb on grains. Eat less bread, pasta, pizza, that kind of stuff and eat more veggies and protein. If you need assistance the Mediterranean diet is pretty good for us. I go with that rather than diabetic diets because diabetic diets often use what I call Frankenfoods. I do not like to use fake sugar, weird fat products....I like real food.
Often low-fat products our bad because a lot of low-fat products have to add something to replace the fat they’re taking out. And that usually ends up to be some sort of sugar so carbs. Read your labels. The other thing is exercise. Got to do it. Period. But you don’t have to do anything wild. For a half an hour, 45 minutes, go for a walk. If you aren’t used to walking, don’t push too hard at first. If you’re already somewhat fit, add whatever whatever you’re doing now add to it some weight training. Weight training builds muscle, muscle is good.
And the third ingredient is water. I read this years ago and drinking the right amount of water really helps a lot. And it’s about 64 ounces a day. Which if you get a 20 ounce refillable water bottle, three water bottles is perfect. Is it boring? As you’re sitting here, typing on your computer, when you take a break after you hit post grab the water bottle, take a gulp, put it down; a few minutes later if you finished another post grab the bottle, take a gulp, put it down.
I play a couple of stupid video games on my phone, and that’s what I do. At the end of a round, while the little birds are doing the dance and yelling and screaming and putting points in places I pick up my bottle and take a drink.
The question was with regards to the interpretation of the TSH result. It wasn't with regards to anything else. The OP is more than able to ask her doctor that question. This is a discussion forum and from my point of view being evidence based I pointed out that one should stay with reliable medical websites for the proper interpretation of the TSH that she was asking for. I cited the practice guidelines for endocrine societies that gave their proper use of the TSH as follows
"Measurement of serum TSH is the primary screening test for thyroid dysfunction, for evaluation of thyroid hormone replacement in patients with primary hypothyroidism, and for assessment of suppressive therapy in patients with follicular cell–derived thyroid cancer. TSH levels vary diurnally by up to approximately 50% of mean values (78), with more recent reports indicating up to 40% variation on specimens performed serially during the same time of day (79). Values tend to be lowest in the late afternoon and highest around the hour of sleep. In light of this, variations of serum TSH values within the normal range of up to 40%–50% do not necessarily reflect a change in thyroid status.
TSH secretion is exquisitely sensitive to both minor increases and decreases in serum free T4, and abnormal TSH levels occur during developing hypothyroidism and hyperthyroidism before free T4 abnormalities are detectable (80). According to NHANES III (11), a disease-free population, which excludes those who self-reported thyroid disease or goiter or who were taking thyroid medications, the upper normal of serum TSH levels is 4.5 mIU/L. A “reference population” taken from the disease-free population composed of those who were not pregnant, did not have laboratory evidence of hyperthyroidism or hypothyroidism, did not have detectable TgAb or TPOAb, and were not taking estrogens, androgens, or lithium had an upper normal TSH value of 4.12 mIU/L. This was further supported by the Hanford Thyroid Disease Study, which analyzed a cohort without evidence of thyroid disease, were seronegative for thyroid autoantibodies, were not on thyroid medications, and had normal thyroid ultrasound examinations (which did not disclose nodularity or evidence of thyroiditis) (81). This upper normal value, however, may not apply to iodine insufficient regions even after becoming iodine sufficient for 20 years (82,83)."
The reference that the other poster made has their interpretation of the TSH as follows,
"Why is the TSH test not enough?
The Thyroid Stimulating Hormone (TSH) test is often considered the diagnostic 'gold standard' of thyroid hormone imbalance. A TSH level above or below the "normal" range is required by some medical professionals before initiating a treatment plan with the goal of keeping the TSH level within this range. However, the TSH test does not reveal cellular hormone status, rather, it measures pituitary gland function. Research continues to demonstrate that the TSH test is not a sufficient measure of overall thyroid function and can be unreliable [1-6, 23]. Therefore, patients with a thyroid hormone imbalance, clear symptoms, and an "in-range" TSH level may not be properly diagnosed or treated if a medical professional relies on the TSH lab test exclusively."
One statement is evidence based on the other is not. Those two statements are completely opposite. The endocrine societies published their guidelines on hypothyroidism and change them and review them periodically on the published research.
I am not a lab tech. I am a Clinical Laboratory Scientist and if you don't know the difference that would be off topic.
I suggest the OP stick to conventional medical sites and guidelines established by endocrinologists.
Then again, if you have no idea of who Richard Shames is, that difference would be off-topic.
I agree with the value of conventional medical sites, I agree with staying away from fads. I also know that "conventional" medical wisdom was that ulcers could be handled with milk, and were not caused by bacteria.
Don't try to shove authoritative quotes down the throat to obfuscate a lack of complete knowledge. It doesn't work. It didn't work with ulcers, it doesn't work here. It is one of the major logical fallacies recognized in debate - argument by authority.
Just curious, as a "clinical lab scientist" what is your suggested protocol on nodules? Would you suggest immediate excision and radiation, or would you watch and wait? Hint - you can ask your insurance company for guidance. It seems to be the arbitrator of health care these days.
Then again, if you have no idea of who Richard Shames is, that difference would be off-topic.
Don't try to shove authoritative quotes down the throat to obfuscate a lack of complete knowledge. It doesn't work. It didn't work with ulcers, it doesn't work here. It is one of the major logical fallacies recognized in debate - argument by authority.
Just curious, as a "clinical lab scientist" what is your suggested protocol on nodules? Would you suggest immediate excision and radiation, or would you watch and wait? Hint - you can ask your insurance company for guidance. It seems to be the arbitrator of health care these days.
I am not shoving my interpretation on the use of the TSH on the OP. I am assuming that they have a conventional medical doctor that is licensed to practice medicine of which state medical boards have over site over in making sure that they practice the standard of care. They have a right to ignore the TSH and give it no value as the other site states but they do value it which is why the question was posed that way here. The OP made no mention of symptoms other than being concerned about weight. Others posted correctly that one does not adjust meds solely for the purpose of weight loss. Those are conventional medical standards. I mentioned no authoritative truths. I mentioned evidence based practices that many endocrinologists reviewed based on clinical studies and whether one should change medical practices with regards to hypothyroidism with the present knowledge base or not. It is the same in the other medial specialities where if the evidence presented (ulcers) is there then the practice guidelines will change consistent with the evidence. The evidence comes first and then the change happens. There is clinical research that has to be evaluated first before it is put into clinical practice. One does not do research of people without their consent.
I don't suggest any protocol other than to rely on conventional medical websites and endocrinologist suggestions. There was a whole push by medical specialists of all specialties to minimize medical errors. The campaign was called "Choosing Wisely". There's some limited information for your nodule questions.
For this one topic and OP I suggest this one. This one is some the pathologist.
"American Society for Clinical Pathology
View all recommendations from this society
Released February 3, 2015
Don’t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order thyroid-stimulating hormone (TSH), and if abnormal, follow up with additional evaluation or treatment depending on the findings.
The TSH test can detect subclinical thyroid disease in patients without symptoms of thyroid dysfunction. A TSH value within the reference interval excludes the majority of cases of primary overt thyroid disease. If the TSH is abnormal, confirm the diagnosis with free thyroxine (T4)."
This is the first time my THS stayed under 5 for a while. I should be able to lose weight with the below results right? Or should my TSH be lower?
I take Levothyroxine everyday
Mon Wed Fri and Sat - 150 mcg.
Tues and Thurs - 100 mcg
Sunday - 200 mcg
My TSH - 3.742 range 0.45 to 5.5
Free T4 - 1.68 range 0.60 to 1.81
Total, T3 - 0.89 range 0.75 to 2.00
It always seems to go up and I have to increase my meds.
IDK if the OP is still even listening - but this post is ON topic. BTW - obviously - the topic is a hot button.
I was hypothyroid, undiagnosed, for some years, until just over 20 years ago I also got diagnosed with an unrelated issue. At that time, the docs ordered full blood tests, and voila! Diagnosed hypo. We can assume I was undiagnosed because I'd had alopecia for some years prior.
So, yeah, IMO losing weight while on thyroid supplements is extremely hard. I'll tend to agree that the hi-protein, moderate fat, lower carb, dietary approach works better for energy. BUT might not be so for you - too many variables. Listen to your energy levels.
Levothyroxine vs synthroid vs dessicated thyroid. Just a word or two. Levo vs synthroid, the diffs are really unimportant. You'll have to take a slightly larger dose of generic levothyroxine, that's all. SOME people, but few, have better results with dessicated thyroid (Armour brand, etc). Most people do slightly better on levothyroxine, whether Synthroid or generic. Talk to your doc about trying one or the other, if you're so inclined. If one provides better energy, you are more likely to be able to control your weight.
Dosage: you are taking a WEIRD dosage! Who gave you those quantities! Are you self-diagnosing? AFAIK, although I'm not an endocrinologist, levo dosing for hypo aims at a steady amount. X mcg per DAY. Not that up and down and all around stuff you are doing. By doing what you are doing, again, AFAIK, your levels are going to jump up and down, and won't steady out, possibly for months. The docs use 6 weeks, but I've seen unstable test results for nearly that many months as a result of inconsistent dosing. Talk to your doc. If you aren't being open and transparent about what you are doing with your doc, it may be time to start.
Lastly, when it comes to test results and normal and all that? You should be talking to your doctor, or reading up on clinical studies - not asking here - UNLESS your real objective is weight loss in the first place. In which case go find a weight-lifters or bodybuilding forum where they discuss such off-label, and sometimes illegal, drug use. At least you can find ppl with experience doing junk like that.
The OP was diagnosed with hypothyroidism and receiving treatment for her condition. What happened to you has no bering in this case and assumes facts not in evidence. If you want to start your own thread then go for it but a prima facia look at it there are red flags for doctor shopping and confirmed with you going to an endocrinologist for thyroid problems and claiming to have lit up red out of range labs that the previous 9 doctors missed for over a decade. Needless to say you are leaving off tons of information tea leave reading of labs.
There is nothing aberrant going on with the OP and her treatment. For general guidelines on diagnosis and treatment I would recommend the practice guidelines that were revised around 2012 and periodically revised based on the current clinical studies and evidence.
There is a tendency that is often seen and promoted by patient advocate sites and that the patient is the boss and they say they have symptoms then it should be treated and in this case there's an implication about weight I have read claims by fathers with severely obese daughters insist that the doctor treat them for hypothyroidism when all the labs are normal and some sites point blank state that labs are not accurate especially the TSH and so you have people telling others to go by just symptoms for self diagnosis and to buy thyroxine from Thailand over the internet. You have doctors, MD's, treating patients and getting them down to a 0 TSH but they have the patient sign a waiver that they were told in writing of the risk.
What are some of the recent studies this with regards to subclinical hypothyroidism also called mild hypothyroidism here.
"However, a recent study published in the Journal of the American Medical Association may give doctors pause. The researchers studied people with mild hypothyroidism who had also had a heart attack. They treated one group of these patients for their mild hypothyroidism, and left the condition untreated in the other group. The study showed that those treated for mild hypothyroidism did not have better heart function than those who were not treated.
When mild hypothyroidism is treated, levothyroxine (T4) is the treatment of choice.
A 2017 trial published in The New England Journal of Medicine found that treating people ages 65 and older for mild hypothyroidism doesn’t have much of a benefit. The authors found no real differences in symptoms between participants who received levothyroxine and those who got a placebo. The authors say many older adults revert to normal thyroid function on their own, without treatment. A follow-up study recently published in the Annals of Internal Medicine analyzed data from patients enrolled in the 2017 NEJM study, and determined that even those with the greatest number of symptoms did not benefit."
Her treatment isn't working! Maybe it's time to, oh, I don't know, run some more tests???? Maybe antibodies? Maybe she has Hashimoto's? Maybe something else? "Synthroid is the treatment of choice." Why? Because no one makes much money off of the alternatives? What if synthroid isn't working, like in the OP's case?
Her treatment isn't working! Maybe it's time to, oh, I don't know, run some more tests???? Maybe antibodies? Maybe she hass Hashimoto's? Maybe something else? "Synthroid is the treatment of choice." Why? Because no one makes much money off of the alternatives? What if synthroid isn't working, like int he OP's case?
This is the first time my THS stayed under 5 for a while. I should be able to lose weight with the below results right? Or should my TSH be lower?
I take Levothyroxine everyday
Mon Wed Fri and Sat - 150 mcg.
Tues and Thurs - 100 mcg
Sunday - 200 mcg
My TSH - 3.742 range 0.45 to 5.5
Free T4 - 1.68 range 0.60 to 1.81
Total, T3 - 0.89 range 0.75 to 2.00
It always seems to go up and I have to increase my meds.
Ask your endocrinologist.
Why do you take different doses on different days?
This is the first time my THS stayed under 5 for a while. I should be able to lose weight with the below results right? Or should my TSH be lower?
I take Levothyroxine everyday
Mon Wed Fri and Sat - 150 mcg.
Tues and Thurs - 100 mcg
Sunday - 200 mcg
My TSH - 3.742 range 0.45 to 5.5
Free T4 - 1.68 range 0.60 to 1.81
Total, T3 - 0.89 range 0.75 to 2.00
It always seems to go up and I have to increase my meds.
It looks like your levels are perfect. Therefore, the reason you're not losing weight, is something OTHER than your levels.
Try eating more nutritionally-dense foods, reducing (or eliminating if necessary) some of the weight-gain trigger foods (such as breads, candy, cake, ice cream, macaroni & cheese, fried foods, etc) and making sure you are getting enough exercise.
Your thyroid levels are not preventing you from losing weight.
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Solly says — Be nice!
BTW - obviously - the topic is a hot button.
