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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.
You need to have a FULL thyroid panel. That includes antbodies and whatnot. A lot of doctors won't even do them. If yours doesn't, find a new doctor. Synthroid is also not your only option, and depending on exactly what the cause of the thyroid issue is, may not be your best one. I take a desiccated thyroid, also prescription. But again, a lot of doctors won't prescribe them. If yours doesn't, find a new doctor. If you're taking Synthroid and it's still not working, then that's a good sign that it may not be best for you
Thyroid issues can be very complex. Most docs, even endocrinologists, don't know enough or just don't want to spend the time to figure out what's going on.
I was where you are. I had horrible experiences with doctors who wouldn't run these additional tests or would just prescribe more Synthroid, even though it wasn't working. I even had one endocrinologist refuse to order ANY test (even basic TSH) because they "could tell just by looking at me" that I didn't have thyroid issues.
Also, everyone's optimal ranges are different. So someone could have a TSH of 4 and feel great. Conversly, someone could have a TSH of 2 and be miserable. A good doctor will treat based on symptoms and not just the number.
I found a great doctor, got on the proper medication, also made some diet changes, and it has made a world of difference. My doctor is a regular famiy pratictioner, but just happens to be very well versed in thyroid issues. So be mindful that an endocrinologist may not be necessary. This website has a lot of good information:
You need to have a FULL thyroid panel. That includes antbodies and whatnot. A lot of doctors won't even do them. If yours doesn't, find a new doctor. Synthroid is also not your only option, and depending on exactly what the cause of the thyroid issue is, may not be your best one. I take a desiccated thyroid, also prescription. But again, a lot of doctors won't prescribe them. If yours doesn't, find a new doctor. If you're taking Synthroid and it's still not working, then that's a good sign that it may not be best for you
Thyroid issues can be very complex. Most docs, even endocrinologists, don't know enough or just don't want to spend the time to figure out what's going on.
I was where you are. I had horrible experiences with doctors who wouldn't run these additional tests or would just prescribe more Synthroid, even though it wasn't working. I even had one endocrinologist refuse to order ANY test (even basic TSH) because they "could tell just by looking at me" that I didn't have thyroid issues.
Also, everyone's optimal ranges are different. So someone could have a TSH of 4 and feel great. Conversly, someone could have a TSH of 2 and be miserable. A good doctor will treat based on symptoms and not just the number.
I found a great doctor, got on the proper medication, also made some diet changes, and it has made a world of difference. My doctor is a regular famiy pratictioner, but just happens to be very well versed in thyroid issues. So be mindful that an endocrinologist may not be necessary. This website has a lot of good information:
None of what was said above is evidence based. I am not going to go through each and every point but each and every point is derived from patient advocacy groups and the patients treating themselves to their hearts content solely based on symptoms and they invalidate every tests there is in order to get there.
What test to do and screen for primary thyroid disorders has been validated with clinical studies and that test is the TSH and that is because the TSH is the most sensitive test out there because it becomes elevated or reduces when one has subclinical hypothyroidism and subclinical hyperthyroidism. The thyroid hormones are still normal and in compensatory mode. Once one detects an altered TSH then one can do antibody tests and thyroid hormone tests.
Blinded clinical studies have found no difference with various forms of thyroid hormones for treatment. Synthroid was picked because of the quality and purity vs other forms and the side effects of using T3 instead of T4 for treatment. T3 is the active form and it hits the person immediately and some people can't tolerate it.
Over treatment occurs when one solely goes by symptomatic relief that can endanger the patient.
Endocrinologist are the specialist that deal with endocrine issues and go by evidence based practices. Other doctors that cater to such patients have lost licenses because of poor medical practices. Patient advocacy groups would share these doctors who treat patients based on self proclaimed diagnosis of hypothyroidism until the doctors asked the websites to take them off the lists because they were being scrutinized by state medical boards.
As far as the OP they were diagnosed and treated by a conventional medical doctor with established protocols.
I don't see a question there that was not answered by other posters. The only thing I would add is that the one should get their blood drawn at the same time of day because TSH is diurnal within a 24 hour clock and most labs except for hospital labs are only open from 9-5. There can be as much as a 50% variance within 24 hours but most of the time it is only statistically different rather than clinically significantly different.
The target TSH level would depend on the patients clinical history. TSH tends to increase with age although there is as of yet no age adjusted reference range. As the gland progressively gets attacked by an autoimmune process the dosage is often increased with time. In rare situations a few cases go into remission with normal hormone production and exogenous hormones stopped.
Last edited by Medical Lab Guy; 04-26-2021 at 10:12 AM..
That's a crazy schedule when it is so close to 150mg each day. You are now taking 1000mg per week. 150mg per day would be 1050mg per week.
Aside from that, I know my doctor kept me on the same dose for years. Probably 10+. As long as TSH was in range. Last 4 years were 2.06, 2.07, 3.6, and 5.5. I have both lost and gained weight during those years. Can't tell that what my thyroid was doing had any impact. I did get a med increase by 25mg after the 5.5 and it dropped down to 3.1 in a month - I was also switched from levo to real synthroid. Looking back, I might should have increased the year before when it went from 2.07 to 3.6 even though it was still in range. This would probably reflect what Medical Lab Guy means by target TSH level depending on patient history - it was in range, but it was a large jump. Unfortunately, it was not taken seriously until it got to 5.5 which is what causes a lot of the patient frustration with doctors who only look for numbers to be in range even if you have been seeing them for years.
I wish I could say that I felt different or it was easier to lose weight after I got treatment, but I just can't. I also have PCOS though that could cloud that up. It's always a surprise what my blood tests are going to show.
If you feel like you want more numbers and/or a second opinion, I had looked into Paloma Health - it's basically a home blood test kit and teledoc (or you can just upload your test results and get a second opinion). It would add TPO (antibodies) and you could elect to add Vitamin D and Reverse T3. https://www.palomahealth.com/ I do know they use more meds than just levo and have a thyroid nutritionalist available at a cost. (Although I normally think stuff like this is available for free online if you have the time.)
None of what was said above is evidence based. I am not going to go through each and every point but each and every point is derived from patient advocacy groups and the patients treating themselves to their hearts content solely based on symptoms and they invalidate every tests there is in order to get there.
What test to do and screen for primary thyroid disorders has been validated with clinical studies and that test is the TSH and that is because the TSH is the most sensitive test out there because it becomes elevated or reduces when one has subclinical hypothyroidism and subclinical hyperthyroidism. The thyroid hormones are still normal and in compensatory mode. Once one detects an altered TSH then one can do antibody tests and thyroid hormone tests.
Blinded clinical studies have found no difference with various forms of thyroid hormones for treatment. Synthroid was picked because of the quality and purity vs other forms and the side effects of using T3 instead of T4 for treatment. T3 is the active form and it hits the person immediately and some people can't tolerate it.
Over treatment occurs when one solely goes by symptomatic relief that can endanger the patient.
Endocrinologist are the specialist that deal with endocrine issues and go by evidence based practices. Other doctors that cater to such patients have lost licenses because of poor medical practices. Patient advocacy groups would share these doctors who treat patients based on self proclaimed diagnosis of hypothyroidism until the doctors asked the websites to take them off the lists because they were being scrutinized by state medical boards.
As far as the OP they were diagnosed and treated by a conventional medical doctor with established protocols.
I don't see a question there that was not answered by other posters. The only thing I would add is that the one should get their blood drawn at the same time of day because TSH is diurnal within a 24 hour clock and most labs except for hospital labs are only open from 9-5. There can be as much as a 50% variance within 24 hours but most of the time it is only statistically different rather than clinically significantly different.
The target TSH level would depend on the patients clinical history. TSH tends to increase with age although there is as of yet no age adjusted reference range. As the gland progressively gets attacked by an autoimmune process the dosage is often increased with time. In rare situations a few cases go into remission with normal hormone production and exogenous hormones stopped.
Well, after seeing close to nine doctors over a decade who refused to even order any more than the basic test, not even to check Vit D levels or anything, including one endocrinologist who said they could tell just by looking at me that I didn't have thyroid issues (that one refused to even test TSH), I found one who ordered them. Low and behold, everything was lit up red because it was out of range. Started NP Thyroid (a prescription medication, not some whacky supplement), and my symptoms resolved where it didn't with Synthroid. What a coincidence! Funny how those other doctors had no problem writing scripts for Synthroid even though they told my my thyroid was fine.
By the way, the doctor who treats my thyroid issues is a traditional MD. I had never even heard of these tests until a dear friend of mine, who also happens to be an MD (Family Practice, but out of state) told me about them. They're both very traditional, classically trained, medical doctors. BTW, the reason the MD who treats my thyroid issues is so well-versed is because his wife went through all this same nonsense. Frustrated with her care, or lack of care, by his colleagues, he set out to learn as much as he could about it.
Well, after seeing close to nine doctors over a decade who refused to even order any more than the basic test, not even to check Vit D levels or anything, including one endocrinologist who said they could tell just by looking at me that I didn't have thyroid issues (that one refused to even test TSH), I found one who ordered them. Low and behold, everything was lit up red because it was out of range. Started NP Thyroid (a prescription medication, not some whacky supplement), and my symptoms resolved where it didn't with Synthroid. What a coincidence! Funny how those other doctors had no problem writing scripts for Synthroid even though they told my my thyroid was fine.
By the way, the doctor who treats my thyroid issues is a traditional MD. I had never even heard of these tests until a dear friend of mine, who also happens to be an MD (Family Practice, but out of state) told me about them. They're both very traditional, classically trained, medical doctors. BTW, the reason the MD who treats my thyroid issues is so well-versed is because his wife went through all this same nonsense. Frustrated with her care, or lack of care, by his colleagues, he set out to learn as much as he could about it.
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."
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."
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.
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