Hoping I can help explain TSH

kats3boys

I am new here and by no means an expert but I have seen lots of postings regarding TSH.

Some of the others posting probably know more than me but I still see the confusion so hoping I can explain it here in simple terms and help a few of you out. Keep in mind that I am not a doctor and I do not play one on TV.

TSH is not a thyroid hormone, it is a pituary hormone that tells the thyroid to produce more or less thyroid hormone, consider it the gas pedal, more TSH is like stepping on the gas pedal trying to get more hormone, letting up the gas pedal and your body is telling it to produce less hormone.

You will see a lot of different ranges 0.3 -5.5, 0.45-3 and almost anywhere in between. They are a based on assays ( some old standards) of healthy people and also people of overt thyroid disease which tends to skew the higher end of the range.

It is still a good starting diagnostic tool for diagnosing thyroid disorder, once you are diagnosed it tends to be less useful.

Keep in mind that the average TSH is 1.25 and if you have had your thyroid removed the TSH needs to be less than 1 or even closer to .1 in the case of cancer as to not stimulate any cancerous thyroid cells that may still be remaining in the body.

The thyroid produces mainly T4 and T3 hormones ( Thyroid hormone with 4 atoms, take an atom off, thyroid hormone with 3 atoms etc.)

T4 is considered the storage hormone and T3 is considered the active hormone, the body converts T4 to T3 by removing and atom.

For those who are not feeling well hypo, low iron and low B12 also tend to have the same symptoms so make sure your doctor tests them.

I am still on the roller coaster but if I can give you any advice it is to not be afraid to speak up and to keep all lab reports and do not be afraid to write on them. The range is all over the place, you need to find your spot,.. if your doctor says it is not your thyroid, then ask him/her what it is..being hypo tends to create an apathy and you need to speak up for yourself if you are not feeling well.

foss44

thankyou very informative

vhines5

Are you sure you don't play a doctor on TV??? LOL

Thanks for the "plain english" breakdown. Dr speak sounds like the teacher from charlie brown to me! Waa waaa wa waa

Well Done!

islandmonkey

Well put!

The only thing I'd add on TSH is that it responds differently to hormones from meds than it does to hormones from your thyroid itself. Therefore, once you're taking meds TSH becomes even less useful, because it can be quite suppressed in people taking meds -- if an uneducated doctor is using TSH as a stand-alone diagnostic tool they might be tempted to say you are "hyper" from too high a dose, and will drop your dosage. This is why it's important to always get your free T3 and free T4 tested, and to always consider your symptoms.

As well, because of all the controversy about what the "normal range" should be, TSH becomes even less useful as a stand-alone tool. Many doctors will use the old range of .5-5.0, and will tell a patient that their thyroid is "normal" or "fine" even if their TSH is 4.5 and they are very symptomatic. Please remember to always get the actual number, and not just your doctor's interpretation of the number ("fine", etc).


Iron and Vit b12 are actually involved in the process of converting T4 into T3, so it's not just that the symptoms are the same - low levels of these can basically make you hypo. Also important in the conversion process are selenium and zinc. If you get iron tested you should also always get your ferritin (iron stores) tested.

Vit this one gets overlooked far too much -- Vit D is required for the active hormone T3 to do its job. You could have perfect T3 levels, but if your Vit D is low you could still feel hypo, because that T3 can't do much of anything. Optimal levels for Vit D are 60-80, but many doctors just try to get people to 30+ (30 being the minimum). Most N. Americans are very Vit D deficient, so this one in particular is very important to get tested!

sharonmunday90

I agree but in the uk my gp only tests tsh and ive been hypo for 20 years. no test for t4 or t3. only treatment levothyroxine.

islandmonkey

I agree but in the uk my gp only tests tsh and ive been hypo for 20 years. no test for t4 or t3. only treatment levothyroxine.

I've heard that's really common in the uk. I live in Canada, and my province is currently phasing out all T3 testing, and apparently others have already done that. Very frustrating!

I know in the US you can order your own labs....any opportunity to do that in the UK?

sharonmunday90

I agree but in the uk my gp only tests tsh and ive been hypo for 20 years. no test for t4 or t3. only treatment levothyroxine.

I've heard that's really common in the uk. I live in Canada, and my province is currently phasing out all T3 testing, and apparently others have already done that. Very frustrating!

I know in the US you can order your own labs....any opportunity to do that in the UK?

its pretty expensive and if it shows you need t3 you still cant be prescribed it. there is a private endo called dr skinner in birmingham who prescribes armour and t3 but hesxreal expensive and once you start treatment with him you gp usually wont help youbatvall. it sucks!

kats3boys

I am in Canada and have no issues with T3 testing, They have phased out T4 and T3 testing in favour of the FT4 and FT3 and the lab has rules as to which order the tests can be run . If you have a known thyroid disorder your GP doctor just has to write the diagnosis on the paper and he can order TSH and FT4 together,but he has to wait 24 hrs for results before ordering FT3. If you have an Endo then there is no issues and TSH, FT4 and FT3 can be on the same lab sheet. I have a standing order for TSH , T4 and T3 every month ( free is the only one the lab does).

islandmonkey

I am in Canada and have no issues with T3 testing, They have phased out T4 and T3 testing in favour of the FT4 and FT3 and the lab has rules as to which order the tests can be run . If you have a known thyroid disorder your GP doctor just has to write the diagnosis on the paper and he can order TSH and FT4 together,but he has to wait 24 hrs for results before ordering FT3. If you have an Endo then there is no issues and TSH, FT4 and FT3 can be on the same lab sheet. I have a standing order for TSH , T4 and T3 every month ( free is the only one the lab does).

My endo has been running free T3, but just told me today that the province is pushing back every time they order it, and are pushing to phase out all free T3 testing (I'm in Saskatchewan). Ontario is apparently already pushing back (though some doctors are more willing than others to argue for the testing).

I also have the standing order, but was told that eventually they just won't run it. It's crazy. I already want to leave this icy, desolate province...this isn't helping. :P

sharonmunday90

Well dont come to the uk as they only test tsh and only prescribe thyroxine :-(

kats3boys

Even with only TSH testing, and only T4 supplementation keep in mind that Synthroid advocates 1mcg per lb for full replacement. Most people on replacement meds tend to feel better with the TSH below 1, after all if you know it is not working properly, why do you want it stimulated?

If you really are having hypo symptoms and this is all you can get, then you need to work with it, make sure your doctor knows you are not feeling well, that you still feel hypo and if you have room to move the TSH ask the doctor to increase your dose.

You also need to make sure you are doing your part.. Do not forget to take your meds.
On an empty stomach, minimum of 1/2 hour but an hour is better before you eat...
No calcium or iron with in 4 hours of taking your meds ( this includes dairy ) as it binds with Synthroid on a cellular level and simply removes it from your body.

sharonmunday90

My optimum is 0.78.

Although my gp waited until it was 4 and had doubled in a month before upping doseage.

Thyroid desease in the uk is a joke!