Ok but that’s a very complicated approach. End of day check ft3 that’s what should be at a good number to feel well.
TSH is used by doctors and they will stop investigating if TSH is between 1-5.
I was suffering very badly with a 4. Something TSH . Sick care doctors would not dig deeper if I went to them. They don’t do it for others all the time. This is why TSH is a waste of time. Just get to the root of it and identify the output.
Very few doctors in the US even know to test ft3 though. I agree that seeing the whole picture is the right way to go about it, but it certainly isn’t how it’s usually done here. They look at TSH and unless it’s absurd they shy away from doing anything.
Friend of mine had a tsh of 5 and had been to multiple doctors that wouldn’t do anything because it was in range. Finally got one to test for thyroid antibodies and it was high enough to make them believe he had a thyroid issue. His life changed in a matter of days once they put him on t4 after years of needing it. Like, night and day, barely able to get out of bed at < 30 years old to feeling like a kid again.
As long as this is practiced there will be people who slip through the cracks, it’s a numbers game and saves a shit ton of money on healthcare.
Thats what happened to me. Overnight my life turned around.
That’s likely because insurance dictates protocol. If the first required protocol is testing of TSH only then that saves them from having to cover further labs (imagine the difference in cost between TSH vs FT3, FT4, RT3, TPO ab & TG ab). If they can say TSH of 4.9 is normal then they can get away with not having to test further or having to cover someone’s lifelong thyroid meds.
TSH
That’s evidence based medicine.
Well it is.
An initial test of TSH only detects >90% of hypothyroid cases.
Unfortunately also in medicine a cost benefit calculation needs to be applied - and if you are in the US its special situation with a health care system which is mainly profit driven.
To identify the remaining <10% of hypothyroid cases, at least in (political not geographical) Europe laboratory evaluation of the thyroid essentially always includes fT3 and fT4. In my 2 years in the medical lab business I have never seen a single TSH only test. But again, lucky me to live in the country i live in.
If depends on what you define as hypothyroid. Sort of like 200ng Total T level is considered normal. If the definition for hypothyroid is TSH >5 then that’s pretty convenient. I’m pretty sure in the future the US will be right there with y’all. They’ll take 70% of our check but we get to say Healthcare is free and be happy they now check TSH and T4.
I’ve gotten a TSH only test… then again endocrinologists in AUSTRSALIA tend to not be very competent. I was told things along the line of
That’s because they only test t4 and TSH. Doctors don’t care to treat thyroid. They don’t care is one is fatigued depressed and suicidal. They’d rather give SSRI AND speed.
If the doctors really knew what they weee doing. They would test free t3 every time. That’s if they even gave a flying shit about thyroid health.
They simply do not
Welcome to ‘Murcia 
Right 
By no means I want to downplay your experience and I am happy that you found a way of treatment that alleviates your symptoms.
But the thing is, it’s way more complicated that just measuring fT3 levels and maybe a combination of lab results and symptoms is the way to go rather than focusing on TSH and/or fT3/4 alone - here I completely agree with you. And most likely most physicians are either bound by law/insurance to stick to the lab only approach or are not capable of adding the symptoms part to the equation. To their defense it’s really difficult to differentiate symptoms of mild hypothyroidism from any other disease resulting in highly similar complaints. As a patient it’s easy to say in retrospect that it should have been clear to a physician what has caused the symptoms - they did go to med school so they should know - but in fact there exists at least another 20 diseases which cause very similar symptoms. That’s the old ‚the more you know the more ambiguous things are‘ problem.
Regarding fT3: there is a lot of data available showing that it’s actually the least sensitive parameter. Serum levels of fT3 do not represent cellular levels of fT3 and fT3 remains ‚normal‘ in many systemic and thyroid specific disease, respectively. It’s cellular levels of fT3 that are the active part and which regulate TSH secretion from the pituitary. That’s why TSH is actually more sensitive in diagnosing hypothyroidism than fT3 alone.
I guess the future (for those who can afford) will go towards establishing personal ref ranges. One gives blood yearly at age 18 to 25 and this constitutes your personal base of sort of ref range.
Regarding T3 vs T3/4 combo therapy i invite everybody interested in this topic to read the very balanced article below.
https://eje.bioscientifica.com/view/journals/eje/177/6/EJE-17-0645.xml
above are complete labs on current protocool of 20mg/day Test Cyp IM injections (140mg/wk); no AI, no DHEA, ~6000mg Vit D3. Bloods taken prior to daily injection, though with daily injection, no trough to speak of.
I still have not experienced symptom relief; those symptoms primarily being brain fog, lethargy, tired, no libido and ED. The only thing that would make me think that i wasn’t injecting water is sleep quality has increased marginally and water retention is noticeable.
After meeting with my healthcare provider, her primary concern was E2 being too high; but i voiced my concerns about AI’s and said i was reluctant to take arimidex as i am not symptomatic (ie no sensitive/puffy nipples or gyno, etc). She was initially wondering about thyroid as TSH was slightly elevated but when T3 and rT3 coming in at normal levels decided no further action was necessary.
My script was re-upped to continue current protocol, which i have been on now for about 10wks. Not sure what else to try; contemplate decreasing dosage or increasing dosage slightly. i likely have enough wiggle room to try 175mg/wk (which would be a 25% increase in dosage). Prior protocol was 100mg/wk and felt identical to 140mg and i ran that for 8-10wks (but only in a weekly injection protocol).
I think you are down to trial and error regarding dose. Could well be that its even not related to T at all.
I would recommend to do a more systematic approach. It will take time, but eventually you will figure out with this if its actually T related or not.
Stay with daily injection.
Start at 80 mg per week split into 7 injections and if you dont improve after 4 weeks increase by 20 or 30 mg per week. Repeat after another 4 weeks and so on.
I’m going to go out on a limb here. I didn’t see any labs for minerals, no Iron, no Calcium, no Ferritin, no Magnesium, no Zinc. May be irrelevant, may not. I also didn’t see a lab for B12. Again, may be relevant, may not. Either way, I’m going to suggest you stop taking Vitamin D in any form other than what the sun gives you and give it a week or two. Personally, that crap makes me feel like I got hit by a truck and it jacks up other levels in my system. All I want to do is sleep and hate people if I take it. And dear god, DO NOT bump it up to 10000 iu’s a day. That’s actually NOT totally safe for anyone.
thanks Johann, i’m not averse to starting back at the beginning and working my way up. I assume i would be ok to drop from 140mg to 105mg/wk straight away? went with 105mg instead of 80mg because 100mg didn’t raise my levels to mid-range and 105mg is a nice round .15mL.
Hardartery, i live in canada, we don’t get sun up here this time of year, so i won’t be able to get much naturally. As for not increasing to 10,000IU, my current capsules are 10,000IUs
Hey I was in the same boat as you about 6 months in and no positive changes. Feels like I have changed nothing. T higher and e2 higher but nothing positive. Did you end up finding a protocol that works for you now?
