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Is my TSH of 6.15 too high?

I had my total thyroid removal in 2006.  I have been on synthroid (100 to 112 mcg) ever since.  My current dosage is 100mcg.  I am a 54 year old woman who until 5-6 years ago was able to manage my weight with exercises and diet.  Over the last 4-5 years I have experienced noticeable hair loss, weight gain, general lethargy, hot flashes and disrupted sleep.  I made several requests of my doctor to change my medication, specifically requesting that he prescribe Armour Thyroid.  At first, he refused to consider switching but has since deflected to other alternatives like increasing my workout and changing my diet.  I live an active lifesty and workout and have an maintain a fairly clean diet but he insists that what I am experiencing is simply getting older.  I don't agree.  After much proding, my internist agreed to order a full testing panel of my thyroid, including TSH, T-4 and T-3.  My results are:  TSH: 6.15 H, T-4: 1.5 ng/dL and T-3: 2.6 pg/mL.  I've been researching my results on various medical websites to better inform myself before my follow-up appointment to discuss my results.  Based on a thyroid test analyzer, my TSH is high, my T-4 is optimal and my T-3 is low.  Is this accurate?  If so, is it time for reconsider my thyroid medication?  I just want to feel "normal" again, find an manageable weight and stop my hair to stop thinning.
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Qhlindsey Feb 3, 2019
Yes, a TSH of 6 is too high.
FT4 = 1.5 ng/dl = 19.3 pmol/L
FT3 = 2.6 pg/mL = 4.0 pmol/L
ratio FT3/FT4 (in pmol/L) = 4.0/19.3 = 0.21
A study in 2011 found that median FT3/FT4 ratio (in pmol/L) is 0.24 for Synthroid only patients.
So your body's conversion of the Synthroid (T4) to T3 is fairly typical for someone taking Synthroid only.

Most doctors put a heavy weight on the TSH reading, so with the high TSH and obvious hypothyroid symptoms, it should be fairly easy to convince your doctor to raise your synthroid dose. A possible plan of attack for you might be to go up to 112 mcg synthroid again while you are trying to convince him or find another doctor to try something else. I think going to 112 would make a significant difference for you.
Helpful - 0
Thank you for your feedback.  I will raise this to my doctor and see what he proposes.
Hi, I'm back after consulting an endocrinologist based on my earlier test scores.  I just wanted to follow-up based on my initial contacts through this site.  The new doctor increased my synthroid from 100mcg to 112mcg and retested my labs.  My results after 60 days on the increased synthroid were:  TSH .746 and T-4, Free 1.82.  My Vitamin D level was 30.0 (normal).  I've lost 10lbs and feel much better.  I attribute my weight loss to a change in the synthroid dose but also I started intermittent fasting - eating only between 10 am and 6 pm.  My new doctor has ordered new labs in another 2 months and said if I continue to lose weight she is going to reduce my synthroid back to 100mcg since it is based on weight.

She insisted that there was no need to change my medication, i.e., synthroid to armour thyroid and that a lot of the symptoms I described were most likely related to the weight gain and incorrect synthroid dosage.  Time will tell.
It's good that your doctor increased your dosage, even if she refused to give you the Armour.  Many of us do just fine on synthetic hormones and as long as you're feeling okay, that's what counts.  

Is it safe to assume that the reference range for the Free T4 is the same as before - 0.8-1.8?  If so, yours is higher than the reference range, which is probably not good.  

Is it also safe to assume that there was no Free T3 ordered?  If not, that's definitely not good since Free T3 is the hormone that's used by individual cells in the body.  The fact that you're feeling better is an indication that you're converting some of the T4 to T3, but without a Free T3 test, we have no idea how much and considering that your Free T4 is over the range, you could be headed for trouble.

Your vitamin D is still too low, even though it's within the normal range - it need to be at least 50-60, or even a bit higher.  

It's good that you've lost 10 lbs and are feeling good.  I agree that most of your symptoms were due to feeling hypo (weight gain and incorrect dosage), but do insist on a Free T3 test, along with the Free T4 and TSH tests next time.  If the doctor isn't willing to do that, it's probably time to look for a different one.  I can already see this doctor micro-managing your dosage based on weight or TSH.
1756321 tn?1547095325
I started thyroid medication with a TSH of 6. I had severe symptoms as it was a combination of cellular and thyroid gland issues. While TSH is not the most accurate of tests as it can be affected by various factors, over 95% of healthy people have a TSH under 2.5 mU/L .
Helpful - 0
649848 tn?1534633700
Hi Qhlindsey and thank you for the additional information.  

Yes, you're quite right that your Free T3 is too low and that you need to take another look at your thyroid medication.

As I noted, the rule of thumb is for most of us is for Free T4 to be about mid-range and Free T3 to be in the upper half to upper third of its range.   As you can see your Free T3 is a long way from being in the upper half at only 16% of the range.  

Your B-12 and Folate are both good - most of us find that B-12 must be kept in the upper part of its range for best result.  Folate should be kept relatively high, as well, since Folate deficiency can mimic B-12 deficiency.  

You don't say if you're supplementing to improve the low vitamin D you had at the end of 2017.  I hope you are.  Vitamin D is necessary for proper metabolism of thyroid hormones, plus vitamin D deficiency can cause some hypo-like symptoms.  Ferritin is the iron storage hormone... iron is necessary for the conversion of Free T4 to the usable Free T3.  Since your Free T4 is higher than it needs to be and your Free T3 is very low, that's an indication that you aren't converting... if you had adequate iron, you might convert better, if not well enough.

Typically, if Free T4 levels are high and Free T3 levels are low, T4 medication is decreased slightly and a source of T3 medication is added.  This can be done in the form of cytomel or it's generic counterpart, which are both T3 only medications or one can be switched to desiccated hormones, which contain, both T4 and T3, such as Armour Thyroid, NatureThroid, NP or WP, etc.  These prescription desiccated hormones are derived from pig thyroid.  

You can talk to your doctor and see if s/he is willing to prescribe a T3 medication... If not, we can help you try to obtain better conversion, which sometimes helps (selenium has been shown to help in the conversion process, also) or it's to find a different doctor.
Helpful - 0
Hi Gracevd70...
"I would say your TSH is too high and causing you issues."  I just want to remind you that TSH is a pituitary hormone, not a thyroid hormone.  TSH, itself does not cause the issues.  It neither causes nor alleviates symptoms.  It's always the presence or absence of actual thyroid hormones (Free T4 and Free T3) that causes or alleviates symptoms.  

Although doctors believe that TSH correlates with symptoms or Free T4 and Free T3 levels, we know it does not; it's merely an indicator of thyroid hormone status in the undiagnosed state.  Once diagnosed, it's pretty much irrelevant, though it can still be used as an indicator only, along with Free T4 and Free T3 and symptoms.  

My TSH, like yours, always runs very low and I've had the same problems you have trying to maintain adequate medication dosages because of it... my doctors always insist I must be hyper because my TSH is suppressed, when I've never been hyper since I've been on thyroid medication even though my TSH has been suppressed since shortly after I began taking it.  I've been through 2 endos, a primary doctor and a nurse practitioner, so far trying to find someone to treat my thyroid in such a manner as to keep from making me more ill (I should note - the first endo did okay; he simply went out of practice)

Although he refuses to increase my dosage(s), my primary doctor has finally figured out that he has to ignore my TSH and go by FT levels, though he's still having a hard time understanding that it's FT3, instead of FT4 that's most important... I keep working at it, because I know I'm eventually going to get him to understand how it all works... Just think, he started out 9 yrs ago, believing that TSH was important, too.  We really *can* train our doctors... :-)
Thank you for your feedback.  I do take Vitamin D supplement and multivitamins for iron.  I didn't know about selenium and will look into that supplement, too.  Hopefully, I am now sufficiently armed with knowledge to have an intelligent conversation with my doctor.  I will follow-up based on what he says.  

Thank you - this website has been a lifesaver.
Good luck and please let us know how you turn out with your doctor...
649848 tn?1534633700
Oh, I get so disgusted with that "you're losing hair, gaining weight, having hot flashes, getting tired because you're getting older" garbage... unfortunately, that seems to be the standard come-back for many doctors.  

You've done the right thing by researching and getting further tests done, though.   I have some questions for you though... Are the T4 and T3 tests, Free T4 and Free T3 or are they Total T4 and Total T3?  Testing for Total and Free T4 and T3 aren't the same and don't give the same information.  It should say on the lab report... we want them to be Free T4 and Free T3 and they appear to be, but I'd like to verify that.

In addition to that, could you please provide the reference ranges for the T4 and T3?  Ranges vary from lab to lab and have to come from your own report for the best comparison.

The rule of thumb (and where most/many of us feel best) is to have Free T4 about mid-range and Free T3 in the upper half to upper third of its range.  

Many of us with thyroid conditions are low in certain vitamins/minerals that are essential for proper metabolism of thyroid hormones.  Many doctors don't think to test for them, so we often have to ask; however, if you've been tested for Vitamins B-12, D and Ferritin, please also post those results, with reference ranges.

Once we have the requested information, we'll be able to better respond to your questions.

BTW - can you, please, tell us why you had your thyroid removed?  
Helpful - 0
Thank you so much for your response.

My T4 andT3 tests were both Free. The T4 range was 0.8-1.8 ng/dL and the T3 range was 2.3-4.2 pg/mL. My Vitamin B12/Folate came back 838 (range 200-1100 pg/mL and 16.0 (reference range Low: 5.4.)  This current test didn’t test my  Vitamin D level but my test in December 2017 (25-OH Vitamin D testing) showed a deficiency 28 L (range 30-100 ng/mL). I have not been tested for Ferritin.

I had my thyroid removed because I had developed non-cancerous nodules on my thyroid (both sides but more pronounced on the left side). My doctors thought it best to remove the entire thyroid instead of just the nodules because they believed the nodules would grow back larger. I was  not a fan of elective surgery and resisted at first. I didn’t like the thought of being dependent on medication for the rest of my life but the thought of a goiter growing on my neck was enough to change my mind. I have wondered over the last few years whether I made the right choice although it’s too late now.

I hope this answered your questions.  Thank you, again.
I had thyroidectomy for cancer 2 yrs ago and your right doctors love to blame weight increase on something your doing and not the fact your missing your thyroid.  I'm the opposite of you my TSH is super low along with low FT3 and FT4 and my Endo wants to keep reducing my meds to the point Im going to be on no meds.  I would say your TSH is too high and causing you issues.
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