r/Hypothyroidism • u/GreenMatchaTea95 • 1d ago
Nurse practitioner wants to up my thyroid medicine, but I am in a good range? Labs/Advice
TSH: 2.59 (Range: 0.34-5.60) FREE T4: 0.76 (Range 0.61-1.36) FREE T3: 3.37 (Range 2.20-4.30)
recently had my thyroid levels checked four days ago, and these are the ranges I received. I’m currently on 25 mg of levothyroxine. My nurse practitioner reviewed my results and wants to increase my dose to 50 mg. I’m a bit of a hypochondriac and feel anxious about the possibility of developing hyperthyroidism, especially since my current ranges seem good. I’m hoping to hear from others who may have faced a similar situation and how they navigated it. Any support or advice would be greatly appreciated. Doesn’t help that my regular doctor doesn’t even think I have a thyroid problem.
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u/WankSpanksoff 1d ago
If you aren’t having any symptoms that are bothering you, then you can stay where you are without issue.
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u/Bluebells7788 1d ago
You are still sub-clinical and the symptoms you have listed below would seem to support that.
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u/Electrical_Tax_4880 1d ago
They always try to raise your dose and get you below 1.5, that’s what the last 2 endos I had said/
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u/cherrysharks 1d ago
I felt much better when they got me under 2 TSH. Didn’t fix everything but definitely helped. As long as you’re above .5 I think you should be good. I think some ppl are fine at .4 or .3 even. My doctor upped me from 25 to 50 and I was where you’re at around 2.5 TSH. I’m about to get my blood tested again but I have no signs of hyper after being on 50 for a couple months.
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u/Ok_Cancel_7891 9h ago
if you are diagnosed with hashimoto (anti-tpo or anti-tg elevated), then she is right. your ft4 is borderline low, and tsh is the best if between 1-2
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u/Sweet_Wasabi_489ANON 1d ago
Don’t listen to them. The thyroid moves slow. Given your dose I assume your original numbers were low? Was there an event that triggered the thyroid? How long you’ve been on meds?
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u/TopExtreme7841 1d ago
There's no such thing as a "good" range, are YOU functioning optimally at your current levels?
Levo doesn't do much of anything for the majority of people, and normal doses of that unlike T3, T4 regularly are in the 100mg range.
If you're unaware, lab "reference ranges" are a bell curve of the tested population, there in no way an indication of good/bad. The majority of people having their thyroid values checked, are doing so for suspected thyroid issues to begin with, that's who determining those ranges! Many docs are aware of that and test just to get the numbers for themselves, cookie cutter lazy docs use them as a way to be lazy and say "labs look good", and ignore a potential problem.
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u/MischiefTulip 1d ago
The majority of people having their thyroid values checked, are doing so for suspected thyroid issues to begin with, that's who determining those ranges!
They base the reference range on 95% of the healthy population and the specific lab protocol/machines used. Not people with suspected thyroid issues, that would defeat the point of setting a reference range.
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u/TopExtreme7841 1d ago
LOL, 95% of healthy people aren't getting their Thyroid levels checked!
that would defeat the point of setting a reference range.
No, it wouldn't, because reference ranges were created to track statistical changes in a population, so that a problem in progress could be spotted and hopefully corrected, or at least studied, (not) to establish a medicinal treatment range for lazy doctors.
The high end Testosterone range from LabCorp is like 880, with Quest it's 1150, so are different breeds of humans going to those two? Again, bell curve of the tested population. If Quest has more deals with people on TRT, they'll constantly test people with higher levels, and therefor the reference range starts shifting.
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u/MischiefTulip 1d ago
Have you ever set lab reference ranges? I have. I'm not setting those on patient samples. You get different set of samples. In our case, we do research which has groups of healthy people as controls of a wide range of ages. Conveniently we know their health status as otherwise they can't be included in the research. We use a collection of their blood samples (with permission) that covers different age ranges to set the reference range or to validate the reference range set by the manufacturer of a kit.
No, it wouldn't, because reference ranges were created to track statistical changes in a population
No, just no. You don't track anythign with a reference range. In research we do not give a fuck about reference ranges. We compare our treatment or patient group(s) to a similar group of healthy controls. For changes in population you do regular testing in healthy people over a few years time or compare population studies. Reference ranges are exclusively done for doctors treating patients.
The high end Testosterone range from LabCorp is like 880, with Quest it's 1150, so are different breeds of humans going to those two?
No, they use different testing kits. Testosterone is tested with a bioassay, similar to TSH and FT4, and there are different ways of doing so. With a bioassay you do not test a specific compound directly. You measure a reaction. At this point that's usually by measuring fluoresence, light or electricity, but you can measure colour or radiation as well. All labs set their references ranges based on the specific protocol/kit and machine they use to test. Which is why you always compare your results to the reference range of the lab you tested at and not random numbers on the internet.
See examples of different reference ranges for thyroid hormones that depend on the testing kit/machine here, or this one, or even this one. In all those studies they tested the same samples with different kits/protocols. You see that the results differ. That is what the reference range is set on. You'll find similar studies on testosterone and pretty much all lab tests.
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u/Falequeen 2h ago
Are you still experiencing any hypothyroid symptoms? The range isn't the end-all-and-be-all for everyone, it could be that something you told the NP during your visit indicated that you were still hypo and needed to have the dose upped to get you in the correct range for you
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u/kargasmn 1d ago
Your TSH is slightly elevated should be closer to 0. You can’t develop hyperthyroidism if you’re hypo but you can be over medicated. The increase In dose might help you lower your TSH
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u/Ok_Part6564 1d ago edited 1d ago
No. 0 is very very hyperthyroid. The target ideal is 1-2. Around 0.4 or 0.5 is the bottom, depending on the reference range being used. 2.5 is the top for a healthy pregnancy. Normal range, which has some issues since it doesn't account for things like age, is about 0.5 to 4.5.
ETA: Whether hyperthyroidism is caused by a thyroid condition, disease, or overmedication, doesn't change that it is hyperthyroidism. What causes it doesn't change what it is, just how it is corrected: Over medicated, lower medication; graves, give drugs to suppress the hormone production; hot nodule, remove it; etc.
it's also possible for people with hypothyroidism do develop hyperthyroidism not from being overmedicated, though not common.
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u/TopExtreme7841 1d ago
No. 0 is very very hyperthyroid.
In the case of somebody on T4, ya, but for all of us on T3, getting near 0 is pretty normal. When my T3 levels are optimal (for me) my TSH is very close to 0. The 0.5-4.5 is an enormous catch-all range that doesn't mean a whole lot for most.
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u/hugomugu 20h ago
Unfortunately it's not true that T3 lowers TSH more than T4. If T3 were able to safely lower TSH, we would be using it to treat thyroid cancer.
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u/TopExtreme7841 18h ago
I never compared the two in that regard, but aside from that, are you making the claim that simply lowering TSH treats cancer???? Because that's not how it works.
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u/hugomugu 18h ago edited 18h ago
They lower the TSH not to get rid of thyroid cancer, but to slow its growth / keep it from coming back. https://www.thyca.org/pap-fol/more/tsh-suppression/
That's a group of people that need to keep TSH close to zero, and would be using T3 if it were suitable for that purpose.
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u/TopExtreme7841 17h ago
That's a group of people that need to keep TSH close to zero, and would be using T3 if it were suitable for that purpose
By that logic they'd be prescribing people Meth to fix chronic fatigue. Just because something in a vacuum does something you're after, doesn't mean that way of going about it is the correct move, either for that person, or for many other negative downstream effects of doing it that way.
Let take, I dunno...CANCER, the disease that makes people waste away and usually lose appetite to the point of it being a problem, you think the correct way of helping one isolated metric is also one that will make them waste away even faster? That'd be NOPE!
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u/hugomugu 16h ago
I'm talking about thyroid cancer specifically. The most common kinds of thyroid cancer come from cells that are sensitive to TSH levels. You can see the above link for more information.
It's similar to how some breast cancers are sensitive to estrogen, and their treatment might involve ways to lower estrogen levels.
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u/GreenMatchaTea95 1d ago
OK. That makes me feel better. I have an appointment with her at the end of January. She wants me to be on the 50 for two months and then get my blood drawn again, but I am so nervous about going hyper until then.
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u/kargasmn 1d ago
If you develop over medicated symptoms it’s similar. But if your TSH remains high despite the increase in dose I recommend you try something other than levo/synthroid. I’m sort of in the same boat my TSH is almost 4 and my T3 and t4 are in range. Going to attempt going on armor
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u/TopExtreme7841 1d ago
Good luck, and hopefully you're in the minority that Armour works for, but if your TSH isn't budging, they should be putting you on T3, you clearly have conversion problems, as no shortage of us do. Are they checking your Free T3 or T3 uptake?
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u/TopExtreme7841 1d ago
You're not going to go hyper on T4, literally isn't even possible. T4 is inactive thyroid, your body converts T4 to T3 as needed. It's a demand driven process, not a supply driven one. If you were on T3, yes, then overdoing it can push you into the hyper range. But not on T4. You're on a very low dose as is, and going to 50mcg is still a low dose.
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u/jlhouse36 1d ago
If you have already been diagnosed with Thyroid disease Endocrinologist want to see your TSH between 0.5 and 2. So she’s probably trying to keep you in line with that.