Thyroid experts, is a TSH of 4.2 too high?

[Owletterocks]

Just wondered if anyone can help. Been on thyroxine for 7 years now, usually 75mcg daily. Lately I have been tired, I have muscle aches and restless legs and am getting palpitations. Had my bloods done and my TSH is 4.2, I feel like that is high for me and I am getting symptoms but the GP isn’t listening and just says that it’s in normal range. I think my dose needs increasing given that I am symptomatic. Any advice? I am thinking of going back and asking another GP or for an endocrine referral

Many other countries consider 3 or 3.5 upper range and would increase your dose. If GP is reluctant, ask for a T4 and T3 test as well

Thanks, I will go back and ask again. It’s annoying when they don’t listen to you. I know on paper that’s a normal level but I know how I feel and I get palpitations when I am under active. I also know I am more tired than usual and dh has noticed it as well. I knew other countries had lower limits than us but I couldn’t remember what they were so thanks for that as well

The objective on thyroxine is to have TSH at 1 or below and FT4 in the top quarter if the reference range so yes, you're almost certainly under treated. Many doctors say a starting dose should be 100 mcg.

I'm interested to read this as mine was "over 7" recently and I have been started on 25mg thyroxine daily. I'd the dose likely to increase? I have to go back for another blood test after 6 weeks.

Sounds like your doctor knows what they're doing. Keep going back every six weeks and getting re-tested. They should keep putting your dose up until you feel better/well. If they don't, get on to one of the thyroid charities and ask for a referral to one of the endocrinologists on their lists.

Way too high. They're supposed to treat symptoms not the blood results. Either see another dr and emphasise your symptoms or buy the book linked below and show gp where it says 'near 1'.

Or ask for endo referral who will say some people need complete suppression to feel well.

My guess is you need either 100, or 125, even as much as 125/150 on alternate days. But you'll have to work slowly up to it and get tested after about 6- 12 weeks to see how symptoms and results go.

You can happily go as low as tsh 0.3 so it's reasonable to go to the gp and say you'd like to maximise your dose within the range as you are very symptomatic at the moment.

www.amazon.co.uk/Thyroid-Disorders-Understanding-Family-Doctor/dp/1903474191

I'm sure somewhere in the nice guidelines it says may need to be in the lower half of the ref range.

This is a local area guideline written by two key endocrinologists who have contributed to the nice guidelines and worked with the British thyroid foundation on their guides and info.

It outlines quite a lot of things including aiming in the lower ref range.

www.northoftyneapc.nhs.uk/wp-content/uploads/sites/6/2012/03/Thyroid-guidelines-North-of-Tyne-Area-Sept2016.pdf

That’s really helpful, thanks. I need another blood test repeating so will be going back once those results are all back to see what to do next. I am going to push for an increase in my dose

Interesting document, but no support at all for T3, which some people cannot manage without, and no mention of secondary or tertiary hypothyroidism.

No but I do know at least one of the Endos did diagnose a lady around here with the type that needs t3. This is the straight forward stuff.