where IS the top of the FT3 range?

[Guest guest]

Hi all

I am confused about the top of the range actually is.

My recent FT3 came in over the range, the range being different what what Toft

apparently (see below) says in his book.

Does the range not change from lab to lab? or is it the same everywhere in the

UK so Toft can make a generalised statement like this?

Would really help me to understand this as I have to have a discussion with my

GP who is TSH-obsessed.

For instance, he did not tell me last two times he took bloods for thyroid. This

when I was having other tests done.

So I took my T3 with brekkie as normal and then gave the blood about 11 or 12

ish...

GP says that fact that he did not tell me he was doing thryoid testing and that

my FT3 may be skewed is irrelevant as what is relevant as far as he is concerned

is that the TSH is still suppressed.

I have given him papers explaining the 'other' view on TSH and he is not

impressed.

And then he kind of 'corners'me when I am at the surgery and asks me questions I

cannot answer.

So as well as any info on where the top of the FT3 range actually is I would ove

please if anyone can help me with this, a simple sentence or two to get across

to the doc WHY it is not important about the TSH being suppressed.

I don't even understand it myself to be honest.

I find myself wondering (and I have never taken T4 on its own) why T4 does not

suppress the TSH if there is enough of it being converted into T3?????

The rationale is, isn't it, that if there is enough T3 being taken then TSH WILL

be suppressed as there is no need for any more thyroid hormone.

Would this same scenario not take place with T4 only meds once converted?

Probably not otherwise docs would be familiar with the consequent suppression I

suppose?

Help???

* where is top of range and

* how to explain this in idiot-speak to me so I can explain it to my doc.

Hope someone can help.

Many thanks.

Mo

Remember the T3 range actually goes up to 8 according to the BMA book by toft,

so this is well in range and nice and high.

[Guest guest]

Hi Mo2,

The way I see it, one needs to apply common sense. Lab reference ranges are guidelines - they are not written in stone, and to my mind the first and foremost indicator of thyroid-health is how we actually feel.

Ref ranges change from lab to lab. I am the last person who should attempt to explain anything technical, but I suppose the slight differences in ranges must have something to do with the way a machine is calibrated. So in my view you can't put a specific universal figure as the top or bottom reference as a world wide indicator. We have to accept the figures that each lab uses - but within reason.

***For instance, he did not tell me last two times he took bloods for thyroid. Thiswhen I was having other tests done.So I took my T3 with brekkie as normal and then gave the blood about 11 or 12ish...GP says that fact that he did not tell me he was doing thryoid testing and thatmy FT3 may be skewed is irrelevant as what is relevant as far as he is concernedis that the TSH is still suppressed.

This is because your GP (wrongly) believes that the TSH is the correct tool to measure if you are on the correct dosage of your medication. He should know better, but it is not entirely his fault, that is what he has been taught, and this silly belief is re-inforced by the guidelines given to doctors by the RCP (Royal College of Physicians).

It is true that your TSH would not have been influenced by your taking your T3 on the day of the blood draw, so from his point of view your GP was correct - only he was using the wrong parameter to monitor your progress. He should have looked at your FT4 and FT3 ... and presumably those haven't even been done. How does the saying go? - you can lead a horse to water, but you can't make it drink....

***I have given him papers explaining the 'other' view on TSH and he is notimpressed.And then he kind of 'corners'me when I am at the surgery and asks me questions Icannot answer.So as well as any info on where the top of the FT3 range actually is I would oveplease if anyone can help me with this, a simple sentence or two to get acrossto the doc WHY it is not important about the TSH being suppressed.I don't even understand it myself to be honest.

I am afraid that nothing you can say to your GP on this matter will fall on fertile ground. You can try, but in my view he has made up his mind to follow the belief of the RCP that the TSH is the "gold standard" for monitoring thyroid disease.

The simple fact is that the TSH is a pituitary hormone. TSH, as the name suggests, is a thyroid stimulating hormone, which tells the thyroid gland if and when the body needs more T4 and T3. When all of those thyroid hormones are supplemented from the outside in pill form, why on earth would anybody in his or her right mind expect a stimulating hormone to stimulate a response that does not need stimulating??? Doctors should know better - but they are either too scared of repercussions from the GMC or too ignorant to let common sense get in the way of treating their patients correctly.

You could ask your GP why he expects your TSH to be "active" when you supplement all your body's thyroid hormone needs. It is perfectly normal for your TSH to be 'out of action' (suppressed) and nothing to worry about.

He will probably tell you that a suppressed TSH can lead to atrial fibrillation (heart problems) and to Osteoporosis (thinning of the bones) .... and that is nonsense as well.

It is true that HyPERthyroidism can lead to both of the above, and hyPERthyroid patients (obviously) happen to have a suppressed TSH. The difference is that in hyPERthyroid patients their bodies are awash with too much thyroid hormone - and this thyrotoxicosis will lead to heart and bone problems (and more). Doctors (wrongly) use the suppression of a TSH in hyPERthyroid patients as "proof" that a suppressed TSH must indicate too much thyroid hormone, which will lead to AF and osteoporosis in medicated hyPOthyroid patients - and this is rubbish. Only an excess of thyroid hormones will do that.

*Your* TSH is suppressed because your body is getting (hopefully) all the thyroid hormones it needs - so there is no need for the TSH to rise and ask for more thyroid hormones.

By contrast, in a hyPERthyroid patient the TSH is suppressed because there are too many thyroid hormones in the body and the body is in a toxic state .... and this will lead to bone thinning and heart problems.

So if your GP thinks that you are taking too much thyroid medication, then he should check not only your TSH, but at the same time your FT4 and FT3. An optimal result would show a suppressed TSH and both the FT4 and FT3 at least in the middle, or, better still, in the upper third of their respective norm ranges.

***I find myself wondering (and I have never taken T4 on its own) why T4 does notsuppress the TSH if there is enough of it being converted into T3?????

Nope, that's wrong - T4 alone will also suppress the TSH ... and it does not even need very much to do so. For example, my own TSH was suppressed by the time I had reached 125 mcg of levo.

I hope this helps,

Best wishes,

[Guest guest]

I think the fact that labs have different ref ranges is a red herring.

It doesnt matter what there reference range in number is, but it does matter

what units they measure the T3. this can only be the different issue to look

at.

as it is they all seem to measure in pmol/l

This may explain better: across the gp surgeries of the land we are told an

average male must weight between 60-100kg. however some surgeries say it is

between 50-110kg. some hospital say 65-115kg. They are all different ranges,

but they are all using the same unit of measurement.

So back to T3, i am very happy to go with the range Dr toft supplies and not the

local lab. it seems most labs go up to 6.5, but Dr toft goes up to 8. This

wouldn't be published by the BMA if it was wrong information.

next time i go and see the endo i will take this book and ask him about this

range and see what he actually thinks for himself.

[Guest guest]

So there is no sense then Sheila to what Tofy says about the ref range in this

booklet?

What I am wondering and this is where the GP corners me, is why a patient on T4

only meds would not have a suppressed TSH if that same T4 is being converted

into sufficient T3 to clear their symptoms ie in patients who do well on T4 as

my GP says ALL his other patients do.

And, of course and by the way, my GP insist that I was never hypoT in the first

place and has been pressuring me for several years now to come off thyroid meds,

sending me for ECGs etc.

He refused to prescribe me anything other than BP meds which I now refuse having

had some v bad sides with trying two or three of them UNTIL I get my TSH where

He wants it.

It is scarey Sheila as I daren't send him the lovely piece from Dr Lowe as this

dr is in charge of sanctioning my DLA renewal upcoming and I have been v

challenging with him and it has got me nowhere except to the point of a

breakdown of the relationship.

I have not been near him since this time last year when I left in floods of

tears and in a v vulnerable state.

Basically at that last session he said I had nothing wrong with my thyroid, that

I had CFS and that my real issue was in not accepting that there no 'magic

bullet' out there that was going to get me well, that I needed to accept things

as they are and stop stressing myself out trying to get well with these ideas

off t'internet.

Oh the usual old stuff that we have all heard a million times.

But these guys have power and in this case I am frightened if I do not meet him

half-way or appear to be doing so in some respect, then I may find myself in v

deep doo-doo pretty soon.

I lost my DLA before because of a doc like this and my home had to go on the

market because of it. Luckily it did not sell and I managed to win my appeal.

I don't want to have to face all of that again and sorting this issue out with

the GP is pivotal in all of this for me.

Thanks Sheila.

Mo

I have changed doctors and that seems not to help one jot because they are all

cut from the same cloth it seems. Well I did have one beauty but he retired and

he has been a hard, if not impossible, act to follow for the other GPs.

the TSH is

> almost always suppressed because the pituitary recognises that there is

> sufficient of the active hormone T3 so it doesn't have to put out TSH to

> tell the thyroid gland to put out more thyroid hormone. The mistake that

> such doctors make is to believe that everybody with a suppressed TSH will

> get osteoporosis or heart problems but this is a ridiculous notion. Thyroid

> cancer patients' TSH is kept deliberately for years, yet they never have any

> problems, so why would your doctor believe you would be any different. My

> own TSH is very suppressed, and I have had two bone scans, both showing that

> I have " the bones as strong as an elephant " according to my endocrinologist.

> No sign of osteoporosis and no sign of any heart problem.

>

> Read what Dr Lowe says

> <http://www.drlowe.com/emailnewsletter/2009archive4.htm>

> http://www.drlowe.com/emailnewsletter/2009archive4.htm

>

> Your doctor should keep his knowledge up to date and read ALL the research,

> not just believe what the BTA tell him.

>

> Luv - Sheila

>

>

[Guest guest]

>

Hi there C,

So Toft is talking through his bot-bot then with what he ays in his booklet of 8

being top of the range?

Yes it certainly helps, this info, in many ways and in particular the

fact the T4 only meds also suppress TSH.

So why is he making a fuss about this? With all of us using Armour or T3 only

meds? if this is already the case with T4 only meds?

OR is it the case that ALL thyroid patients on T4 only are purposely kept out of

suppression and that is ONE reason why a lot of them are kept unwell??????

Is this what goes on??????

And my GP insists that I am hyperthyroid basing this on a fast pulse which has

now resolved itself. I was on beta blockers for it for 2 years then it became

apparent this time last year that my pulse was reacting to certain foods (see Dr

Ccoca's Pulse Test in Files section) and it was this that was sending my pulse

high.

It is fine now....

I went to see the consultant at the local CFS clinic who also came to this same

conclusion that I was overmedicated on thyroid and this was causing the high

pulse. And he wrote to the GP recommending he get me lowered on thyroid meds

asap.

I did get the FT4 and FT3 results as well, and of course being on T3 only the

FT4 was under range and the the FT3 over range but then it would be having just

taken 50 mcg T3 two hours before the blood draw...

That's another area of confusion for me as I have heard several different bits

of advice on when to stop T3 before a thyroid test and I am not sure which is

true... One source said about 12 hours before draw, another a couple of days,

another with brekkie and take blood when T3 peaks....

So who knows, those suggestions from three diffent thyroid experts.

That was v helpful indeed C. I will now print it out and arm myself before

facing the beastie again.

I am thinking of getting myself a little recorder thingee like I think Dawn said

she did so I can remember exactly what doctors say when I am with them. I often

forget things that I meant to say or if asked awward questions my brain cannot

respond quickly enough and I think after3wars of what I wish I had said or

should have said or wish I had known more about so I could sensibly answer.

To that end I am considering asking the GP if he would consider emails

communication for some consults cos that way I have to thinkk, and consult other

sources for info if necessary, and can reply in my own good time.

Does anyone think this is a good idea or one that would likely be acceptable to

doctors?

I am thinking if explained properly, the brain fog issues, that if would be kind

of unreasonable for them to refuse?

Disability discriminatiopn or suchlike?

Whatchathunk folks?

And thanks again C.

Mo

The simple fact is that the TSH is a pituitary

> hormone. TSH, as the name suggests, is a thyroid stimulating hormone,

> which tells the thyroid gland if and when the body needs more T4 and T3.

> When all of those thyroid hormones are supplemented from the outside in

> pill form, why on earth would anybody in his or her right mind expect a

> stimulating hormone to stimulate a response that does not need

> stimulating???

[Guest guest]

Thanks FJ ~ I suppose that really is the bottom line with all of this ie what

dose and blood levels clear us of all symptoms.

Well said!

Mo

>

> For me to feel well, my Free T3 is always just slightly over range (less

> than 10 percent) and my Free T4 is above 75 percent. I take five grains of

> old Armour/Naturethroid.

>

> Fibrojay

>

[Guest guest]

This might confuse you even further Mo http://thyroid.about.com/cs/testsforthyroid/a/freet3_2.htm

So How Do I Interpret My Free T3 Levels?

To keep

things simple, I am going to use pg/dL as a common unit of measurement for the

rest of this article. Diagnostic Automation, Inc, one company that makes a lab

test for Free T3, lists their reference range as 140 – 420 pg/dL. The NACB is composed of

international members as well as members from the United States. They published

a consensus statement, and a majority of their committee members decided to

list a reference range in a little bit higher: 200 – 500 pg/dL. The Family Practice

Notebook may be using different laboratories, have a different population, or

wanted to be even more “sensitive " at finding people to be hypothyroid.

They prefer to use a range of 230 – 619 pg/dL. Lastly, the reference range for Quest Diagnostics is narrower:

230-420

pg/dL.

Luv

- Sheila

Hi there C,

So Toft is talking through his bot-bot then with what he ays in his booklet of

8 being top of the range?

[Guest guest]

Hi Mo2,

***So Toft is talking through his bot-bot then with what he ays in his booklet of 8being top of the range?

Hmmm, not sure when this booklet had been published ... was it before he became the previous President of the RCP by any chance? That might explain a more generously viewed ref range. Once those endos climb up the social ladder of the establishment, they usually start singing from a very different hymn sheet. Even our friend (not!) Weetmann was once upon a time publishing thyroid-sympathetic articles, but he was a mere doctor then, now he's a Prof and sooo much wiser ......

***Yes it certainly helps, this info, in many ways and in particular thefact the T4 only meds also suppress TSH.So why is he making a fuss about this? With all of us using Armour or T3 onlymeds? if this is already the case with T4 only meds?OR is it the case that ALL thyroid patients on T4 only are purposely kept out ofsuppression and that is ONE reason why a lot of them are kept unwell??????Is this what goes on??????

You are not wrong.... Think about it - who is losing out when patients get too well ? .....You think I am joking? - think again.....

***And my GP insists that I am hyperthyroid basing this on a fast pulse which hasnow resolved itself. I was on beta blockers for it for 2 years then it becameapparent this time last year that my pulse was reacting to certain foods (see DrCcoca's Pulse Test in Files section) and it was this that was sending my pulsehigh. It is fine now....

Shows how much he knows about thyroid disease... A fast pulse rate does NOT exclude Hypothyroidism. True, most hypos are bradycardic, but some are the opposite ... I am one of them with a resting pulse of between 80 -100. I have had this for the past 12 years (10 years before diagnosis and treatment), so it is not something that has been brought on by medication.

Dr. Skinner says in his book (quote): An interesting and critical point is that a number of severely hypothyroid patients can have a tachycardia and not bradycardia, presumably relating to a compensatory mechanism to drive thyroid hormone to thyroid-starved body tissues or perhaps driven by the adrenal glands or even by chronic anxiety which patients reasonably experience from the manifold symptoms of Hypothyroidism. It is a therapeutic delight when tachycardia is reduced by thyroid replacement and most patients are aware of their change in heart rate without actually taking their pulse. I emphasise that absence of bradycardia or presence of tachycardia should never be taken to exclude a diagnosis of Hypothyroidism... (unquote)

***I went to see the consultant at the local CFS clinic who also came to this sameconclusion that I was overmedicated on thyroid and this was causing the highpulse. And he wrote to the GP recommending he get me lowered on thyroid medsasap.

Perhaps you should give him Dr. Skinner's book for Christmas and put a marker at page 63 ....

***I did get the FT4 and FT3 results as well, and of course being on T3 only theFT4 was under range and the the FT3 over range but then it would be having justtaken 50 mcg T3 two hours before the blood draw...That's another area of confusion for me as I have heard several different bitsof advice on when to stop T3 before a thyroid test and I am not sure which istrue... One source said about 12 hours before draw, another a couple of days,another with brekkie and take blood when T3 peaks....

The T3 is the most volatile of the thyroid parameters. I am not quite sure when exactly the T3 peaks after ingestion, but I think you could get a 'high' and a 'low' within the span of 12 hours easily (possibly even less). In my opinion there is no point in checking the thyroid function at all when a patient is on no other thyroid medication but T3 alone ... The TSH is bound to be totally suppressed, the FT4 will be well below the ref range, and the FT3 could be just about anywhere, depending on when the patient has taken the last dose. Even without a blood test you will know when you are on too much, your body will tell you loud and clear.....

***I am thinking of getting myself a little recorder thingee like I think Dawn saidshe did so I can remember exactly what doctors say when I am with them. I oftenforget things that I meant to say or if asked awkward questions my brain cannotrespond quickly enough and I think afterwards of what I wish I had said orshould have said or wish I had known more about so I could sensibly answer.

Good idea.... Make sure the little red indicator light doesn't give the game away (stick some black tape over it), or ask the doctors permission if he objects to you taping the consultation. No reason why he should refuse, but you never know ....

***To that end I am considering asking the GP if he would consider emailscommunication for some consults cos that way I have to think, and consult othersources for info if necessary, and can reply in my own good time.Does anyone think this is a good idea or one that would likely be acceptable todoctors?

Sounds like an excellent idea from a patient's point of view .... but I doubt very much if the GP would see it in the same light. Ignoring for a minute the time that they would have to invest in writing to patients outside office hours, there would be confidentiality aspects to consider (anybody could be at the other end of the computer) and possibly a number of other things I can't think about off the top of my head - but IMHO from a GP's point of view this kind of communication would destroy the hold and advantage they have over us mere mortals when we sit in front of them. Few doctors are interested in actually listening to the patient. They are the professionals, and they are holding the strings. Call me a cynic, but the health industry is just that - an industry, a business. It is firstly about power and money, secondly about health. Nice if it can all be combined, but if not - tough luck.

***I am thinking if explained properly, the brain fog issues, that if would be kindof unreasonable for them to refuse? Disability discrimination or suchlike?

Why not try it on and ask him? he can't do more than refuse. Some doctors do value feed-back from their patients, but it is usually the private consultants who "allow" patients the luxury of contacting them direct. My ENT is such a gem. He has invited me to email him if I have any worries... and he does even reply, albeit a few days later. But I have yet to come across a GP who will communicate with his patients this way. Still - don't ask, don't get....

All the best,

[Guest guest]

So it looks like you pays yer money and you takes yer choice eh Sheila?

Maybe has the right idea, not to stress about it and just go on

symptoms as there seems to be such a divergence of opinion on when to take T3

meds before a blood draw.

It is the TSH of course that is the bugbear with my GP and there is no getting

through to him. He is a young doctor which I had hoped would be an advantage -

open minds and all that - but on the contrary it seems he is v much under the

control of the senior doctors at the practice and when they say jump.......

and the senior doctors are under similar pressures from above......... they ask

" how high " as well.

I agree with that the whole system is rotten to its core.

Many thanks.

Mo

>

> This might confuse you even further Mo

> http://thyroid.about.com/cs/testsforthyroid/a/freet3_2.htm

>

>

>

[Guest guest]

Hi and good morning....

One well known doctor says that it is possible to be hyperthyroid and not know

it by symptoms as the receptors become blocked through over-stimulation.

Has anyone ever heard of this?

I take your point totally about who benefits..... for sure... and I am wondering

what the rationale is with most GPS (anyone on the list on T4 only meds, or

experience of them and GP's take on their TSH status suppressed or not????)as to

WHY their thyroid patients on T4 would need to be producing some TSH?

IS it all down to the fear of heart trouble and osteoporis? Or is there

something else.....

Apart from the Giant Scam of course

I think it has gone beyond the point of trying to educate him now.. last time I

tried to do that face to face is when he got really angry and reduced me to

tears.

I DO h owever need to rebuild some sort of reasonable relationship with him and

if anyone has any thoughts on how to reconcile these two conflicting issues I

would love them forever. And a day

Mo

>

[Guest guest]

Hi Mo, As to T3 testing with or without meds the best thing is, whatever you decide to do, be consistant. I take all my meds before breakfast in one dose, so I get a blood draw appt as early as I can, and don't take my meds before the draw, so when I take them after, it doen't mess too much with my routine. I get consistant results. Occasionally I'll get a surprise draw which I always try to wriggle out of as I know that my T3 will be about twice what it usually is, I try to explain this, but noone listens. > Subject: Re: where IS the top of the FT3 range?> > > > >> Hi there C,> I did get the FT4 and FT3 results as well, and of course being on T3 only the FT4 was under range and the the FT3 over range but then it would be having just taken 50 mcg T3 two hours before the blood draw...> That's another area of confusion for me as I have heard several different bits of advice on when to stop T3 before a thyroid test and I am not sure which is true... One source said about 12 hours before draw, another a couple of days, another with brekkie and take blood when T3 peaks....> > Mo> > > > ------------------------------------> > TPA is not medically qualified. Consult with a qualified medical practitioner before changing medication.> >

[Guest guest]

Hi J

You take all your T3 in one dose?

They (the GP) keeps catching me out by doing thyroid testing without telling

me.....

And, as I posted earlier, then saying the FT3 is irrelevant...

So you have not had any T3 for 24+ hours when you are tested?

Mo

> As to T3 testing with or without meds the best thing is, whatever you

decide to do, be consistant. I take all my meds before breakfast in one dose, so

I get a blood draw appt as early as I can, and don't take my meds before the

draw, so when I take them after, it doen't mess too much with my routine. I get

consistant results.

[Guest guest]

Hi Mo,

Don't offer your doc blood for tests if he springs it on you, just say no.

Glynis

> Hi J

> You take all your T3 in one dose?

> They (the GP) keeps catching me out by doing thyroid testing without telling

me.....

> Mo

[Guest guest]

Hi Mo, Yes! I only take one dose a day- and never take it if I'm going to the doc- she's caught me out too and refuses to understand the difference it makes to the tests. Once bitten twice shy- I got my dose cut in half and she wouldn't raise it again after I'd had a 'good' blood afterwards. If I take my T3 before blood is drawn the result is exactly double than if I took it yesterday- if you see what I mean!! > Subject: Re: where IS the top of the FT3 range?> > Hi J> You take all your T3 in one dose?> They (the GP) keeps catching me out by doing thyroid testing without telling me.....> And, as I posted earlier, then saying the FT3 is irrelevant...> So you have not had any T3 for 24+ hours when you are tested?> > Mo> > > > > > ------------------------------------> > TPA is not medically qualified. Consult with a qualified medical practitioner before changing medication.> >