G.P has worried me. Advice re blood results please

[lucylocks]

Hi

Had my appt. yesterday with G.P. and she said I was over medicated. I am taking 100mcg levo. Latest test results TSH 0.25 (range 0.35 - 4.7) T4 12 (range 7.80 - 21.00) Note on lab report says please note FT4 results are approx. 2 pmol/L lower than the previous method. G.P. wanted to reduce back to 75mcg but I went through everything I've learnt from this site and Doctor Tofts book with her and she agreed I could stay on 100mcg but said she would enter it on my records that we had had this discussion but then worried me by saying so if I get atrial fibrillation in 10 years time it would be my fault and not hers. I then asked her to refer me to an endo which she has agreed to do and said waiting list would be about 2 months. I posted results in a post last week but will list them again as I really need reassurance I am doing the right thing by staying on 100mcg.

April 2013 taking 75mcg levo TSH 4.3 (range 0.5 - 5.0) T4 not done, increased to 100mcg 15th May

Results from Blue Horizon 15th June TSH 0.49 (range 0.27 - 4.2) T4 20.1 (range 12.0 - 22.0) FT3 3.7 (range 3.1 - 6.8)

Results 10th July TSH 0.25 (range 0.35 - 4.70) T4 12 (range 7.8 - 21.00) note on lab report next to this saying Free T4 results are approx. 2 pmol/L lower than the previous method.

As you can see from the Blue Horizon results to the lastest ones my T4 has dropped, what does this actually mean?

why has it dropped, if anyone could answer this and advice on whether I am O.K. to stay on 100mcg I would really appreciate it.

Many thanks browny

[PinkNinja]

Please don't worry. My TSH has been below range for years and nothing has happened. Experts in thyroid matters feel that you should be ok provided your TSH is well within range. As your T4 is at the lower end of the range, you are almost certainly fine.

There has been recent research suggesting that TSH isn't a reliable test for hypothyroid patients because it doesn't respond in the same way to thyroid hormone levels as it does in healthy patients. Your doctor should be going on your T4 and T3 results really

Carolyn x

[lucylocks in reply to PinkNinja]

Thanks Carolyn for your quick response, I do not quite understand as you say your TSH has been below range for years but then say Experts feel that you should be O.K. provided your TSH is well within range but mine is below, Do you mind clarifying please, I am a bit confused but it doesn't take much these days

Many thanks browny

[TTLady in reply to lucylocks]

Hi browny

My TSH is 0.08

A suppressed TSH is not a problem unless your T3 Is high. It's elevated T3 which causes heart & bone issues not your T4.

In my opinion your T4 is a bit low but maybe you convert very well. If you experience any hypo symptoms your body would easily cope with an increase, you certainly don't need any kind of decrease

[lucylocks in reply to TTLady]

Thanks TTLady

Feel better after reading your reply, just wish like everyone else on this site Doctors were more informed

Best Wishes browny

[Stourie in reply to lucylocks]

My tsh is 0.01 and my dr and endo are fine with that, so please don't worry at all. You WILL be alright with a tsh of 0.25. honest.

Jo xx

[lucylocks in reply to Stourie]

Many thanks Joanna

That's really reassuring

Best Wishes browny

[RedApple Administrator in reply to lucylocks]

I think Carolyn typed TSH by mistake, when she probably meant T3.

[lucylocks in reply to RedApple]

Thanks RedApple

I understand now

Best Wishes browny

[shaws Administrator in reply to lucylocks]

There's no need to worry. Your most likely to have heart problems with undertreated/undiagnosed hypo.

My TSH is 0.01 and am fine and GP is happy. This is an excerpt from Pulse Online, and you will see that it is o.k. to have a low or even suppressed TSH. Unfortunately GP's know very little.

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

[lucylocks in reply to shaws]

Many thanks Shaws

Feel better after your reply, as my T4 is not now in the upper range does that mean I need more levo or does it mean I am not converting T4 into T3 and would do better with T3 added

Many thanks browny

[shaws Administrator in reply to lucylocks]

The best way to know if the medication is working for you is for your GP to ask 'how do you feel' and if you feel good you are on the right dose. If you still have symptoms you need an increase.

My TSH is 0.01 and am well. The TSH is variable throughout the day and it is best to have your blood test early a.m. before medication.

[lucylocks in reply to shaws]

Thanks Shaw

Best wishes browny

[PinkNinja in reply to lucylocks]

Sorry. I meant your T3! Brain fog moment!

[lucylocks in reply to PinkNinja]

Many thanks Carolyn,

Your reply has put my mind at rest

Thanks so much

Best Wishes browny

[PinkNinja in reply to lucylocks]

Also sorry for not responding earlier. Not getting notifications means we don't know when someone replies. Thank goodness they are working now!