Please advise on my blood result and the response from my doctor. Have been taking 75mcg thyroxine for 12 months.

[Susan66]

May TSH - 2.13 (0.27-4.2)

Ft4 . - 1.1 (0.8-1.7)

August TSH - 3.1 (0.3-3.6)

Ft4. - 1.4. (0.8-1.7)

Ft3. - 2.06. ( 2.2- 4.2)

As you can see my TSH is up, and ft3 is very low.

My doctors reply via email was

When monitoring thyroid function test we looked at TSH first as most specific marker for dose modification .FT4 is a second less important marker . but FT3 is not used at all.

As per your results, you only need to increase your dose a little bit

Make it 75 6 days per week and 100 one days per week .

I thought Ft4 and Ft3 were more important that TSH.

Thanks for any advice.

Susan.

[shaws Administrator]

Whatever your GP is saying - it has no relevance on your TSH which is too high as the cut-off in the USA is 3 to diagnose hypothyroidism.

Someone will correct me if I am wrong but I think the range your GP quotes is for people without hypothyroidism (i.e. normal healthy people). This is an excerpt of an article in Pulse online and if you would like a copy to give to your GP email [e-mail]. You can also purchase from Amazon a booklet by Dr Toft of the British Thyroid Association which I believe may help your GP too.

Excerpt

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.

[tegz]

Looks like classic undermedication- but 'How are you feeling'?

I hope you show your GP Shaws' points above- he needs to know!

Email will do nicely..

[Susan66 in reply to tegz]

Hi tegz, I feel really well, lots of energy, sleeping ok, anxiety and depression very little....but still not able to lose weight.

Do you think the extra 25mcg once a week is going to make a difference?

[tegz in reply to Susan66]

Dose is weight dependent -I should be on about 175 not 25

I would say if weight is the issue then nothing to lose by going higher T4- if no bad effects currently.

Just remember to trim back dose when you have done the same trim

Looks like you're the ideal GP classicT4 try out patient from here-

I hope he appreciates it

[Susan66 in reply to tegz]

tegz, what do you mean when you wrote " I should be on about 175not 25 " are you referring to me ?

[tegz in reply to Susan66]

No, that's me [from when I checked] -at my weight.

You'll have to work out what's best for you, let us know how it goes...

[shaws Administrator]

You may well lose weight if you have an increase in your levothyroxine. Some do and these are two links which may give you some information.

Two links here:-

web.archive.org/web/2010112...

web.archive.org/web/2010112...

[Susan66 in reply to shaws]

Many thanks Shaws.