TSH and liver function Advice please

[Roz123]

After my last test in August my doctor finally put me on 25g of levothyroxine with a TSH result of 7.03 and said to retest in another 6 weeks. I did so and the result was 4.26, so no adjustment made to meds as the receptionist said this was normal. I didn't take her word and asked to speak to doc. He said this was high side of normal and agreed to retest in 2 months. I have now had a thyroid, cholestrol and liver test on 7/11/13. These are the results: Thyroid TSH 4.46 (range to 5) T4 15.1 (range 12-22) - Cholestrol 5.93 (under 5.2) and liver function 44 (range 42). So again no adjustments to meds.

However, they want to retest in two months. I asked what the liver function meant and they said usually heavy drinkers or alcoholics had this and as I don't, told them so, they said this also might be a side effect of medication?? Does anyone know if 25g levothyroxine since 1/8/13 would cause this. The only other med I have been taking for a number of years is a fluid tablet called bendroflumenthiazide. Anyone know??

[shaws Administrator]

25mcg of levothyroxine is a very, very small dose. I was told I should have been given 50mcg when first diagnosed by a Professor of Endocrinology - not 25mcg.

Always take other medication/supplements 4 hours apart from levo. Take levo either in the morning before breakfast with one glass of water and wait for around an hour before eating. You can also take it at bedtime not having eaten for 2 hours beforehand.

Your TSH is too high for someone on medication. Higher cholesterol is one clinical symptom of hypothyroidism and this is what Dr Toft of the British Thyroid Association says:-

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.

*****

I would email [e-mail] and ask for a copy of the whole article above and give one to your GP and his Receptionist so that they can both be educated in the treatment of hypothyroid

patients.

[Jackie]

Hi As regards the liver function if worried ask for the full test LFT`s , having severe liver disease, I have never heard of the one you mention, certainly not used by my Hepatologist, liver specialist. However, a little out on liver is Ok as such a wonderful organ.

Best wishes,

Jackie

[nobodysdriving]

Your doctor is keeping you hypothyroid by the looks of it...TSH still quite high to be honest, fT4 on the low side, your cholesterol still not optimal. If you are having any hypo symptoms ask to increase to 50mcg Daily x

[debjs]

Some of my liver enzymes are slightly high and I have been told this can happen in hypothyroidism and resolves when adequately treated.

[Roz123]

Thanks to everyone who commented. Much appreciated.