Bloods in October,endo wants to reduce meds. but to what? Help please.

[beaton]

After the awful endo appointment last week when to endo registrar wanted to reduce my doesage,I am still waiting for the hospital to contact me.

Bloods in Oct. were TSH 0.08 T4 12,7 (range 11 24) T3 in August was 4.8

Basal temp.34.8

BP 150/85 Pulse

Dose 100 mcg. T4 20 mcg T3 divided into two.

After visit reduced dose as told to 50 mcg T4. plus 10 mcg T3

I was ill very cold and shaky. That was Friday,I am still waiting for the promised phone call from the endo nurse.

I don't know if to give up the quick acting T3 and go back to my previous 150 mcg T4 dose or just reduce both T3 and T4.

Help please.

[Moggie]

Did you take your T3 on the day of your tests as this can give a false reading - if you did then you need to explain to the nurse that this is what happened and ask her to have a word with then endo for you.

Moggie x

[beaton in reply to Moggie]

Hi Moggie,no I didn't take any meds at all that day,I was expecting them to take bloods,but they didn't.

I spoke to reception Tuesday as I had heard nothing,it was she who asked the nurse to ring and made me another appointment with the man himself,in January.

[Moggie]

Sound to me like they have reduced you to much. Usually they reduce one or the other but not both. If you still have enough T3 left I would be tempted to reduce my T4 to 50mcg's as asked to and keep my T3 at 20mcg's and see how things go.

Are you getting on o.k. with the T3? If so they I would fight to keep it at 20mcg's, if not then maybe allow them to reduce this by 10mcg's but keep your T4 at 100mcg's but I wouldn't be allowing them to reduce both as they have reduced your meds by 50% and that really is not good. Yes your TSH is low but you are on T3 and it will be but your FT3 is not high (although you didn't give a range I am assuming the range would stop at about 6'ish).

Moggie x

[beaton in reply to Moggie]

Thanks Moggie, wasn't given range for T3. I shall take your advice. Fingers crossed the hospital will ring....one day.x

[Moggie in reply to beaton]

You need to be going on how you are feeling more than what they are saying your blood results are. Reducing you by 50% just goes to show that they are going by your TSH alone, which is fairly useless when you are on T3.

Moggie x

[beaton in reply to Moggie]

Thanks Moggie,If I could get hold of that registrar,well I'd better not say.xx

[shaws]

These are a few links. How were you feeling when your October tests were taken? If you were feeling well, I personally wouldn't change. No doubt they made a decision on your TSH result (mine is 0.01 and am fine). When you take T3 too your T4 will be lower than the normal range when taking T4 alone.

Cursor to questions dated August 13, 2002: January 30, 2002 and January 2, 2002

web.archive.org/web/2010103...

This is from Dr Toft and if you want a copy of the whole article for your Endocrinologist, email [e-mail] and ask for the Pulse Online article.

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.

[beaton in reply to shaws]

Thanks Shaws,yes I was feeling OK. I will email Louise.