What do you think of my progress after 6 weeks on Thyroxine? Will I get a dose increase?

[mk366]

So I had all of the classic hypothyroid symptoms for ages but kept being told normal (obviously because of TSH)

My TSH Was always betwen 1 and 2 so not even close to being a problem. But I had been suffering very much with feeling the cold, brain fog, not being able to lose weight, hair thinning and constipation. It was only when I did loads of research and wrote a letter to my GP asking her if she would request free T3 and free T4 so I could be sure it wasn't that (before I went down the chronic fatigue syndrome route!) She was reluctant at the appointment, saying I would definitely not have a thyroid problem with my TSH at 1.5 ish. But it turned out she requested them and these were my results at the beginning of December:

TSH 1.4 (0.3-5)

Free T3 2.1 (3.1-6.8)

Free T4 10.7 (12-22)

The first couple weeks of taking thyroxine were awful, I felt SO tired, so depressed and just sluggish in general. Then after about four weeks things started moving, i have way more energy, I've got my spark back, I visit the toilet sometimes three times every day compared to once every 4 days! and I feel warmer. I also havent had one episode of brain fog, which is so unusual because that was one of my most debilitating symptoms. Not sure if I will start to lose weight because I've been eating excess due to university exams.

Anyway I had my 6 week blood test this week and here are my results:

TSH 0.97 (0.3-5)

Free T3 5 (3.1-6.8)

Free T4 16.5 (12-22)

To the naked eye this looks pretty good, combined with my clinical progression as well it seems that things are working. I was wondering though do you think I will stay on my initial dose (50mcg) or should I ask to try 75 mcg. I kind of want to feel the best I can possibly feel and really back to normal. I do feel way better but I know there's room for improvement. Maybe I should downplay my clinical progression to see what the doctor thinks.

This also shows that some people are more affected by a smaller TSH window i.e I feel crap at 1.4 but good at 0.9.

Hopefully I can receive some guidance and also provide more information for people out there suffering. The last 6 weeks of my life have been massive after feeling rubbish for so long.

Thanks for all your support, when I was first diagnosed this board was my rock and everyone was so helpful and I promised I would always come back and say that things do get better- as everything had been so negative about thyroxine...but it can and does work for some people, I guess.

[Duchy82]

I agree thyroxine does work for a lot of people but not all and you do need to give it a chance as it is slow acting.

I would ask for the 25mcg increase if you feel there is room for improvement although your gp might not be keen on it. You could always have a compromise as a back up if you get a no or if you feel shes not sure about it and suggest alternate days of 50 and 75mcg you would then still get the increase you wanted and she can save a bit of face. Just suggest with it that you are well aware of the symptoms of overmedication and will drop straight back to 50 if you get them although i think its unlikely that will happen.

As long as you approach it carefully and not be too forceful about it you should succeed its a fine balance i always said that i still had symptoms eventhough blood results were better and could i try an increase and gp agreed to treat on symptoms as your tsh was low in comparison to your symptoms to begin with your gp should be more open to treat on symptoms than most.

Good luck!

[shaws Administrator]

Thank goodness she did the T4 and T3. Lots of people are undiagnosed due to the TSH only. It takes some time to work up to a dose that relieves your symptoms and always get a print-out of your blood tests for your own records. Also, if you haven't had a B12, Vit D, iron, ferritin and folate, ask for these too. The first two are usually deficient in hypo and iron is needed to convert T4 to enough T3.

Theoretically (although GP's seem not to know this) we should have increased meds until clinical symptoms go. This is what can happen if not on enough hormone. Go to question dated June 8, 2001 :-

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

The best way to know if the medication is working properly is to ask yourself 'how do I feel' and if 'fine' you are on the right dose. Sometimes when clinical symptoms come back another small increase in meds is due.

I hope you recover quickly as many do well on levothyroxine.

[Ansteynomad]

With a 'normal' TSH and both FT4 and FT3 below range, this looks like secondary hypothyroidism, for which the protocols say that you should be referred to an endocrinologist. However, your GP seems to be doing a reasonable job (with your encouragement lol) but yes, there is room for an increase.

Remember, secondary hypothyroidism has to be treated by FT4 and FT3, not by TSH and both of these are still far from the top 25% of the range, which is where they really need to be.