My TSH was 2.86 T4 21 T3 3.6. Do these look ok? Dr doesn't want to increase levothyroxine as I have anxiety symptoms

[130396]

*(tummy keeps doing sommersaults...... like exam nerves!!!)

[shaws Administrator]

You anxiety may be a clinical symptom as your TSH is still high for someone on medication. It is helpful if you can put the ranges of your blood tests as labs differ through out the country and it makes it easier to comment.

Your GP must be one of those who believes keeping the patients' TSH within range. This is an extract from Dr Toft which was in Pulse Online (doctors' mag) and you can show a copy to your GP. You will see from this that your TSH is too high although some may say they feel o.k.

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.

[130396 in reply to shaws]

Hi again

The ranges in this area are

TSH .1 - 5.0

FT4 12 - 22

FT3 3.8 - 6

If you think these could be better if my TSH was lower and the others were higher wouldn't that make me feel even more anxious?

[shaws Administrator in reply to 130396]

I am not medically qualified but it is the ex President of the British Thyroid Association who I quoted above it is his recommendation.

Personally, I think it is the levothyroxine which makes us feel anxious and this is a link which may be helpful.-

drugs.com/answers/side-effe...

When I was having problems with levo I was given Eltroxin which made such a difference, a Brand name which has now been discontinued in the UK. This is an excerpt and you will see the Endocrinologists in the USA were against the introduction of generics.

While the United States Food and Drug Administration (FDA) approved the use of generic levothyroxine for brand-name levothyroxine in 2004, the decision was met with disagreement by several medical associations.[6] The American Association of Clinical Endocrinologists, the Endocrine Society, and the American Thyroid Association did not agree with the FDA that brand-name and generic formulations of levothyroxine were bioequivalent.[6] As such, it was recommended that patients be started and kept on either brand-name or generic levothyroxine formulations and not changed back and forth from one to the other.[6] For patients who do switch products, it is recommended that their TSH and free T4 levels be tested after six weeks to check that they are within normal range