Hi, here are my recent bloods. Please could you give any advice. I'm on 150mcg Levo. Been treated for last 14 years (I'm 37). GP wants to reduce my thyroxine even though I have no hyper symptoms and still some hypo symptoms. I also take Vit D and Berroca daily.
TSH 0.01
FT4 18.7 (11.00 - 22.60)
FT3 5.2 (3.50 - 6.50)
Vitamin D 46.1 nmol/l
Serum B12 394 mg/l (211.00. - 911.00)
Serum ferritin 13 ug/l (15.00 - 290.00)
Haemoglobin est 113.00 g/l (115.00 - 150.00)
Haematocrit 0.333 ratio (0.36 - 0.46)
Seeing my GP next week. I know any reduction will make me feel unwell but they are very TSH fixated!!
Thank you in advance for any help
Louise
Written by
Polina44
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First thing I will say is - don't reduce levo if you're feeling o.k. Your GP is just doing it because your TSH is low. I don't know how many GPs only diagnose by the TSH only and not the patients clinical symptoms. You will most probably develop more if you reduce.
He cannot make you change your dose but we are so used to following doctors instructions many of us do what they say automatically but to do so with thyroid hormones it's not a good thing at all. This is how we should be treated so that we recover our health.
Your FT4 and FT3 are fine so it must be B12 and D which is giving you clinical symptoms. Has your GP taken any action over these and your ferritin level?
Your blood tests aren't all at an optimum level, which they should be. As long as they are 'in range' GPs think everything is well. We have to be towards or in the upper range of any minerals/vitamins.
My TSH is often 0.01 - and my doctor has never tried to reduce.
Your B12 is too low. Supplement with sublingual methylcobalamin B12. You cannot overdose, excess is excreted.
Ferritin is below range. Someone will come along and give you advice about it.
Vitamin D is too low, and with B12 and D low you may be experiencing symptoms. Both are very important hormones. I believe Vit D should be around 70.
Thank you for this. Yes I never take my Levo before a test. I am taking Vit D and Berroca but will look at upping my dose!! I have to have repeat bloods next week so I'll see if anything varies? I've had a recent Dexa scan as a result of an unexplained fracture and it was fine. Turned out to be a stress fracture from running everyday following no excercise!! Can I refuse to reduce my Levo dose?? Can they refuse to prescribe??
They cannot refuse to prescribe. Just play it cool and say you are a member of Thyroiduk.org who is one of the NHS Choices for advice. You now have a copy of Dr Toft's recommendations and that it is o.k. to have a low or suppressed TSH or the addition of some T3. Email louise.warvill@thyroiduk.org and ask for a copy of the Pulse online article by Dr Toft. Question 6 is the one you want to highlight. 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.
****
Dr Toft was President of the BTA and is the Queen's Physician when she's in Scotland.
Polina, Dr.A. Toft discusses some patients needing a low or suppressed TSH to feel well in the link below. He says that FT4 may be over range but FT3 must remain within range. TSH there is no indication that you are overmedicated other than suppressed TSH which is to be expected on 150mcg. Email louise.warvill@thyroiduk.org.uk if you want a full copy of the article to show your GP.
Ferritin is below range so your GP should prescribe iron. Ask for Ferrous Fumarate which is less hard on the gut than Ferrous Sulphate. Take each iron tablet with 500mg-1,000mg vitamin C to aid absorption and mitigate constipation.
Supplementing 5,000iu vitD3 for 6 weeks and then cutting back to alternate days will improve vitD and 1,000mcg B12 methylcobalamin sublingual tablets, spray or patches will improve B12.
Iron and vitD should be taken at least 4 hours away from Levothyroxine.
The Vitamin D Council suggests that a level of 50 ng/ml is the ideal level to aim for. This is why the Council recommends that adults take 5,000 IU/day of vitamin D supplement in order to reach and stay at this level.
The Endocrine Society recommends taking a vitamin D supplement of around 2,000 IU/day to reach and stay above a level of 30 ng/ml. This is what the Endocrine Society recommends as the ideal level to aim for. Lastly, the Food and Nutrition Board recommends 600 IU/day of vitamin D supplement because they believe 20 ng/ml is the ideal level to aim for.
This is a excerpt re Ferritin - I don't know why the columns all went squeegee on the vitamin D above but I've rearranged them now.
The average reference ranges for ferritin are 14-170 micrograms per litre, but our research shows that ferritin should be at least 80 ug/L (micrograms per litre) in women for hair follicles to function at their best.
I'd like to say a few words to your GP. Mr. or Ms. GP, what are you going to do about my very low ferritin which is so necessary to convert T4 to T3, or would you like to order my T3 separately?????? Also, did you notice my hematocrit is not even in range????
Polina, this makes me ill....don't lower your T4. Tell him he can resuggest it later when and if you get your ferritin and iron level raised. You must be anemic, right?
If they won't concede, change doctors. I hope you are taking B12, you need to get that way up.
Two years of reading here and I still cannot believe the GPs in the UK. Terrible.
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