"Now my query is that each time the GP increased my dosage the TSH went down so why has the new GP decreased my dosage?"
Because she doesn't like your TSH to be that low and she is dosing by TSH only. Have you got the reference range? Is your TSH still in range or below range?
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well. How do you feel?
If you feel OK on your current dose, and your GP wants to reduce your dose, ask her why. The answer could very well be "you are over medicated". If so, ask for FT4 and FT3 to be tested. You are only over medicated if FT3 goes over range.
Thank you very much for your reply. I should have given the T4 results together with the TSH results - Here they are:-
2006 result - 4.38 TSH given 25mg T4 9.4
2007 " - 1.7 " " 50mg T4 12.0
2009 " - 3.72 TSH " 75mg T4 9.0
2010 " - 0.82 TSH " 100mg T4 11.6
2011 " - 1.16 TSH " 125mg T4 12.8
2011 " - 0.35 TSH " 150mg T4 13.5
2013 " - 0.45 TSH " 175mg T4 14.4
2017 result - 0.37 TSH T4 13.9
The GP said the reference range was - 0.27 to 4.2 for TSH and 12 to 22 for T4.
I'm not quite sure what you mean when you say "she is dosing by TSH only"
As regards how well I feel?
I've been feeling "out of sync" for a little while now and this luckily coincided with my annual Thyroid Function blood tests.
When I asked the GP to explain the numbers further as I was confused (basically as my first post ie: my original GP seemed to put the dose UP as the TSH reduced - she said "you must not get obsessed with the result numbers!!)
I said "I just don't feel to well" She replied "well that could be something else"??
Which wasn't particularly helpful.
Thank you very much for taking the time to read my post and to reply, I'm very grateful for your input.
"I'm not quite sure what you mean when you say "she is dosing by TSH only"
When you are showing symptoms of Hypothyroidism your TSH will rise. When it goes over the top end of the range you should get a diagnosis and be started on Levo. You can see that from your original result in 2006 when your TSH was 4.38 (0.27.4.2).
Taking Levo will result in your TSH decreasing, which is what you need. As I said the aim of a treated hypo patient generally is for TSH to be 1 or below. Most GPs are obsessed with keeping TSH in range and panic when we get near the bottom or go under range. That doesn't mean that we are over medicated. FT4 (Free T4) can safely go over range (another panic trigger for most GPs) but as long as FT3 (Free T3) stays in range we are not overmedicated.
(The Free T4 and Free T3 are what is measured in the blood)
From ThyroidUK's 'Treatment Options' under 'Hypothyroidism' on their website:
" Dr Toft states in Pulse Magazine, "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)."
Dr Toft is a leading endocrinologist and past president of The British Thyroid Association and if you would like a copy of the article you can email louise.roberts@thyroiduk.org.uk
[If you've not already done so, look around ThyroidUK's main website for lots of thyroid related information, this is ThyroidUK's forum, thyroiduk.org.uk/tuk/diagno... ]
With the range of FT4 being (12-22) then in all of your tests you will see that yours has always been near the lower end, and your current level at 13.9 is very low. It should be nearer the top end, usually within the top third of the range, if that is where you feel well. So there is absolutely no reason for reducing your Levo, doing so will increase your TSH (which is what your GP wants to see) but will also reduce your FT4 and the result of this will bring back your hypo symptoms.
You are feeling 'out of sync' because you are not optimally medicated. You may need an increase in your dose of Levo BUT you are already on a highish dose. As your FT4 is very low in range it's possible there is an absorption issue and the T4 isn't being utilised.
What would also be very useful is to have your FT3 tested. It could well be that you may not be converting T4 to T3 well enough. T4 is a storage hormone of which some converts to T3 which is the active hormone required by every cell in our body. If your FT3 is low you won't feel well, but you have so little T4 anyway that it's hardly possible to see how you're converting.
It may be something else, and that something else is usually that our vitamins and minerals aren't optimal and unless they are thyroid hormone can't work properly. Have you had the following tested, if so post the results (with reference ranges), if not ask for them to be done:
Vit D
B12
Folate
Ferritin
Sorry if all this is confusing, it can be at first as there is such a lot to learn. Read it over a few times.
Keep asking questions and check out ThyroidUK's website.
So you are not overmedicated as your Ft4 is still way below what it should be (top quarter of range), but your GP is choosing to ignore that and reduce your dose because of your TSH level (which is largely irrelevant once you are on meds). She's the one who is hung up on numbers. Your FT4 is low and you don't feel well = you are still hypo and need a dose increase QED. Occam's razor says it is not likely to be something else: the simplest solution is usually the correct one. Ask Louise.Roberts@thyroiduk.org.uk for the Pulse article that explains that some people need low TSH and even overrange FT4 to feel well and show it to your doctor. If she thinks she knows more about the thyroid than the ex-president of the British Thyroid Association, then it's time to find a new doctor ...
If your GP won't do the full thyroid tests and many won't then you may have to save up for yourself. Look at the Thyroid Uk site for details of where to go for tests but also lots of other useful info as well. The tests may show you aren't converting well and for that to show you need the FT4 and the FT3 result then you can work on your general health to help that for a start.
Thank you very much for your reply. I should have given the T4 results together with the TSH results - Here they are:-
2006 result - 4.38 TSH given 25mg T4 9.4
2007 " - 1.7 " " 50mg T4 12.0
2009 " - 3.72 TSH " 75mg T4 9.0
2010 " - 0.82 TSH " 100mg T4 11.6
2011 " - 1.16 TSH " 125mg T4 12.8
2011 " - 0.35 TSH " 150mg T4 13.5
2013 " - 0.45 TSH " 175mg T4 14.4
2017 result - 0.37 TSH T4 13.9
The GP said the reference range was - 0.27 to 4.2 for TSH and 12 to 22 for T4.
I'm not quite sure what you mean when you say "she is dosing by TSH only"
As regards how well I feel?
I've been feeling "out of sync" for a little while now and this luckily coincided with my annual Thyroid Function blood tests.
When I asked the GP to explain the numbers further as I was confused (basically as my first post ie: my original GP seemed to put the dose UP as the TSH reduced - she said "you must not get obsessed with the result numbers!!)
I said "I just don't feel to well" She replied "well that could be something else"??
Which wasn't particularly helpful.
Thank you very much for taking the time to read my post and to reply, I'm very grateful for your input.
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