Right or wrong?

[Debs1960]

Just been back to see GP who has said that because the Well woman check shows my TSH level has come down since starting levothyroxine (now 2.4 range 0.3 to 5.5) I'm on the dose I need to be on which is only 25? I had this test not knowing so I'd had the levothyroxine and coffee before the test he said that wouldn't make a differance?

[SeasideSusie Remembering]

Debs1960 We always recommend blood tests be done at the first appointment of the morning, fasting overnight (water allowed) and leaving off Levo for 24 hours. This gives the highest possible TSH which is what is needed when looking for an increase in dose or to avoid a reduction. It also gives continuity of conditions so that all future tests can be compared accurately. Doctors won't recommend this because all they look for is whether you come somewhere within the range.

Always take your Levo on an empty stomach, one hour before or two hours after food, with water only, no coffee, tea, milk, etc. This way means that nothing affects the absorption of Levo.

As far as where in the range most people feel best, Dr Toft, past president of The British Thyroid Association and leading endocrinologist, said this in a Pulse Online Magazine article:

"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)."

You can obtain a copy of the article by emailing [e-mail] . Highlight question 6 to show to your GP then ask for an increase in dose. Retest again after 6-8 weeks, another increase if necessary, another retest after another 6-8 weeks etc until your symptoms abate and you feel well.

[Debs1960 in reply to SeasideSusie]

Thanks for quick reply I know about when to do test from the invaluable information on this site 😊 I just didn't know they were testing my thyroid when I mentioned it I was told it wouldn't make a difference I'll do as you suggested though my gp has said to re test anyway but think I may leave it a couple of weeks? x

[Angel_of_the_North]

Wrong! The aim of levo treatment is to remove symptoms, which, for most people, means that TSH will be under 1 and FT4 (and FT3) in the top quarter of their ranges. Having levo before the test will give you a false low TSH and high FT4. If you fell well, that's fine, but 25 is usually a starter dose for someone very frail.

[Debs1960 in reply to Angel_of_the_North]

Thanks for reply they only tested TSH as part of my Well woman check!! I feel rubbish no better than when my TSH was 7.7 though I do have a lot of stress at the min 😒 I've never thought of myself as frail at 57? Originally wouldn't give me any medication until they tested the antibodies which came back over range!! x

[Angel_of_the_North in reply to Debs1960]

A really low dose often makes you feel worse as stops your thyroid producing most of what it was managing to do before, but does not provide enough to make up for the loss. I'd see about changing your GP as that one is going to keep you feeling ill. It's worth getting the Dr Toft Pulse article from [e-mail] to show to your doctor when you ask for an increase.