Hi guys,
On thyroxine my TSH dropped to 0.6 (I am taking 50mcg) but my endo recommends to cut down to 37.5mcg saying that 0.6 is low and may not be normal for me. I started taking 37.5mcg which almost straight away affected my energy levels. Feel tired again...any ideas on this? Is my endo right?
How would your endo know what is normal for you? do you have any other test results with ranges?
Did the endo ask you how you were feeling? or did they just see a slightly suppressed tsh and thi k oh ohhh ?
What is the range for the TSH?
If you get a copy of your blood test results from the GP, with the ranges and post for comments.
When you have a blood test for your thyroid hormones it should be the very earliest possible, fasting (you can drink water) and allow 24 hours between your last dose of levo and the test and take afterwards. This prevents your results being skewed and they may adjust your hormones unnecessarily so.
I wouldn't adjust as your dose is so very low, i.e. 50mcg but bear in mind I am not medically qualified but had undiagnosed/ untreated hypothyroidism and am now well.
Your Endocrinologist is another who appears to use the TSH alone to adjust your hormones. Thyroid hormones are very, very important as they run our whole body's system, i.e. from head to toe and the brain/heart are dependent on them to function optimally.
Your GP should test your Free T4 and Free T3 and thyroid antibodies as these are important and are rarely done. You can, if you can afford it, have these done by one of our recommended labs. I shall give you a link just for information.
thyroiduk.org.uk/tuk/testin...
The only thyroid hormone which is required for our body to function is T3 the only active thyroid hormone. Levothyroxine (also known as T4) is inactive and has to convert to T3 so you need an optimum dose of levo.
TSH is not a thyroid hormone and I'll give you an excerpt below from a doctor who was President of the British Thyroid Association who said:
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)."
Due to the fact that most medical professionals are unaware how best to treat patients (by their clinical symptoms) and don't take note of the blood test results and particularly use the TSH alone which is from the pituitary gland to adjust hormones. We feel best when it's below 1, and some need it suppressed.
We have to read, learn in order to recover our health.
You take levothyroxine on an empty stomach with one full glass of water and wait about an hour befor eating usually when we get up is best or at bedtime as long as your stomach is empty.
0.6 is good for most people and certainbly not low. What matters is your FT3 and FT4, which should be in the top quarter of their ranges - and how you feel, of course.
Many thanks for the reply. FT4 is 12.34 pmol/l (ranges: 10.80-22.00). Free T3 is 3.92 pmol/l (ranges: 3.10-6.80).
Those results are both much too low for you to feel well. You need to be aiming for a Free T4 of at least 19 and Free T3 of around 5.5 (or more). You need a dose increase.
As others have pointed out it's FT4 and FT3 results that matter. If you had one of those being over their ranges then maybe a reduction would be necessary. Telling by your symptoms I'm going to say it probably wasn't the right call.
Many thanks for the reply. FT4 is 12.34 pmol/l (ranges: 10.80-22.00). Free T3 is 3.92 pmol/l (ranges: 3.10-6.80).
Both are a bit low. Did you have symptoms around the time of this blood test? Most people feel better with FT3 and FT4 at least halfway in the range, preferably further up (in the top quarter of the range), you are near the bottom.
Your ratio of FT4:FT3 is quite good, meaning that at least at the moment you are converting the hormone well. I would think if you are still symptomatic a slight dosage increase would have been better, but definitely not a decrease in any case as it will likely lower your FT3 results even more.
Thanks for the reply. When I was taking the test, I felt quite OK. After I lowered the dosage, I started lacking in energy and feeling quite low (which may or may not be connected to thyroxine).
It most likely is related to your dosage being lowered, and also could be related to your Hashimoto's. Firstly the reduction in levo would lower your FT4 levels, leaving less of the hormone to be converted to T3. This right off the bat (with your results) would be the likely cause.
Yet you also have Hashimoto's, and it is common for Hashimoto's patients to go through "swings" while their gland is still active. When damage occurs the thyroid tends to dump excess T4 which is stored in the gland's tissue, this temporarily makes a patient "hyper" and has an effect on TSH and FT4/FT3 levels. If you were going through such a swing during that blood test it could be that the results are actually showing the gland activity. But you may then go through a period of calm where your thyroid isn't being as heavily attacked, and during these times your hypo symptoms return. It is tricky dosing a Hashi's patient in the beginning stages for this reason. Eventually as the thyroid gets damaged it is able to produce less hormone, your medication will then have to be increased to make up for it, but also the swings become less drastic and dosage becomes easier (in normal cases).
So there are things like dietary changes that can be made to help calm the Hashimoto's attacks and swings, lowering antibodies (like going gluten free). There is a lot to read about on this forum, I won't get into it here since it's a long topic and it's worth doing a search on this forum for "lowering antibodies". One thing that is worth doing is optimizing vitamin levels (vit D, B12, folate, ferritin) these vitamins are often low in hypos and they lead to their own symptoms, optimizing them helps to aid in better absorption of levothyroxine.
In the end you will likely have dosage changes coming up over the years as your gland activity changes. So it's good to be aware of your symptoms and know the signs of undermedication. Find a doctor who takes your symptoms seriously and isn't afraid of a lower TSH result, and when all else fails become more knowledgable than your doctor 
Thanks a lot, Dang. Sometimes I wonder how much doctors really know...
You're very welcome!
Doctors are just people, most of them aren't as knowledgable as people imagine, but just like any profession there are those who do a great job. Think about hiring a carpenter to build a new fence, you would likely go through a few different companies or contractors, looking at their portfolios and checking their references, and then you hire the one who does the best job. If you don't, you're likely to end up with a horrible fence. Yet many don't shop around for doctors like we do with labourers, and just expect them to already be the "pro with the great portfolio". Haha sorry rant over!
Yulia2010,
What is your TSH range? TSH 0.6 is within all the TSH ranges I've seen so it is not low.
Guys, many thanks for your replies. My other results are as follows: TPO is 573 IU/ml (ranges: 0.00-34.00), thyroglobulin antibodies are 1508 IU/ml (0.00-115.00), total T4 is 96.78 nmol/l (66.00-181.00)
TPO and thyroglobulin antibody levels over the range (as yours are) indicates Autoimmune Thyroiditis (AIT) also known as Hashimoto's Thyroiditis. This is the cause of your hypothyroidism, and due to the autoimmune nature of it your thyroid levels will fluctuate in the early stages of the condition and you may find it hard to find an "even" dosage. Your symptoms may swing from hypo to hyper and back, but as the condition progresses you will likely need more thyroid medication as you become more hypothyroid. Total T4 along with your FT4 result that you gave shows that you have room for improvement by increasing your dosage (if you are symptomatic).
My TSH is 0.06 and everybody is happy, me, my doc and the endo. They know how I'll react if they make any sort of criticism!
Your TSH SHOULD be <1 for you to feel OK when on any sort of thyroid medication. What really matters is how you feel.
Tsh and thyroidectomy 
Fluctuating TSH/Treatment with TSH of 3.5
brands of thryroxine
T3 and suppressed TSH
Suppressed tsh when on T3
