Reducing dose

[Chelsie117]

I have just joined and my doctor has asked me to reduce my thyroxine from 175mcg levo and 20mcg t3 to 25mcg levo I am not feeling over medicated and I still have hypothyroid symptoms any ideas why? I have been taking levo since 2011 thank you

tsh <0.02 range 0.2 - 4.2

free t4 26.5 range 12 - 22

free t3 4.1 range 3.1 - 6.8

ferritin 16 range 15 - 150

folate 2.2 range 2.5 - 19.5

vitamin b12 207 range 180 - 900

total oh vitamin d 13.5 range <25 severe vitamin d deficiency patient may need pharmacological preparations

[cjrsquared]

He truly wants you to drop your Levo by 150mcg, that is ridiculous! Your ft4 is over range but considering that you are also taking 20mcg t3, your ft3 is still quite low suggesting that you do not convert t4 to t3 very well. It would be more reasonable to suggest that you drop levothyroxine by 25 or 50 mcg, then retest in 6 weeks with a view to increasing liothyronine to bring ft3 higher in range. It may be that the lowish ft3 is why you still have hypothyroid symptoms. Are your vitamins and minerals in range as iron deficiency anaemia, low vit b12 and low vit d, can mimic hypo symptoms but also inhibit the conversion of ft4 to ft3.

Hopefully some of the other more experienced contributors will also respond soon. Goodluck.

[Chelsie117 in reply to cjrsquared]

Thank you yes he wants to reduce to 25mcg and yes vitamin and mineral results are in range

[startagaingirl]

Hi and welcome. Just to clarify, have you really been asked to reduce your dose TO 25 mcg or should that be BY 25mcg? I will assume the latter as the first would be really unjustified.

Your FT4 is well over range but your FT3 is quite low in range. Given that you are already taking some T3 that shows that you are not converting well. Such a high FT4 may in itself give you issues in that your body may convert extra to reverse T3, blocking receptors and making you feel even worse.

There are a couple of issues and approaches here - an underlying one first. Have you had your nutrients vit D, vit B12, folate and ferritin checked? If any of these are less than optimum (relatively high not just in range) then your conversion will suffer and you won't be able to effectively use what you do have. Then to avoid making this worse, a normally recommended approach would be to change your treatment ratio - take less T4 and more T3 instead.

If you already have those nutrient values (with ranges) then post them alonside your thyroid numbers above and members will be able to give specific advice.

Gillian

[Chelsie117 in reply to startagaingirl]

Thank you yes I have been asked to reduce to 25mcg and i have been told everything is in range for vitamins and minerals

[greygoose in reply to Chelsie117]

Do not do that. That is too much of a reduction and could make you feel very bad. Reductions should be done 25 mcg at a time, just like increases. Any more than that will stress the body too much. Just reduce BY 25 mcg, and retest in 6 weeks.

Vitamins and minerals just 'in range', is not good enough. The ranges are far too wide. They need to be optimal. And, to know if they're optimal, you need to have the exact numbers and ranges. If you have them, post them here, and people will help you.

[Chelsie117 in reply to greygoose]

Thank you they have been added to the post

[startagaingirl in reply to Chelsie117]

Hi - well first off, totally ignore that instruction to drop to 25mcg, that would leave you very, very sick. Second - change your GP if at all possible and Third - your nutrients are not only not all in range - see your folate - but they are all at the very low levels typical of hypos and need to be supplemented.

Your GP should prescribe folic acid to bring folate up and loading doses of vit d followed by a maintenance dose to bring that up. With vit D it is important to also take vit k2-mk7 to direct increased uptake of calcium to bones & teeth rather than soft tissues and also magnesium, but don't expect your GP to know this. You also need to supplement vit B12 and iron, but as these are just within range you may struggle to get your GP to prescribe these.

There are lots of threads on supplementation, search in the box top right for "vitamins and minerals" to find more details.

Good luck

Gillian

[shaws in reply to Chelsie117]

Don't follow his instructions. Thyroid hormones have to be increased gradually so it follows decreases have to be low as well. Follow greygoose 's advice but you have to supplement B12 with sublingual methylcobalamin B12 which dissolves under the tongue. The aim is to be at the top of the range. Deficiency can cause serious neurological problems.

It looks as if your doctor is another who hasn't a clue. He has only gone by the TSH result and thinks you're going to have a heart attack but the TSH is nothing to do with the thyroid gland. Most doctors think 'in range' is perfect but not if it is at the bottom of the range or below. TSH is from the pituitary gland which if thyroid hormones are failing, it tries to attempt to flag the thyroid gland into producing more hormones.

In range may be o.k. for a healthy patient, but not if hypothyroid. We have a very serious disease which has to be treated optimally which means a low TSH, with good FT4 and FT3 results. Your FT4 is on the high side. This is a copy from above:-

ferritin 16 range 15 - 150 - far too low

folate 2.2 range 2.5 - 19.5 -far too low

vitamin b12 207 range 180 - 900 - far too low - should be around 900 to prevent neuroligical symptoms.

total oh vitamin d 13.5 range <2 - you need a prescription for D3.

[shaws]

Did you leave a gap of 24 hours between your last dose of thyroid hormones and the blood test?

[Chelsie117 in reply to shaws]

Thank you yes I did

[galathea in reply to Chelsie117]

Your ferritin is at the bottom of the range, it needs to be half way through else you cany make use of the t4 .

You need some iron, but dont take it amywhere near the thyroid meds.

X

[Chelsie117 in reply to galathea]

I will go to doctor and discuss results of these

[lc1973 in reply to Chelsie117]

Good plan Chelsie. I think your doctor should have discussed these results with you as although some of them are in range they are rock bottom in the range, if you were nearer the top of the range i'm sure you would feel a lot better than you do, and having low ranges of these vitamins will make you feel very unwell with hypo symptoms too. Your FT4 is over range (too high) but not much FT3 is being converted probably due to your low vitamin levels..i have this problem too and others have suggested to me and i am suggesting to you as well that this be addressed otherwise your thyroid medication wont be working very well. I am not medically trained by the way, just hear to learn and try and help others. Go see your doctor... he or she should listen to your symptoms and not be guided by your results in range or otherwise. Good luck.