What to expect when on Levothyroxine?

[Seton]

Hi, wonder if some of you can please help me. I've only recently been diagnosed with hypothyroidism, my only symptom was being tired.

My first set of bloods showed

TSH: 12.6

T4: 8

T3: ( I lost this one)

I don't have the ranges to hand but looking on Thyroid UK they say usual tests are:

TSH (0.4 - 4.5)

T4 (10 - 24)

T3 (4 - 8.3)

So, to start I was given 100mg of levothyroxine. After 3 months my bloods are:

TSH: 0.01

T4: 18.7

T3: 6.4

My dose has been reduced to 75mg to bring my TSH up a bit.

I wanted to ask two questions:

1. I have read that reducing the dose to raise the TSH is common, however wont this in turn reduce by T3 and T4?

2. I have been feeling better on the levo, however I still have days when I'm tired and want to have a sleep. Is this normal as it's worrying me? I don't know how long things take to settle down, surely now my T3 and T4 are in range should I now been having NO days of wanting to sleep? Or is it not that simple?

Any reassurance would be appreciated.

[jimh111]

It would be useful to have dates for when you were diagnosed and had your dose reduced to 75 mcg. It's also worth asking the surgery for the reference intervals for your blood tests. You should start to feel better within a few weeks but it can take a long time to fully recover, up to six to twelve months.

When diagnosed your TSH was only a little high but your fT4 looks quite low (assuming typical reference interval of e.g. 10.0 to 20.0). Your doctor got you onto a decent dose quickly and from a blood test point of view the reduction to 75 mcg makes sense. The blood tests don't always reflect how we feel or actually how we are. However, it is early days for you and I'd be tempted to go by the blood test results for a few months.

Do you have any other symptoms other than feeling tired? Hypothyroidism presents with lots of signs and symptoms. Often hypothyroidism seems to lead to anaemia and this can cause tiredness. I'd mention to your doctor that you are still tired and suggest he checks your iron levels, if they haven't already been checked.

We patients find it can take a long time to sort out thyroid problems, it is much more complicated than the medical profession believes it to be.

[Seton in reply to jimh111]

I was initially diagnosed May 2017 so was on 100mcg for 3 months. My latest bloods were last week and started 75mcg last week too. does this help?

My only symptom has been tiredness. In May I had 7 blood tests done, from what I can remember this included Iron, Vit B Complex, Kidney, Gluten, diabetes so it doesn't appear I'm deficient in Vit B or Iron.

[Whiterose in reply to jimh111]

I am puzzled. I received this info on my bloods: TSH: 0.57 T4 21 and T3 -3.8 cam anyone make sense on this?

[greygoose]

You cannot use just any old reference range to interpret your results, you need to know the reference range used by the lab where the tests were done. That's very important because ranges change from lab to lab, according to the machine they use to do the tests.

You're right, it's not that simple. For a start, you should have your nutrients tested : vit d, vit B12, folate and ferritin. These need to be optimal for your body to be able to use thyroid hormone. And, if they are sub-optimal, they will cause symptoms. If your ferritin is low, that will make you tired. But, don't expect any help from your doctor with the results, he won't have a clue! Just post them here, with the ranges, and people on here will help you interpret them.

[Seton in reply to greygoose]

Just called the doctor and here are my results from last week with ranges:

TSH: 0.01 (0.34 - 5.6)

T4: 18.7 (7.9 - 20)

T3: 6.4 (4.0 - 6.6)

As I said above, due to the TSH, my GP has reduced the LEVO to help bring it up a bit so have been on 75mcg for a week

In general the last 3 months since starting Levo I've been feeling much better however for the last few days I've been feeling tired again. I'm not expecting the reduction in Levo to have created this tiredness so perhaps it's something else?

I guess I just assumed that once the T4 and T3 are within range then I'm better...

[Angel_of_the_North in reply to Seton]

If you felt good, there was no need to reduce your levo as your free T4 and free T3 were both in range. It looks as though your conversion is very good, so the dose reduction probably won't make much difference. But your doctor should not adjust dose by TSH, which is not a thyroid hormone, but by the levels of free T4 and free t3.

You also need to know your levels of ferritin, B12. folate and vit D.

[shaws in reply to Seton]

I agree with Angel_of_the_North he should have left your dose alone. The problem is that they are told that a low or suppressed TSH is bad - when it isn't. If we're feeling well on a particular dose and your results look perfect to me I'd be apt to increase your dose up again.

The TSH is from the Pituitary Gland. I posted this link the other day.

[Seton]

Would a drop from 100 to 75mcg make me tired? Started the 75 on Saturday and on Monday the sleepiness started? Seems to quick to be the lower dose does it?

[jimh111]

Could be you need to go back to 100 mcg. Hypothyroidism is progressive and so your dose needs increasing a little occasionally until your thyroid has completely failed. If tiredness is your only symptom your thyroid treatment will not be far off, although the tiredness may be due to something else.