Another doctor’s appointment- advice please

[Chelidonium62]

I’ve got a doctor’s appointment tomorrow to discuss my latest test results and would appreciate some advice on them so I know the best thing to say. I was diagnosed hypothyroid last year and started to feel better in the summer after a dose increase to 75mg of Levo, however my TSH dropped to 0.16 (0.2-4.2)and the practice told me to drop to 75mg three days a week and 50mg the rest. I didn’t want to as I was feeling well but I got a message back that although I was feeling well if I continued on 75mg I would start to feel tired again. I did what I was told as I didn’t feel I had much choice but my health has just gone downhill again and I feel so tired and cold again. I was told to have a retest in twelve weeks which I did. I’ve just checked my recent test results and my GP has marked them, normal and no action required. My TSH has gone up to 2.71 (0.2-4.2) following Levo decrease in late July.

I don’t have a T4 result this time as this isn’t tested here if results are in range.

My results from July ; TSH 0.16 (0.2-4.2) T4 18.6 (11-22)

Last vitamin, mineral results;

Vitamin D3 64nmol (>60 sufficient) April 2017 (a drop from 87 in February)

B12 368 ng/L (180-630) August 2016

Serum ferritin 89 ng/ml (12-233) August 2016

I’m taking ferrous fumarate 210mg daily

Vitamin D3 1000iu Daily

Methyl Vitamin B12 1000mg Daily

Vitamin c 1000mg daily

I’m going to ask to go back up to 75mg and make a fuss if they don’t agree. Is 0.16 TSH so bad? It’s only just under range. Even if I can get a dose increase I don’t want to be in the same situation if it drops again.

Thank you for your help. Sorry for such a long post!

[lc1973]

Defo ask for an increase. Explain your ongoing symptoms. Your results on 75mcg were much better and i expect you felt better than you do now? My TSH is 0.03 and my GP is happy with that but i didnt get an FT4 or FT3 result with that so i've just paid for a private blood test to make sure i'm converting all of the levothyroxine i'm taking.

[Clutter]

Chelidonium62,

TSH 0.16 is fine as long as FT3 remains within range. It's unlikely FT3 is over range with FT4 18.6. . Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

VitD is optimal >75 and most people are comfortable around 100. I would supplement 5,000iu D3 for 6-8 weeks then reduce to 5,000iu alternate days and retest in April. Take vitD 4 hours away from Levothyroxine.

[Angel_of_the_North]

TSH isn't really all that important as long as it is under 1. It's free T4 and free T3 that should be measured and acted on. You didn't need a decrease at all.

[Chelidonium62]

Thank you lc1973, Clutter and Angel of the North for your replies. I managed to get all those points across and think it showed I knew what I was talking about, thanks to you. The doctor I saw has increased my dose of levothyroxine back to 75mg and put a note on the system to say not to reduce it even if my TSH drops below range. If that does happen he has said we will look at T4 and decide what to do then. He did say he didn’t want it to drop below 0.5 but I’ll cross that bridge when we come to it.

He doesn’t think I’ll become over medicated on 75mg but it helped being able to show I was well informed so he knows I would get back in touch if I felt I was (I don’t think for a minute that will happen though). I don’t think he’d have decreased my dose if I’d seen him before - it was another GP who phoned me. He said I was possibly quite sensitive to the dosage so I’m hopeful I could reduce very gradually in future if required

We didn’t discuss vitamins and minerals but I will take your advice Clutter. I was grateful to get the increase so thought I’d manage those myself for now

I feel so relieved that I might start to feel better soon. Thanks again for your support, it makes all the difference.