Latest test results: advice please

[Saraband]

Hello everyone, I’d appreciate your thoughts and advice on my latest test results and current situation.

I increased the levo from 75 to 100 in September and immediately felt an improvement. I know it takes time for the increase to work its way into the system, but I have found that I notice a difference very quickly with every increase. Each time (this will be the 3rd increase) I’ve had a period of feeling much better which then falls away. Each time the period of feeling good has got longer: a week, two weeks, and this time about 6 weeks. This time I started to realise what ‘optimal’ might mean: I felt better than I’ve felt for years and hoped perhaps I’d found my ideal dose.

But again, things began to slide. I envisaged that this most recent test would indicate a further increase but I’m not sure now, and wonder where to go next. Here are the results, with corresponding figures from earlier tests:

TSH 0.113 (0.27-4.2) (Nov 17) Dropped from 5.64 (0.27-4.2) in June and 2.9 (0.35-4.94) in Aug

T4 19 (12-22) (Nov 17) Increased from 15.66 (12-22) in June and 12.3 (9-19) in Aug

T3 4.77 (3.1-6.8) Increased from 4.49 (3.1-6.8) in June. (Not tested in Aug)

Needless to say, the accompanying report from Medichecks advises that I’m over medicated and need to reduce the dose. I have some questions that I’m hoping you may be able to help me with:

1. Am I right in thinking that with T4 and T3 still within range, I am not over-medicated?

2. Although there is a clear increase in T4 over the 2 tests, T3 doesn’t seem much different. Is this significant?

3. I have re-read the symptoms of being over-medicated and was surprised to find that at least some of them seemed applicable although certainly not all. It has me wondering whether a further increase would be risky (and I doubt whether my gp will agree to it anyway). I’m also wondering about the thyroid-adrenal connection and wondering if this may be impacting on how I’m feeling. I had already noted that when I began feeling unwell again, it coincided with a point where several slightly stressful events occurred. I began feeling panicky, nervous and irritable with a general feeling of being unable to cope. I felt very tired yet unable to sleep - thoughts racing. They were really very minor events, but my lack of resilience to life and inability to handle stress has been very marked for a number of years. At one time I took such things in my stride but have struggled increasingly in recent years. So I am wondering if I should consider an adrenal supplement as the next step.

Some advice would be much appreciated.

Thank you

[SlowDragon Administrator]

Your FT3 is still low

How are vitamin D, Folate, ferritin and B12 levels?

If these are low then improving might increase conversion

If these are already good you have two options

Try increase in T4

Or add small dose of T3

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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 articles from Thyroid UK email [e-mail]. print it and highlight question 6 to show your doctor.

[Saraband in reply to SlowDragon]

SlowDragon , I haven't had my levels of Vit D etc tested for a while, but they seemed ok when last tested. B12 was lowish, though within range, and I've been supplementing this. I already take Vit D. Perhaps it's worth having these retested? Is it likely I can have this done on through my GP?

I have wondered about T3.

[SlowDragon Administrator in reply to Saraband]

You can try via GP first

Private tests available if no luck

thyroiduk.org.uk/tuk/testin...

Medichecks or Blue Horizon are the most popular. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

Just vitamin D tests via

Vitamindtest.org.uk -£28

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

[shaws Administrator]

Did you allow a gap of 24 hours from your last dose and the test? Did you have a fasting (water only) blood test?

[Saraband in reply to shaws]

Hi shaws Yes, on both counts