Thyroid UK
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Doctors

I’d went to the doctors the other because I’m having problems with my stomach again. And feeling under the weather. Got to wait for test results to come back. But have seen 3 other different doctors at gp but none of them have said till now that to reduce my Levo before this one. These was test results in August. Serum free T4 level 19.5 pmol/L [9.01 - 19.05]

TSH level < 0.01 miu/L [0.35 - 4.94]

Serum free triiodothyronine level 4.2 pmol/L [2.63 - 5.7]

And she said on Wednesday I should go down to 150 Levo. I see endo on the 8th next year. And told her that my normal doctor who isn’t there at the moment doesn’t even mess with the endo Work. So I think you should wait and see what he says first. She said ok.

But still feeling under the weather.

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Your FT3 is already LOW

You don't want to reduce dose, it will go lower still

Ignore GP, endo is in charge of your thyroid

As you have had thyroidectomy you quite likely need addition of small dose of T3

Ask you endo to consider this. Private prescription if your local CCG making it difficult

Also ask your GP now to test vitamin D, folate, ferritin and B12

Put a new post up when you have results

If GP is difficult about staying on this dose give them copy of this article

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 dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.

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The reason ft3 is low is because I’ve had a completely Tyriod remove due to cancer. Endo said it’s got to be that low.

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No, it's the TSH that has to be kept low when you've had cancer, not the FT3.

Keeping your FT3 low will raise your TSH, which could stimulate any remnants of thyroid tissues left behind, to regrow, and the cancer with it. I think your endo needs to go back to thyroid school!

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never know that. It’s only been high over the last three or four blood test now. The doctors would always send me a text to go for a test. Haven’t had one since August now. I’ve not seen the endo since last Christmas. I’d asked him when I see him in January.

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OK, so if I were you, I wouldn't touch my dose, just carry on as you are until you see your endo. Your TSH is suppressed as it should be. But, you do have a conversion problem, and you need to talk to your endo about that.

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Thank you

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You're welcome. :)

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I agree with SlowDragon, you feel bad because your FT3 is too low, because you aren't converting levo (T4) to T3 very well. It would be a good idea to reduce your levo, but only if you replace it with a little T3. :)

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Haze1975,

GPs should not interfere with the endocrinologist's treatment plan (except when the endo has obviously got it wrong). If they need to, they should consult with the the endo first.

Your GP is advising you reduce dose because your TSH is suppressed and FT4 mildly over range. However, you aren't overmedicated because your FT3 is within range. FT3 is just over halfway through range and reducing dose will cause FT3 to drop.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

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Thank you all. I did tell her, I think she should wait until endo see for a review. And I would talk to him when I see him. Because the doctor who normally takes care of me has been off for a long time now but hopefully she should be back with a bit of luck soon. And even she won’t messy with the endo Work either.

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You could ask GP to test your vitamin D, folate, ferritin and B12

If these are too low then it can affect conversion.

Very common to be low

They need to be at good levels, not just "in range"

Put results (and ranges) when you have them on new post and members can advise

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