Newbie

[Sarakj]

GP wants me to reduce is he correct to do this diagnosed 2011 with hypothyroid taking 175mcg levo thankyou

TSH 0.02 (0.2 - 4.2)

FREE T4 20.9 (12 - 22)

[SeasideSusie Remembering]

Sarakj

Has your GP said why he wants to reduce your dose?

If it's because your TSH is suppressed then he is wrong - see thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.

Also -

Dr Toft 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 article by emailing [e-mail] print it and highlight question 6 to show your doctor.

Your FT4 is well within range and before even contemplating changing your dose you need your FT3 testing. It's FT3 over range that will show if you are overmedicated.

Have you had thyroid antibodies tested?

Have you had vitamins and minerals tested?

Post any results if you have, and say if you are supplementing with anything and the dose.

[Sarakj in reply to SeasideSusie]

Thankyou endo before him used to test Free T3 and was always in range but this endo asks for full thyroid profile and Free T3 doesnt ever seem to be tested

[SeasideSusie Remembering in reply to Sarakj]

My hospital lab only tests FT3 when TSH is suppressed. My most recent test through GP showed TSH 0.02 (mine is always suppressed) and they did FT3 as well as FT4, but I suppose they're all different.

However, FT3 result aside, you have access to the Dr Toft article that you can use to support not reducing your medication, and if it was me I would refuse based on those test results unless FT3 is tested and shown to be over range.

What about antibodies and vitamins and minerals?

[Sarakj in reply to SeasideSusie]

I am to reduce to 25mcg levothyroxine and TPO antibodies 804.5 (<34) TG antibodies >1000 (<115) will post vitamins and minerals later when I have access to them

[SlowDragon Administrator in reply to Sarakj]

You should only ever reduce dose by 25mcg

To reduce from 175mcg to 25mcg is madness

Refuse to do this and contact Endo

Your GP is an idiot

[Sarakj in reply to SlowDragon]

Endo asked me to reduce to 25mcg

[SlowDragon Administrator in reply to Sarakj]

That’s mad

You have Hashimotos

Are you on strictly gluten free diet

Highly likely your vitamins are dire

Low vitamins stop thyroid hormones working

Your FT4 is in range

Post vitamin results when you have them

[Sarakj in reply to SlowDragon]

Not gluten free because GP wants me checked for coeliac

[SeasideSusie Remembering in reply to Sarakj]

Endo asked me to reduce to 25mcg

Utter stupidity on the part of you endo. He's obviously a diabetes specialist and hasn't a clue about treating hypothyroidism but pretends he does! Personally I would ditch this endo and find another one if you really wish to continue seeing one.

Email [e-mail] for the list of thyroid friendly endos, see who is in your area, ask for feedback from members (replies will have to be by private message), then ask your GP to refer you to a recommended one. That's your best chance if you do want to continue with an endo.

[Sarakj in reply to SeasideSusie]

Thankyou been through every endocrine department within my city and have only ever gotten on well with one out of 3 of them. She has moved cities now

[SlowDragon Administrator]

Refuse to even consider change in dose until all vitamin levels and FT3 have been tested.

FT4 is in range and TSH is largely irrelevant on Thyroid replacement hormone

[Sarakj]

Have left a voicemail saying I refuse to reduce dose until free T3 has been checked. I also said I do not convert T4 to T3 and would like to know why free T3 has not been checked since he took over my care

[SlowDragon Administrator in reply to Sarakj]

Well done

Obviously your vitamins must be dire if they want to test for coeliac

How long have you been waiting for test?

If they can't give you a date for endoscopy then you might consider going gluten free straight away

Hashimoto's affects the gut and leads to low vitamin levels

Low vitamin levels stop Thyroid hormone working

Blood tests then can show low TSH and poor conversion

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

your new endo doesn't have a clue obviously

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

See Box 1. Some possible causes of persistent symptoms in euthyroid patients on L-T4

onlinelibrary.wiley.com/doi...

[Sarakj in reply to SlowDragon]

GP suggested I do gluten challenge in August this year but haven't been given date for endoscopy

[SlowDragon Administrator in reply to Sarakj]

Tell him you have waited long enough. It's supposed to be 6 weeks maximum wait

Majority with Hashimoto's are gluten intolerant not coeliac

So regardless of test result you would need to at least try strictly gluten free diet for minimum of 6 months to see if it helps.

You don't need any gut symptoms

[SlowDragon Administrator]

See this post just added by lynmynott

healthunlocked.com/thyroidu...