Hi when should levothyroxine be reduced please? My results are all in range except for TSH which is below range thank you
TSH 0.02 (0.2 - 4.2)
Free T4 20.7 (12 - 22)
Free T3 3.9 (3.1 - 6.8)
Symptoms are
Goitre
Ankle and wrist swelling
Tiredness
Weight gain
Feeling low
Confusion
Dizziness
Ears ringing
Heavy periods
Broken sleep
Diagnosed 2012
Taking 175mcg levothyroxine
On Levothyroxine it's very common that we need dose high causing low TSH
On Thyroid replacement its largely irrelevant
See this post from Lyn Mynot today (chairman of Thyroid UK)
healthunlocked.com/thyroidu...
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.
You results show poor conversion
Do you have Hashimoto's (high thyroid antibodies)
Have you had vitamin D,folate, ferritin and B12 tested? If so post results and ranges too
Have you had DIO2 gene test?
thyroiduk.org.uk/tuk/testin...
Results added
Dizzy and tinnitus likely due to low B12
Insomnia can be low vitamin D
TPO antibody 980.5 (<34)
TG antibody >1000 (<115)
So this is Hashimoto's also called autoimmune thyroid disease
About 90% of all hypothyroidism in Uk is due to Hashimoto's
Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise
Hashimoto's affects the gut and leads to low vitamin levels
Low vitamin levels stop Thyroid hormone working
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
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...
Either ask GP to test these vitamins or get private tests
thyroiduk.org.uk/tuk/testin...
Medichecks Thyroid or Blue Horizon are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
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, lowest FT4 and most consistent results
Your FT3 is very low in the range.
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