Dose reduction: I am new, endo wants me to reduce... - Thyroid UK

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Dose reduction

Jinian profile image
26 Replies

I am new, endo wants me to reduce based on below bloods.

TSH *0.02 (0.2 - 4.2)

Free T4 20.6 (12 - 22)

Free T3 3.9 (3.1 - 6.8)

Diagnosed 2011, symptoms are constipation, weight gain, dry skin, goitre, hair falling out, feeling cold all the time, tiredness, memory loss and confusion, dizziness, low blood sugar, heavy and irregular cycles. Was taking 175mcg Levo.

Thank you!

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Jinian profile image
Jinian
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26 Replies
lady_eve profile image
lady_eve

There are other members of this forum better informed than I, but it looks to me as though you aren't converting T4 to T3 properly.

My most recent test results were TSH 0.04, FT4 20.10, FT3 4.70. I saw a private endocrinologist yesterday who did not query those results in any way and was happy for me to continue levothyroxine at the current dose.

I think your endo is jumping the gun with a recommendation to reduce. I'm guessing he's never discussed T3 replacement with you?

Wishing you well.

Jinian profile image
Jinian in reply to lady_eve

Was on T3 briefly and it helped. Endo took me off it. Thanks

Clutter profile image
Clutter in reply to Jinian

Jinian,

Did endo say why?

Jinian profile image
Jinian in reply to Clutter

Yes he said it would make me worse and not better. I just don't think he advocates it. Previous endo advocated it with no problems.

Clutter profile image
Clutter in reply to Jinian

Jinian,

Was it helping you?

Jinian profile image
Jinian in reply to Clutter

Thanks yes it was helping me

Clutter profile image
Clutter in reply to Jinian

Jinian,

And still endo withdrew it?

If you want sources where to buy Liothyronine without a prescription write a post asking members to send you the information via private messages.

Jinian profile image
Jinian in reply to Clutter

Ok will ask for private messages for sources of T3. Yes endo still withdrew it

Clutter profile image
Clutter in reply to Jinian

Jinian,

Be aware that adding T3 may further suppress your TSH. You may need to tell your endo or he will continue reducing dose.

lc1973 profile image
lc1973

I agree with Ladyeve. Looks like a conversion problem as in not enough FT4 converting to FT3. i think your Endo should be reducing your levothyroxine a little and adding some liothyronine. The important thing is how do you feel, i am thinking that the symptoms you describe are how you feel now in which case they all shout hypothyroid to me. Im in a similar situation to you but my FT4 went over range so i have reduced my levo by 25mcg and am trying to add in some liothyronine but i'm having difficulty getting it right so i am seeing an endocrinologist next month who i hope is going to help me.

Clutter profile image
Clutter

Welcome to the forum, Jinian.

How much does your new endo want 175mcg decreased?

I suspect your endo doesn't like TSH suppressed. You are not overmedicated though because FT4 and FT3 are within range. 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 endo.

Jinian profile image
Jinian in reply to Clutter

100mcg levothyroxine. Thanks

Clutter profile image
Clutter in reply to Jinian

Jinian,

That's ridiculous. It's debatable whether suppressed TSH even means you are overmedicated when FT4 and FT3 are within range but even if you are dose adjustments are supposed to be gradual, in 25mcg increments at six week intervals with thyroid function tests to establish whether further adjustment is required.

Was it a trainee or consultant endocrinologist you saw?

Jinian profile image
Jinian in reply to Clutter

Consultant

Clutter profile image
Clutter in reply to Jinian

Jinian,

I'm horrified. Did consultant look very young?

Jinian profile image
Jinian in reply to Clutter

No I'd say he was in his mid 50s? I looked him up and he is a specialist in diabetes and endocrinology

Clutter profile image
Clutter in reply to Jinian

Jinian,

Most endocrinologists specialise in diabetes not thyroid. Shocking that an experienced consultant should be so ignorant about dosing though.

RobbieThroid profile image
RobbieThroid

Low TSH Normal T4 Normal T3 and her symtoms could mean early signs of Thyrotoxic so the Dr wants to decrease slightly which could be wise and retest. Also are you taking the generic or actually using SYNTHROID because Levo generic is not reliable formulation and can also contribute to some of the symtoms.

Another good way to tell if you are Thyrotoxic is to test you morning basal temperature and blood pressure....do it for at least a week and let the Dr see the results. Could be the best indicator of Thyrotoxic.

Clutter profile image
Clutter in reply to RobbieThroid

RobbieThroid,

FT4 and FT3 are within range so Jinian is not thyrotoxic. Decreasing from 175mcg to 100mcg is NOT a slight decrease and it most certainly is not wise.

Synthroid is not available in the UK. The 4 generic makes approved for use in the UK have to meet MHRA licencing terms and standards before approval. Synthroid marketing would have you believe that generics are no good but there are plenty of people who do not do well on Synthroid and prefer other brands or generics.

RobbieThroid profile image
RobbieThroid in reply to Clutter

Her tsh is low and her T4 is tetering to the high side...I never said what her Dr wanted to reduce to was slight...I said it could indicate a slight reduction is possibly in order but to be sure she should be tested basal on temp and blood pressure before she ever gets out of bed.

I don't think Levo is anywhere as good as Synthroid and my Surgeon told me that so I believe him he is a Trauma Surgeon. I don't like either one.

I had severe problems with synthroid ...aches pains high heart rates blood pressure etc. I went through 5 doctors before I found one who would let me go on Naturethroid...

So I don't advocate synthroid in any way...didn't work for me. Sorry didn't realize I was in UK...

My Dr does a complete workup on all my vitamins minerals ferratin calcium b12 etc vitamin d before he ever suggests any kind of change.

I never said she was thyrotoxic...it says she COULD be showing early signs. And I certainly should of worded the slight reduction better because reducing by 75 mcg is drastic not slight.

BTW had my thyroid removed in 2016.

Clutter profile image
Clutter in reply to RobbieThroid

RobbieThroid,

Synthroid isn't easily available outside of USA. I thought we had it bad in the UK with 4 generic makes to choose from but many countries only have one make/brand of Levothyroxine available to them.

I had my thyroid removed in 2012. TSH has always been <0.01 which is lower than the 0.05 my endo would prefer. Not overmedicated because FT4 and FT3 are within range. I was doing well on Liothyronine (T3) but I felt poisoned when I was switched to Levothyroxine (tried several brands) and became mostly bedbound. I'm good on Levothyroxine + T3. FT3 was below range on Levothyroxine although FT4 was good. It's fairly common for thyroidectomised patients to need T3 in addition to Levothyroxine, or NDT, to deliver good FT3.

My first endo told me vits & mins would be fine because my complete blood count was good. I arranged for my GP to do the tests. VitD was severely deficient, folate deficient, B12 low and ferritin high. Endo was shamefaced and checks vitD and calcium along with TFT, FT3, thyroglobulin and thyroglobulin antibodies annually now.

RobbieThroid profile image
RobbieThroid in reply to Clutter

Wow the Endo in UK is generous with .05 tsh ...here they want .20...and the t4 and t3 in the midrange normal. Unfortunately I had to stop the Naturethroid because I was not absorbing the pills and went very hypo...I just switched to dessicated that is in capsule form and my TSH went down to .01 my t4 high so I know I need to back off a little. I'm switching to Thyrovanz or may go to Thyro Gold.

I know most people do better with some NDT as I have.

Too bad they don't make the freeze dried capsules in prescription.

Clutter profile image
Clutter in reply to RobbieThroid

RobbieThroid,

No, UK endos & GPs like TSH in range but I had thyCa and suppressing TSH <0.1 is recommended to reduce likelihood of recurrence.

Do you mean you are getting a compounded NDT in the capsule or an OTC supplement?

Thyrovanz doesn't say how much active T4 +T3 it contains so you'll be dosing by symtoms. 300mg ThyroGold is roughly equivalent to 3 grains NDT.

Jinian profile image
Jinian in reply to RobbieThroid

Not thyrotoxic if my thyroid hormones are in range. I take Teva and my blood pressure is always high and pulse low and body temp low

RobbieThroid profile image
RobbieThroid in reply to Jinian

How long have you been taking Levo 175mcg and did you have your thyroid removed?

Jinian profile image
Jinian in reply to RobbieThroid

Thanks been on 175mcg levo for 5 months and I still have my thyroid

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