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Thyroid UK
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TSH 0.08 Physician wants to lower my dose of levothyroxine. Your opinions please

I am taking 75 micrograms of levothyroxine, for hypothyroid.

My TSH is 0.08 The lab report says the units are uIntUnt/mL

The normal range for the lab for TSH is 0.55-4.78

My Free T4 is 1.4 ng/dl, with the normal range listed as .67-1.52 ng/dl

They will not test my Free T3, in spite of me having asked 2 different doctors and 2 different nurses over a period of 6 months

My primary care doctor wants me to lower my dose of levothyroxine from 75 micrograms to 50 micrograms because my TSH is low.

I'm concerned because the first day of Winter (USA) is in 6 days, and I do not tolerate cold weather well at all. Also my energy level is low, but this could be because I don't sleep well at all.

I have chronic anxiety, and just saw a psychiatrist who says that I am taking too much levothyroxine and I need to lower the dose.

Your opinions please. Thanks very much.

11 Replies
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Your doctor is wrong. TSH is irrelevant when treated with levothyroxine. Your FT4 level is in range - ergo, you cannot be overmedicated.

But you have my sympathy, because doctors just don’t seem to know this stuff. :(

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rjb112

My opinion - no, refuse to reduce unless FT3 is tested and shown to be over range, only then can you be overmedicated. As Jazz says, TSH is irrelevant when on thyroid meds, it's a pituitary hormone, not a thyroid hormone.

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I would get your vitamin levels tested because you have anxiety which can be caused by low vitamin levels. The ones you need testing are:

Vitamin B12

Folate

Vitamin D

Ferritin

All need to be mid-range with B12 needing to be near the top of the range for thyroid medication to work well and for us to feel well. These are vital for people with hypothyroidism and are commonly low.

Anxiety can also be a result of being undermedicated or fluctuating thyroid levels which may trigger off a release of adrenaline to compensate for not enough thyroid hormone. Have you got thyroid antibodies?

If you are not sleeping well, it could be low B vitamin levels but get your vitamins tested before you begin to supplement. If your B's are alright but low and you don't need B12 injections, you could then take a good B complex with the methylated forms of B's which may improve your sleep. Make sure you get out into the light for at least 15 mins every day as it helps to reset your body clock for better sleep.

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Regarding:

"I would get your vitamin levels tested because you have anxiety which can be caused by low vitamin levels. The ones you need testing are:

Vitamin B12

Folate

Vitamin D

Ferritin"

+++++++++++++++++++

I've been taking Vitamin B12, both cyanocobalamin and methylcobalamin, and folate and Vitamin D:

My blood levels are:

Vitamin D: 42.4 ng/mL, reference range of lab: 30-140

Folate: 23.0 ng/ml (Lab slip says "High") reference range 3.0-20 (I've been taking 1,000 mcg folate for the past 7 weeks)

Vitamin B12: 1195 pg/ml (High) reference range: 211-911 (I was taking 1,000 mcg daily but stopped after the lab test showed the level was high)

I am unable to find a Ferritin lab result right now......

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You would probably benefit from increasing your Vitamin D. My TSH is .04 (.45-5.33). I take 75 mcg. T4 on five days a week and take 17.5 mcg T3 everyday. My endo would like my TSH to be higher but so far she is letting me get away with it. I am in US also in the northeast. I need more hormone in the colder months. Google "Any Lab Test Now". If there is one near you, you can go there and get your T3 tested on your own. You have too many symptoms. If you reduce your dose you will surely feel worse. Try to find a doctor in your area who is more comfortable treating thyroid disease. Have you been checked for antibodies? Do you know if you have Hashimoto's? You could also have these tests at Any Lab Test Now.

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"Have you been checked for antibodies? Do you know if you have Hashimoto's?"

I have not been checked for antibodies. Do not know if I have Hashimoto's. I am limited to the VA system (Veteran's Administration), and I do not always get what I ask for. For example, I have asked for my Free T3 to be tested on four separate occasions, to 2 different doctors and 2 different nurses....and have yet to get Free T3 tested.

Per your suggestion, I just Googled "Any Lab Test Now", but the nearest one is 238 miles away.

I am taking your suggestion to increase my Vitamin D. I started tonight.

Anyone else who has opinions or ideas, they are greatly appreciated. Thanks so much

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Read SeasideSusie's posts on vitamins. She has gotcit nailed so excellent advice on what you need to take and why. Doctors never seem to suggests doses capable of making a difference.

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Both doctors are talking a load of bollocks ...

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Definitely refuse to reduce your dose! This is a very common poor decision made by doctors, and it can make you very ill, and take months or years to recover from.

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It sounds like you’re in the United States. If so and you use the VA doctors you’re not gonna find anyone who will test the bloods for free T3 and you’re going to continue to hear that the TSH is too low. You will need to find a functional doctor - that is an option for you. Sometimes you find a D.O. That is a functional doctor easier than you might find an M.D. The functional doctors now about free T3 and they know the TSH is not the holy Grail of gauging Hashimoto’s which is most likely what you have. 85 percent of people with low thyroid have Hashimoto’s an autoimmune disorder. When you know the enemy...... The VA might test you for Hashimoto’s surely they have an endocrinologist - that’s usually what it takes to find out for sure on the Hashimoto’s an endocrinologist. Even with them they don’t seem to know very effective methods for treating Hashimoto’s or auto immune disorders.

In the meantime the advice you’re getting on methylated B vitamins is right on. I’ve had Hashimoto’s for over 30 years and suffered from anxiety from time to time. I’ve always taking vitamins but only recently did my functional doctor do a genetic test! How about that genetic test with a functional doctor - don’t tell me they don’t know their science! Anyway he found out that I have to genetic weaknesses in metabolizing folic acid and the B vitamins. The test said it’s a very common disorder common in over 1/3 of all those tested. The remedy or the way that I can shore up this weakness - is the methylated B vitamins and folic acid. I’ve been taking them for about 60 days now and it’s a whole New World oh my. I know you can imagine what it must be like not to have anxiety. And it’s not all in my head kind of thing as I’ve been told by Various doctors in the past. And it’s not over medicated or too low TSH. My last TSH was .01 (10 days ago) and I have no anxiety but I am taking the methylated vitamins. Do you try the methylated vitamins B12 B6 and folic acid - they usually come combined here in the US. There are several different brands I’ve tried couple. One called methyl protect is very good. They can only be sold by doctors - but you don’t need a prescription. You could find an equally good brand from a health practitioner or really good health food store.

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"It sounds like you’re in the United States. If so and you use the VA doctors you’re not gonna find anyone who will test the bloods for free T3 and you’re going to continue to hear that the TSH is too low."

Yes, I'm in the US, and I can only receive medical care at the VA, from the VA doctors. I've tried four times to get my free T3 tested, the most recent being one week ago, and have been unable to get it tested.

"The VA might test you for Hashimoto’s surely they have an endocrinologist - that’s usually what it takes to find out for sure on the Hashimoto’s an endocrinologist. Even with them they don’t seem to know very effective methods for treating Hashimoto’s or auto immune disorders."

I did see an endocrinologist at the VA, for my thyroid, about 4 years ago. Even the endocrinologist did not order a free T3. If I remember correctly, she ordered a TSH and a free T4. She seemed to base her treatment on the TSH. She prescribed levothyroxine and then sent me to my primary care physician for follow up.....did not even set up a follow up appointment with endocrinology.

"In the meantime the advice you’re getting on methylated B vitamins is right on"

I've been taking 1,000 mcg of L-methyl folate from Life Extension. (6s)-5-methyltetrahydrofolate........for about 7 weeks.........It is not helping at all......and my folate lab test showed a high reading......I've also been taking 2 forms of Vitamin B12 (methylcobalamin and cyanocobalamin), and a multivitamin/multimineral supplement from Life Extension. So I've already been taking the methylated B12 and methylated folic acid. But nothing is helping at all.........

Very bad Anxiety, extreme hypersensitivity to noise, very loud tinnitis (ringing in the ears), insomnia, pain.......sorry, what a mess.

I have a followup appointment with psychiatry in January for the anxiety and insomnia. It will be a different psychiatrist than the first one, but I'm sure that he will also tell me I have to lower the levothyroxine dose, due to the TSH of 0.08

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