Thoughts on recent results

[NealF]

Morning

I had half my thyroid out in July due to a 2cm nodule. Currently on 50mg of Levo. Does anyone have any thoughts on my results? Am currently supplementing B12, so I think I can start easing off on this, and I'm also supplementing Ferritin and Vit D, but looks like I will keep doing these as still a bit low? Main symptom at the moment is massively aching legs as soon as I stand up to do anything, its nerve pain.

Thank you in advance.

Neal

TSH 2.47 mIU/L 0.27-4.20

FREE THYROXINE 16.7 pmol/L 12.00-22.00

TOTAL THYROXINE(T4) 100.0 nmol/L 59.00-154.00

FREE T3 4.88 pmol/L 3.10-6.80

REVERSE T3 18 ng/dL 10.00-24.00

REVERSE T3 RATIO 17.65 15.01-75.00

THYROGLOBULIN ANTIBODY <10 IU/mL 0.00-115.00

THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00-34.00

ACTIVE B12 *> 256.0 pmol/L 25.10-165.00

FOLATE (SERUM) 19.58 ug/L 2.91-50.00

25 OH VITAMIN D 78.7 nmol/L 50.00-200.00

FERRITIN 191 ug/L 30.00-400.00

[SlowDragon Administrator]

You need Levothyroxine dose increase. Aim is to increase the dose in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Your FT3 is pretty good considering how high your TSH i, so you look like a good converter

Just need high dose, retesting again in 6 weeks

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 [e-mail]. print it and highlight question 6 to show your doctor.

Prof Toft - article just published this article

rcpe.ac.uk/sites/default/fi...

[Clutter]

NealF,

Ask your GP to increase Levothyroxine to 75mcg. TSH is a little high for comfort and FT4 is less than halfway through range and FT3 could be higher.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.27 - 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 [e-mail] if you would like a copy of the Pulse article to show your GP.

Thyroid antibodies are negative for autoimmune thyroiditis (Hashimoto's).

Ferritin is optimal halfway through range so you can stop supplementing or reduce dose to once or twice a week to maintain level.

VitD is replete but could be higher in range and needs maintenance until March so I would continue supplementing.

B12 and folate are good.

[NealF]

Thanks, I was thinking along the lines of your replies. I will be seeing my endo early in Jan, so will request a rise in Levo then. Is she likely to increase, or will I have to kick up a fuss for it?

[NealF]

Save me writing my results again, I saw my endocrinologist yesterday and she is not increasing my meds. She said TSH goes up and down during day, so I can ignore that, and if I take anymore T4 I will become T4 toxic.

She is looking at pre-op levels and has matched that, even though I wasn't right prior op. Also a lot of my issues are nerve related now, so is referring me to Neuro. It's a complete mess!

Can anyone offer any ideas where I go next??

Thanks

Neal

[NealF]

Bump