I am new I had my thyroid removed in 2012, endo says it is ok for me to alternate dose of Levo 75/100 but I don't feel any different and still have symptoms of puffy eyes and face and weight gain any ideas what I need to do? Thank you
TSH 1.65 (0.2 - 4.2)
Free T4 16.1 (12 - 22)
Free T3 4.2 (3.1 - 6.8)
Do you have any recent blood tests with ranges that you could share. 75mcg is a very low dose for someone with no thyroid.
Welcome to the forum, Jb87.
It sounds as though you may be undermedicated. Can you post your TSH, FT4 and FT3 resuslts and ranges and members will advise?
TSH 1.65 (0.2 - 4.2)
Free T4 16.1 (12 - 22)
Free T3 4.2 (3.1 - 6.8)
Jb87,
There is scope to increase dose to 100mcg daily to raise FT4 and FT3. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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 dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP or endo. The Thyroid UK office opens on 3rd January.
Ask GP to also test vitamin D, folate, ferritin and B12
These are often too low when on Levothyroxine
Many who have had thyroidectomy subsequently need addition on small dose of T3.
But getting Levo dose increased first, plus vitamins optimal
Then retest and see if FT3 has improved. It should be above 5.5
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
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.
Prof Toft - article just published now saying T3 is likely essential for many. Note in particular he says he is reluctant to knock out Thyroid these days due to completely inadequate level of medication afterwards
Dose is too low. Ideally you want a TSH under 1 (often ex-hyper people need it right at the bottom of the range) and free T4 and free T3 in the top quarter of their ranges.
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