Thyroxine - should I reduce

[Blondiejayjay]

I have Hashimoto’s (30+ years)

I take 100mcg of thyroxine since September last year. I have hypo symptoms.

Latest blood test

TSH 0.005 (0.38-5.33)

FT4 6.7 (7.0 -16)

FT3 4.2 (3.8 - 6)

This mirrors my results in June 2017.

GPs comments- borderline test again 3 months.

I’m not quite seeing what I’m borderline as.

Question- should I ask for a reduction in thyroxine?

Kind regards

[SlowDragon Administrator]

Are you only taking Levothyroxine or do you also take T3?

If only on Levothyroxine you definitely don't need to reduce dose, more likely increase

Yes you have very low TSH

Your results also show extremely low FT4

Have you had vitamin D, folate, ferritin and B12 tested

Low vitamins can cause low TSH

Are you on gluten free diet as you have Hashimoto's?

[Blondiejayjay in reply to SlowDragon]

Hi Slowdragon

I have been taking all vitamin supplements recommended for thyroid selenium, vitamin d sub lingual b6 and 12. A liquid gental iron which has folate and b vitamin in as well, magnesium.

I am told my vitamins and fbc are satisfactory I’m going to pick up a printout of results so that I can assess as I have been dosing up since June last year.

I tested negative last year for intrinsic factor antibodies.

I saw an Endocrinologist last year who said stay on same dose but I have seen no improvement in my overall health.

I avoid gluten.

My thoughts are if the vitamin tests are bumping along the bottom I should ask for malabsorption investigation. And perhaps to be referred to an Endocrinologist who has knowledge of Thyroid

[SlowDragon Administrator in reply to Blondiejayjay]

All thyroid tests should ideally 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. (Patient to patient tip, GP will be unaware)

Is this how you did the test?

Did you stop vitamin B complex before tests?

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

100mcg is not a high dose. You may just need higher dose of Levothyroxine. FT4 appears to be much much too low. FT3 not really adequate either

Yes definitely get copies of recent results

Do you avoid gluten absolutely?

Might need to be grain free

Considered dairy as possible issue?

Or nightshades (potato, tomato, peppers and aubergine)

[Blondiejayjay in reply to SlowDragon]

Thanks to all the good advice on here I did the fasting as suggested and stopped the vitamin b supplements about 2 weeks ago.

I was recently very uncomfortable with oral Lichen Planus and it was my Dentist who suggested GP should test bloods etc.

I also get up at least 3 times a night for a pee, have disturbed sleep and recurrent cold sores and feel generally spaced out. I have a slow pulse rate of 40 too.

I could do better on avoiding gluten.

Raw tomatoes and peppers make my mouth sore so I don’t eat them much

[SlowDragon Administrator in reply to Blondiejayjay]

Sounds like you react to both gluten and nightshades

You do need to probably avoid gluten totally

Gluten takes weeks/months for antibodies to subside each time we eat it

chriskresser.com/the-gluten...

Don't know much about nightshades

You may need small addition of T3 if you don't respond to just increasing Levothyroxine

Email Thyroid UK for list of recommended thyroid specialists, some are T3 friendly

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 print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to get enough FT3

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

[Blondiejayjay in reply to SlowDragon]

Thank you

[Clutter]

Blondiejayjay,

There's nothing borderline, FT4 is below range!

Don't reduce dose, that will make your FT4 and FT3 drop further. Your GP should refer you to an endocrinologist to see why FT4 is below range on 100mcg but TSH is very suppressed.

[jimh111]

This indicates central hypothyroidism (insufficient TSH from pituitary). Should be investigated by an endocrinologist who knows what they are doing.

[Blondiejayjay in reply to jimh111]

It’s disappointing that it wasn’t checked last year. These doctors don’t like being told or guided as to what they should do.

I suppose because I’ve been treated for Hashimoto’s for so many years there’s an assumption that it’s the dosage that needs adjusting