Hello good people, I need some clever minds to help me.
I am struggling to attain a euthyroid state as my GP and Endo keep changing my dose of combination therapy (without asking how I feel!) as they are reactive to the supressed TSH.
My previous NHS results 10/5/2017 TEVA Oral Solution LT4 65mcg (13ml)/Sigma Pharma LT3 15mcg
TSH *0.28 mu/L 0.4 -5.5
FT4 12.6 pmol/L 11.0 -26.0
FT3 4.2 pmol/L 3.0 - 6.0
My previous Medichecks results 14/12/2017 TEVA LT4 75mcg/Mercury Pharma LT3 25mcg:
TSH *0.027 mIU/L 0.27 - 4.20
FT4 *10.2 pmol/L 12.00 - 22.00
TOTAL THYROXINE (T4) *56.8 nmol/L 59.00 - 154.00
FT3 4.49 pmol/L 3.10 - 6.80
REVERSE T3 11 ng/dL 10.00 - 24.00
REVERSE T3 RATIO 26.57 15.01 - 75.00
These are my latest Medichecks results 6/3/18 with a current dose of LT4 50mcg/LT3 30mcg (…I ask for the LT3 to be increased by 5mcg, as the LT4 reduction of 25mcg made me feel terrible).
TSH *0.018 mIU/L 0.27 - 4.20
FT4 *7.92 pmol/L 12.00 - 22.00
TOTAL THYROXINE (T4) *51.0 nmol/L 59.00 - 154.00
FT3 5.32 pmol/L 3.10 - 6.80
THYROGLOBULIN ANTIBODY 108.000 IU/mL 0.00 - 115.00
THYROID PEROXIDASE ANTIBODIES 13.7 IU/mL 0.00 - 34.00
ACTIVE B12 160.000 pmol/L 25.10 - 165.00
FOLATE (SERUM) 16.72 ug/L 2.91 - 50.00
25 OH VITAMIN D 158 nmol/L 50.00 - 200.00
CRP - HIGH SENSITIVITY 0.63 mg/l 0.00 - 5.00
FERRITIN *166 ug/L 13.00 - 150.00
I am on modified Paleo diet and am pleased about the auto antibody levels, as it is the first time I have got them in range. Also I am supplementing and all the vits/mins look good – need to tweak ferritin and possibly consider methyl folate instead of folic acid.
My FT3 at 5.32 is looking great and cognitively I feel much, much better although my energy levels are still low. I would guess (!) that symptomatically and getting the FT4 into the upper quarter that my optimal dose is 100mcg LT4 and 30mcg LT3… ignoring the suppressed TSH.
I remember someone on HU TUK saying that they had requested their HPs ignore the supressed TSH.
The only issue I am led to believe for supressed TSH is osteoporosis. I do weight bearing exercise to strengthen bone as best as I can and I supplement with Mg/CA/Vit D/Vit K and monitor my calcium levels (CORRECTED CALCIUM 2.31 mmol/L 2.20 - 2.60). I have not had a bone density DEXA scan. The other issue sometimes uttered by HPs is heart problem…my QRISK Cardiovascular Disease 10 year risk score is a 1.47%. And just my luck, my Endo has bizarrely stated suppressed TSH causes cognitive issues (see my previous post).
I have the GP next Tuesday and the Endo in April…I just don’t know how to approach this issue with my HPs, other than perhaps offering a patient letter confirming that I would like the TSH value to be disregarded, so that they are both ‘covered’.
Any thoughts /insights please?