Thyroid UK
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GP reduced Levo

How can I persuade my GP to return my levothyroxine back to 125mg from the 100mg I was prescribed 10 days ago? I am starting to feel hypo again and have managed to get a telephone appointment for a week on Wednesday to discuss this with him. He is saying my TSH at 0.02 is too low (it was 100 when diagnosed 2 years ago) but I felt very well at that and my T3 was 3, T4 about 8, both of which are smack on where they should be. I know he thinks I am over medicated, but what can I say to persuade him to return my stolen 25mg of levo? Please advise. Thanks.

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Email Dionne at tukadmin@thyroiduk.org for a copy of Dr Toft's article in Pulse magazine, print it off and highlight question 6 for your GP.

thyroiduk.org.uk/tuk/about_... > Treatment Options

The relevant part reads

"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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist.

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Thanks so much. I will do this. I knew you would have the answer for me!

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For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies, FT3 and FT4 plus vitamins

It is largely useless determining medication level on TSH alone

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

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, and T3 12 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)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

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

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

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Thanks for your advice. As you say it is impossible to get the full screening, my T 3 testing was a surprise after repeated requests, but I do know I have Hashimotos from previous testing. I also take a ton of vitamins and minerals so feel I am ok with that. I am gluten and lactose free too and eat a very healthy diet.

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Hashimotos can cause fluctuations in results including very low TSH mwhich might be higher next time tested.

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I wasn’t aware of that. I will inform my GP. Thanks.

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As others have replied as long as FT3 is in range and FT4 in range or even just over a low TSH is not a problem when you are on levo.

Many have posted about GPs and endos reducing levo because of low TSH and without a FT3 test when the likely cause was a Hashi flare up.

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Thanks again. I am building my case nicely (I hope) for my GP.

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