Views on latest blood tests please

[MCDW]

I've just returned from a visit to the GP following recent blood draw. I've been on 100mcg levothyroxin daily for the last 4 months but my GP now wishes to reduce that to 100mcg and 75mcg on alternate days. These are the latest results ... and I'd appreciate your comments. (I'm not of the opinion I need to reduce my dose - and actually wonder if I have a conversion problem.)

TSH. 0.09. (0.35 - 5.50 mu/L)

Free T4 20.5. (9.00-22.70pmol/L)

Free T3 4.5. (3.50-6.50pmol/L)

She is aiming for a TSH of 0.5 as suggested by the endocrinologist.

She tells me that if overmedicated it can cause heart problems, and osteoporosis in the longer term. I did argue the case that both T4 and T3 were in range, so why did I need to have a dose reduction? My main symptom is constipation which, although improved, hasn't been resolved - and I take Magnesium Citrate daily to manage it.

I would appreciate your views on these latest results (blood was taken first thing in day with no thyroxin or food before).

[SeasideSusie Remembering]

MCDW

Yes, you have a conversion problem.

Your FT3 is 33% through range and FT4 is 83% through range. They should be in balance, in the upper part of the range if that is where you feel well.

[MCDW in reply to SeasideSusie]

Thanks - I did wonder. As I have a conversion problem, does that mean I ought to be supplementing with T3? If so - what would be an ideal addition of T3 at this stage - and should I maintain 100mcg levo daily - or reduce levo slightly?

My GP is generally supportive ... but it's clear she's not particularly clued up on this (like many) - so I may need to deal with this myself. Thankfully, the constipation is the main annoyance - and I feel generally pretty well.

[SeasideSusie Remembering in reply to MCDW]

MCDW

This is not medical advice as I am not qualified, but what I would do if those were my results.

Because taking T3 can lower FT4 (and it will also lower or suppress TSH) I would leave your Levo dose as it is for now and add 1/4 of a T3 tablet, wait 2 weeks, if all OK add a second 1/4. You then have a choice. Wait 6 weeks, retest to check your levels, or add a 3rd 1/4 then 6 weeks later retest to check your levels.

Low and slow is the way to go with T3, checking both FT4 and FT3 levels to see where you feel best, and keeping FT3 in range.

[shaws]

Refuse and state that your FT3 is not in the upper level. I do wish they would stop mucking about and stating misinformation about heart or bones. We are more likely to develop either of these with too low a dose.

Also tell him that the TSH is from the pituitary gland which rises if our thyroid gland is failing. Now that you are replacing it with synthetic levothyroxine the TSH is immaterial.

A past post:-

healthunlocked.com/thyroidu...

If you refuse he will probably reduce your dose anyway (to cover himself) that's why many on the forum source their own and get well.

If you feel fine on your present dose, tell him you don't want to reduce.

[MCDW]

Many thanks SeasideSusie. I will follow up your suggestion. I have already acquired some T3 (Tiromel). (Hopefully I can convince my GP of approach so at least can maintain T4 via NHS.)