Swollen fingers..reduce levo dose?

[Jen15]

Hi

my endo has said I need to be as close to TSH 0.1 as possible but no lower.

My blood test results today are as follows

TSH 0.03

T4 20.1 (range 9-20)

GP rang me to say i should slightly tweek my levo dose. I am currently taking 100 mcg levo a day. She has instructed me to cut my dose on one day a week down to 75 mcg.

Could my recent problems with swollen/stiff fingers be due to being slightly overmedicated? I feel very well otherwise.

Thanks

[SlowDragon Administrator]

You need to know FT3 and what vitamin D, folate, ferritin and B12 levels are too

Do you have Hashimoto's? Also called autoimmune thyroid disease diagnosed by high thyroid antibodies?

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

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.

If on Levothyroxine, don't take 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)

[Jen15 in reply to SlowDragon]

Thanks for your reply,

I do have Hashimotos. My vitamin D and B12 levels are optimal.

I will get a FT3 blood test as you recommend.

Any thoughts on whether my swollen fingers indicate being over medicated?

Thanks

[SlowDragon Administrator in reply to Jen15]

No idea, sorry. More likely under medicated

Important to test folate and ferritin

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

[Jen15 in reply to SlowDragon]

Yes I'm strictly non gluten.

I will get my ferrin and folate tested.

Many thanks for your advice.

[Aurealis]

Swollen fingers tends to be a sign of undertreatment.

[Jen15 in reply to Aurealis]

Yes, I thought that swollen fingers signified undertreatment, but my blood test results (see above) say otherwise. It's all very confusing!

[AnnaSo in reply to Jen15]

But you don’t know your T3. I myself have been top of the range in T4 But my T3 is at the very bottom of the range. You cannot judge without T3.

[Jen15 in reply to AnnaSo]

Do you have to take T3 to overcome this

?

[AnnaSo in reply to Jen15]

I’d say step one is to try to address the potential conversion issue first. If your levels of zinc, iron, cortisol, selenium are not optimal then T4 to T3 conversion is impacted. If all these are optimal but conversion still not happening as we’d like (T3 top of the range) then taking T3 is an option as is NDT. Personally, my nutri ya are now optimal but I’m still a poor converter. Adding T3 also did not solve issues (or yet).

But you would not know what’s your conversion is like until you test T3 and T4 at the same time

[Jen15 in reply to AnnaSo]

Thats really interesting, thank you. I will get my T4 and T3 tested at the same time. Although I should mention that I have had the DIo2 gene test to make sure that I shouldn't have a problem converting T4 to T3.

Also,I thought that being at top of range for T4 was a good thing? Perhaps I misunderstood that.

[AnnaSo in reply to Jen15]

There is a whole bunch of nutrients required for conversion though 🙂optimising their levels (optimal top of the range, not just ‘in range’) should ALWAYS be step one as poor conversion can be caused by sth as simple as low zinc or iron (notabene very common as thyroid sufferers very often have low stomach acid and do not digest and absorb nutrients from food well - supplementing with Betaine HCL helps with that). For many issues continue as they are not optimal in zinc, iron, selenium mainly. Simply popping a T3 is not a solution here. You can do yourself harm as you cannot determine adequate T3 dose if your iron or cortisol is out of whack. You can end up pooling and making yourself worse off. Having said that, T3 it the route if the conversion continues to be an issue despite optimal nutrients levels and stable cortisol.

[ShootingStars in reply to Jen15]

Hi Jen15. Swollen fingers means inflammation. It could very well be caused by an imbalance of thyroid hormones or by something else. Having that level of FT4 indicates it's too high. It's very likely that FT3 is too low. Your ratio of T4 to T3 sounds like it's really off. When properly medicated, FT4 will probably be slightly lower that FT3, not the other way around. The thing about symptoms is that they mostly live in either the low or the high part of the range. We have two thyroid hormones that work together, not just one. Neither should be at the very top of the range, and neither should be below 50% of the range. (if someone is only taking T3, this does not apply). Both FT3 and FT4 have zones within each respective lab range that are considered to be optimal, or where patients have the least symptoms.

Your doctor stating that your TSH "needs to be as close to TSH 0.1 as possible but no lower" is nothing short of entertaining. He is completely wrong and doesn't understand thyroid function because TSH is not the main focus when it comes to treatment. The main focus is the levels of your FT3 and FT4. Your endo has somehow failed to test your FT3, the active thyroid hormone, which is what T4 is converted to. Yes, TSH needs to be suppressed ideally below 0.5, but does not need to be down to any specific number. What DOES matter most are your FT3 and FT4 levels. With your symptoms and a too high FT4, it is most likely that you are not converting T4 into T3, or your FT3 is too low.

Back to the subject of inflammation. This could be Hashimoto's related. What are both of your thyroid antibody levels, TPOab and TGab? It could also be caused by diet. Gluten free is recommended for Hashi's. Since it's an autoimmune disease, the autoimmune diet also recommended no soy and no dairy. All three of these foods are inflammatory. Nightshade foods are also inflammatory. They are foods like potatoes, tomatoes, all types of peppers, eggplant, etc. Other causes could be too much sodium. Do you eat salty foods?

If your FT3 is too low (it should be close to 75% of range and FT4 should be between 50% and 75% of range), then yes, the only way to fix this is to take T3. You'd lower your T4 dosage since it's making your FT4 too high, and you'd add T3.

[Jen15]

Thanks for your detailed reply ShootingStars.

I didn't realise that T4 at the top of range was a bad thing. I have taken a DI02 gene test to check that I should be able to convert T4 to T3 without any issues and that result came back ok. I will get some more blood tests done for both T3 , T4 and antibody levels, TPOab and Tgab.

Much appreciated!

[AnnaSo in reply to Jen15]

It is not a bad thing Jen, unless it is not converting to T3 ☺️ get your T4 and T3 done and you’ll get the full picture then 👍🏼 if is the fingers swelling your only symptom? Do you consume a lot of sodium? I retain water like crazy if I overdo salt to the point my jeans can be too tight overnight! just a thought ☺️

[Jen15]

Thanks Anna,I really appreciate the advice.

Why on earth is T3 testing not done as standard on the NHS? It makes no sense to me.

[Svava]

Hey Jen, are you feeling better with your fingers? I have the same problem (I think due waterretention) and found this posting via the search function. I dont know why doctors are so in love with these TSH-thing....here in germany the same, that makes me crazy.