Info on NHS guidelines

[Louisesymons]

Hi I have hashimotos for some 10 plus years. Only really felt better in the last two. I am taking 165mgs of levothyroxine, and feel normal. Over the last year my TSH levels have been suppressed and my gp wants to lower my dose of levothyroxine. When I have a private thyroid test my T3 is borderline and on the low side. My American consultant feels I shouldnt have my levothyroxine reduced and thinks i will again yo-yo back and forth with weight gain and depression as my T3 levels and reverse T3 are low. Are there any NHS guidelines for T3 levels ? Is there any argument I can make to my gp? The last time he just said the NHS says my TSH levels have to be higher ....end of argument. No consideration was given to my T3 levels. Any thoughts ?

[Marz]

Please post your results with ranges so members can advise. I see you joined a few years back so hopefully you will have read the various posts concerning Docs going by the TSH only. One just posted by helvella and PR4NOW so click onto names in blue and have a read 😊😊

[SlowDragon Administrator]

If your FT4 and FT3 are within range you are not over treated

What are your levels of vitamin D, folate, ferritin and B12? These need to be optimal. Many Hashimoto's patients need to supplement to maintain decent levels.

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

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 have high enough FT3

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...