FT4 level too high for an increase: Hi all. I... - Thyroid UK

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FT4 level too high for an increase

Skye889 profile image

Hi all. I take 125 mcg Levo, still have fatigue, muscle aches, eczema. Any idea when this will improve. I had my dose increased nearly 7 weeks ago.

I seem to have a bit of rheumatism too, my knees and ankles ache and swell during damp and sometimes humid weather. My endo has said my FT4 is too high for an increase and if I increase to 150mcg it will go over range. Looking to get a second opinion from another endo. Thanks for any advice!

25 April 2018 - thyroid function test - GP comments - satisfactory

TSH 4.22 (0.2 - 4.2)

FT4 17.2 (12 - 22)

FT3 4.0 (3.1 - 6.8)

TPO antibody 804 (<34)

18 Replies

You're FT4 is only mid-range. I doubt an increase of 25 mcg will send it over-the-top. Your TSH is much too high for someone on thyroid hormone replacement, and your FT3 is much too low. You really do need an increase. And your symptoms won't improve until your levels are higher. Obviously your endo is a diabetes specialist and knows nothing about thyroid.

Do you know you have Hashi's?

Skye889 profile image
Skye889 in reply to greygoose

Thank you I was told by a haematologist I have thyroiditis. Endo has said nothing about the antibodies meaning Hashis

You do need more replacement hormone to get your FT3 to at least halfway thru range ie 5 plu; your FT3:FT4 ratio suggests you might be converting T4 poorly to active T3. Youhave Hashimoto's (high TPO) characterised by poor gut absorption and often low nutrients levels? So have you had Vit D, B12, folate and ferritin tested ( to reach upper part of ranges) and supplemented if necessary, or take selenium( 200 mcg particularly good to help conversion)?

Thank you yes I do supplement but have felt no difference with what I take. I will be taking selenium as well

Iwantanswers profile image
Iwantanswers in reply to Skye889

When I was so fatigued, muscle aches, and short of breath turns out it was Vitamin D deficiency more than my thyroid. Once Vit D got into the low range of normal I started feeling better. So much of this goes hand in hand. Hope this helps.

SeasideSusie profile image


My endo has said my FT4 is too high for an increase and if I increase to 150mcg it will go over range

Your endo is talking rubbish. Probably a diabetes specialist, most of them are. If you're looking for a second opinion from another endo then first of all send for the list of thyroid friendly endos from Thyroid UK - email Dionne


Also, arm yourself with information about optimal levels. From thyroiduk.org/tuk/about_the... > Treatment Options

Dr Toft 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)."

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

You can obtain a copy of the article by emailing Dionne at tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.

As for your raised antibodies which confirm Hashimoto's, this is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results. Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...





As Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It would be a good idea to have the following tested

Vit D




Skye889 profile image
Skye889 in reply to SeasideSusie

Thank you they have been tested back in April 2018

You are currently undertreated so you have lots of symptoms.

The only way to find out what will happen to your test results on a higher dose is to increase the dose and have a test 6 weeks later.

More importantly - hopefully after six weeks on a higher dose your symptoms will have gone and you will feel strong enough to tell endo that you won’t reduce it.

The most important thing is that you feel well and can live your life. The test results are a secondary consideration - there are some of us that never feel well with test results in range.

Good luck x

Skye889 profile image
Skye889 in reply to Aurealis

Thank you I am due bloods next week

SlowDragon profile image

Sore joints likely low vitamin D. This is extremely common with Hashimoto's.


Skye889 profile image
Skye889 in reply to SlowDragon

Thank you I have been told my vitamin D in range but will post these again

Thank him/her for having your best interests at heart, but it’s your body your health your responsibility and you feel you will benefit from a slight increase. Suggest a split dose of 150 and 125 alternate days putting you at 137.5 I very much doubt that will put your T4 over range. Your endo is not working in your best interests if he disagrees.

Skye889 profile image
Skye889 in reply to NickP1

Thank you I am getting bloods for thyroid done next week and whatever the bloods will say I will insist on an increase.

Treepie profile image
Treepie in reply to Skye889

Make sure the blood is taken before 9am,fast and do not take levo until after the take .

Skye889 profile image
Skye889 in reply to Treepie

The blood test will be done at my local hospital and they open at 8.30am. I will be getting blood drawn as soon as they open. I never take levo 24 hours before blood draw and I fast. Thank you

Mmm not enough thyroxine in my opinion.

I had all of your symptoms when I was reduced, took extra and all of the symptoms disappeared within five days.

Find a better Endo who actually listens to you....they are rare!

Good luck.

Hi. I have had issues with my levothyroxine and my cortisol. Next time you have a blood test get your cortisol level checked also. Cortisol and thyroid need to be balanced.

Skye889 profile image
Skye889 in reply to McPammy

Thanks I had cortisol checked in 2014. It was said to be low

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