Advice please

[Ibiza2018]

After some advice

My recent blood tests have come back

TSH 0.11 0.35-5.0 Abnormal

F T4 20.0 9-24 Normal

F T3 4.1 3.5-6.5 Normal

Last time my TSH was abnormal they lowered my levo even though T4 & T3 we’re normal and it made me feel tired and achy. I was on 100mcg and it got lowered to 75mcg. I did return to the gp and I now alternate 75/100.

Is there anything I can suggest to the gp other than lowering my levo. I did previously have an abnormal antibodies result 281iu/mL 0-50. Unfortunately they wouldn’t test this again even though I asked

Thanks

[SeasideSusie Remembering]

Ibiza2018

I did previously have an abnormal antibodies result 281iu/mL 0-50. Unfortunately they wouldn’t test this again even though I asked

You don't need them testing again. Once Hashi's is confirmed that's it. Antibodies fluctuate anyway. Best to address the Hashi's by adopting a strict gluten free diet and supplement with selenium l-selenomethionine 200mcg daily as this can help reduce the antibodies, as can keeping TSH suppressed.

TSH 0.11 0.35-5.0 Abnormal

F T4 20.0 9-24 Normal

F T3 4.1 3.5-6.5 Normal

You don't need to lower your Levo. Dosing by TSH is wrong. It's the thyroid hormones - FT4 and FT3 - that are important when taking replacement hormone. If FT3 is within range then you're not overmedicated.

See article in Pulse magazine by Dr Toft, past president of the British Thyroid Association and leading endocrinologist, which says

"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 article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

Also something else to point your GP in the direction of - see pathology.leedsth.nhs.uk/pa...

Scroll down to Thyroxine Replacement Therapy in Primary Hypothyroidism

and you will see in the box

0.2 - 2.0 miu/L Sufficient Replacement

> 2.0 miu/L Likely under Replacement

In fact your results indicate you may benefit from the addition of T3 to your Levo.

[Mary-intussuception]

Well your FT3 may be in range but only just. It's in the lower half of the range and FT4 is OK. Can't see how GP could justify a reduction in Levothyroxine if your symptoms returned when dropped back to 75mcg. If dose reduction is suggested remind GP of this and point out low FT3 ??

I assume by Antibodies you mean TPO (Thyroid Peroxidase Antibodies ) in which case this result confirms you have Hashimoto's Autoimmune Thyroiditis. No, they won't test again. Not necessary.

[Ibiza2018 in reply to Mary-intussuception]

Thank you for your help. The first gp I saw back in June suggested I might not even have a underactive thyroid with my low TSH result. I was very confused after being on levo for 9 years. I did start taken HRT and asked if this might of affected my results but he said no.

I had a u/s which came back clear.

I will bring up the FT3 level if they want to lower my meds.

Thanks

[Ibiza2018 in reply to Ibiza2018]

Just as I thought gp rang and suggested lowering my meds. I told her i done this previously and felt worse. She agreed to keep me on the same dose and retest in 8 weeks