TSH - mu/L 0.21 (0.35. - 5.5 ) below low ref limit
Free T4 - 20pmol/L ( 9.0- 23 )
T3 - 4.5 pmol/ L (3.5 - 6.5 )
Ferritin.- 160.0ugl (30.0- 400.0)
Vit D 88nmol/L haemoglobin 32mmol/mol. My dr wants to reduce my thyroxine from 100mg to 75mg but I feel so well on this dose and under active symptoms come back on the lower dose - any advice would be very much appreciated.
These results look good, your TSH is a touch low but it often is on levothyroxine and your fT3, fT4 are reasonable. When hypothyroid on levothyroxine it takes a little more T4 to compensate for the loss of T3 from the thyroid and the loss of part of T4 to T3 conversion that comes from the thyroid. This slightly higher T4 tends to lower TSH. Be persuasive and stay on 100 mcg.
Thank you for your reply, how do I persuade my doctor to let me stay on this dose, although he is being supportive, he is reluctant to take the responsibility to let me stay on the higher dose, I have told him I would rather live with the risks than feel like I do on the lower dose. Can herefuse to prescribe the higher dose.
He could refuse and should refuse if he honestly feel it is the right thing to do. I dont' think this will happen. Follow Wildbird's advice and offer to monitor your pulse. There is guidance which suggests your levels are fine, sorry I don't have time to track it down. I would go the common sense route than throwing research at him. A partnership approach is more likely to succeed.
I had a similar result to yours a few months ago, with low tsh, free t4 and t3 in the reference range. I have not reduced my Levo as the lab report acknowledges that the result is probably healthy for me. I agreed to a retest in three months and pointed out that I probably needed to have a higher free t4 to convert to a modest t3. Try and stay firm and remind your GP that TSH reference ranges are a tool for diagnosis, they are not an indicator of thyroid health once treated. As you feel well, that should be the goal of treatment.
Thank you so much for your reply, how did you persuade your doctor to agree, mine is really nice but he is very reluctant ?
I pointed out that as my free t4 and t3 were in the right place and that I had no symptoms of over replacing, the TSH was not the most important result. I assured the GP that I would be back in an instant if I had any symptoms of too much Levo. I do not, neither by the sounds of it do you. Offer to have an early retest, in three months. I would be very surprised if by that time your tsh was still low. It is low but NOT surpressed and that’s the important thing. Reducing your dose by 25mcg, will in effect remove 1/4 of your meds, then you will be more hypo and feel unwell. Hopefully your GP will work with you to maintain your current wellbeing.
Your reply is so appreciated , he has agreed to let me stay on this dose until the end of September, after I burst into tears , but I will go to see him, and reiterate what you have said, are you on thyroxine only ? Another post said he thought I needed t3 but not sure if I want to go down that route buying it online. No I don’t have any hyper symptoms either, so if I promise to go back if I do,hopefully he will agree to keep me on 100 fingers crossed 🤞
Yes I am on thyroxine only, no chance of t3 where my surgery is concerned. I am glad that you can continue as you are. It is very frightening to have a condition which so few doctors understand. Just when we get to feel ok, they decide that we need a dose reduction. I asked my GP if life feeling like an exhausted lizard 🦎 was the hight of her ambition for me on a reduced dose. On hearing that, she left me as I was. I believe that we have to advocate for ourselves to get what our bodies cannot produce.
Simplyred57
Your GP obviously wants to reduce your dose because your TSH is slightly below range, dosing purely by TSH result is wrong. TSH is not a thyroid hormone, it's a signal from the pituitary. The pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
To avoid a reduction in your dose of Levo, refer to the article by Dr Toft, leading endocrinologist and past president of the British Thyroid Association, where he states in Pulse Magazine (the magazine for doctors)
"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)."
Even though the article refers to Total T3, the same principle
applies to Free T3.
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.
You can also refer to how far through their ranges your FT4 and FT3 are.
Your FT4 is 78% through range, your FT3 is only 33% through range. If your dose of Levo is lowered then not only will your FT4 lower but your FT3 will lower as well, and it's low T3 that causes symptoms.
Thank you so much for that, I will go with all the information you have given me.
Hi just one thing to ask you ,can I make the decision for my dosage based on what you said regarding my levels in your last post, or is it the doctors decision ultimately?
Simplyred57
It's usually the GP's decision on how much they will prescribe. Unless you have a GP who has an open mind and is willing to listen to your point of view. Maybe your GP will agree to be guided by what Dr Toft says.
You could say that you have taken advice from NHS Choices recommended source of information for thyroid disease (which is ThyroidUK) who pointed out the article written by Dr Toft. Don't mention the internet or forum, they don't like that, but ThyroidUK is a charity recommended by NHS Choices and may or may not hold some sway.
Perfect thank you 🙏🏽
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