Thyroid function test results after dose decrease. Should I decrease the dose again?

[Ujna]

Hi again

22/8/2018 on 75 mcg levo

Serum free t4 18 (12-22)

Serum tsh 0.03 (0.27-4.2) low

Serum t3 5.1 (3.1-6.8)

28/6/2018 on 100 mcg levo

Serum free t4 22 (12-22)

Serum tsh 0.01 (0.27-4.2) low

Serum free t3 6.3 (3.1-6.8)

26/4/2018 on 50mcg

Serum free t4 14 (12-22)

Serum tsh 3.3 (0.27-4.2)

T3 not tested

All the above times, blood test done around 9 am on fasting and levo taken only after blood test that day.

Above are the results taken while on 50 mcg, after Levo dose increased from 50mcg to 100mcg and then dose decreased from 100mcg to 75 mcg. I'm also on ferrous fumarate 210mg since May one twice a day and take 100 units vitamin d daily and also holland & barrett complete B vitamin B complex. I always take my supplements atleast 5 hours apart from levo.

Now at 75 mcg I'm feeling better than when I was on 50mcg or 100mcg. But still not close to normal. My knee pain while on 100mcg is gone now. But tiredness & low energy still exist. I'm still not gluten free but I eat less gluten containing foods these days because I feel much gassy when I eat those foods. Should I ask for coeliac blood test or should I start eating gluten free diet myself. I'm avoiding soy.

Should I decrease my levo dose as tsh is low? Should I take 50mcg & 75mcg in alternate days. At 50 mcg I wasn't well. Any advice would be appreciated.

Thanks

[shaws]

TSH is not a thyroid hormone - it is from the pituitary gland and rises when the thyroid gland is having a problem. I shall give an extract from an expert on hormones:-

The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy. Dr. Lindner has found that, in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the

dose is reduced. With levothyroxine therapy alone, the FT4 frequently needs to be above the range, even just to normalize the TSH in primary hypothyroidism. Dr. Lindner is frequently consulted by patients on T4 therapy who have FT4 levels low in the range

and low FT3 levels. A doctor has to learn new skills in order to adjust thyroid doses according to symptoms and the free hormone levels. Even the free serum FT3 and FT4 levels, with or without treatment, do not tell the whole story. Human physiology is much

more complicated than that. There are many mechanisms by which relative resistance to thyroid hormones can occur. Some persons may require doses of NDT, or of T3 alone that produce levels well above the reference ranges. In the best tradition of

clinical medicine, a physician should prescribe thyroid hormones as needed to eliminate the symptoms and signs of hypothyroidism without producing any symptoms or signs of thyroid hormone excess.

hormonerestoration.com/Thyr...

Just taking your results into account - this seems perfect:

28/6/2018 on 100 mcg levo

Serum free t4 22 (12-22)

Serum tsh 0.01 (0.27-4.2) low

Serum free t3 6.3 (3.1-6.8)

[Ujna in reply to shaws]

Thanks Shaws for the useful information🙏🏼

[FancyPants54]

On 100 your blood results for T4 and T3 were looking very good. How long did you stay at that level? You list vitamins that you take, but do you know what your levels were when you were on 100 Levo? If I were you and you still don't feel good, I'd go back up a bit. Try 75/100 and give it a good long time to settle. I've had some horrible side effects when increasing doses, but they do eventually disappear.

You have answered your own question about whether you should reduce further. You were not well on 50, so don't go there.

[Ujna in reply to FancyPants54]

Thanks FancyPants54 for your suggestions🙏🏼

[SeasideSusie Remembering]

Ujna

Serum free t4 18 (12-22)

Serum tsh 0.03 (0.27-4.2) low

Serum t3 5.1 (3.1-6.8)

Should I decrease my levo dose as tsh is low?

No. Look at your actual hormone levels. FT4 is 60% through range, FT3 is 54% through range. You are certainly not overmedicated. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well. TSH is a signal from the pituitary to tell the thyroid to produce hormone. When the pituitary detects too little hormone the TSH is high, when it detects there is enough hormone the TSH is low telling the thyroid it doesn't need to produce any more. So you are taking thyroid hormone int he form of Levo, your pituitary has detected this so doesn't need to send the signal, hence low TSH.

What are your current nutrient levels? In May they weren't optimal and they need to be for thyroid hormone to work. From your previous thread healthunlocked.com/thyroidu...

ferritin 4.9 (13-150) - what happened about this, it was dire. Were you tested for iron deficiency anaemia?

Vit d 88.8 - recommended by the Vit D Council to be 100-150nmol/L. You say "100 units vitamin d daily" is that 100mcg or 1,000IU (international units)? Do you take magnesium and Vit K2-MK7 as cofactors of D3 mentioned?

folate 5.8 (3.9-26.8) - needs to be at least half way through range

b12 427 (197-771) - needs to be top of range

You say "holland & barrett complete B vitamin B complex". I'd ditch that cheap and nasty supplement and get a decent one. It contains the wrong form of B12 - cyanocobalamin instead of methylcobalamin, and folic acid instead of methylfolate (this was explained by SlowDragon in your previous post). Look at Thorne Basic B or Igennus Super B (which SlowDragon recommended).

If you have confirmed Hashi's then it would be worth trying a strict gluten free diet.

[Ujna in reply to SeasideSusie]

Thanks SeasideSusie for the detailed explanation & suggestions🙏🏼

It's 1000 units of d3, sorry a typo. How much of k2 & magnesium for that d3 dose? Holland Barrett was referred to me by my friend, I think I should switch to igennus super B now.

My current nutrients levels aren't tested, may be in few weeks after the iron course is complete.

[SeasideSusie Remembering in reply to Ujna]

Unja

Vit K2-mk7 90-100mcg is fine for up to 10,000iu D3.

Magnesium just take what the recommended dose is on the pack, choose the best form to suit your needs

naturalnews.com/046401_magn...

[Ujna in reply to SeasideSusie]

Thanks