Reduction in levothyroxine query

[SilentDreamer]

Hi, just a quick question, I've just received a phone call from Dr to reduce my levothyroxine from 100 down to 75. When I asked why it was due to my TSH in June being 0.87 (0.27-4.2 being the range). I've been feeling a lot better in myself apart from having very low mood. Back in June my bones were aching, no energy being a few of my symptoms. I'd had total thyroidectomy in Mid March this year. They want another blood test in 1 month. Any thoughts and how long does your mood be affected? I have stopped eating gluten and only have some goat based dairy. Many thanks

[SlowDragon Administrator]

See my reply to virtually identical post just below yours

healthunlocked.com/thyroidu...

[SilentDreamer in reply to SlowDragon]

Thank you I read your reply on the other post, I will request the other tests....

[jimh111]

Your doctor does not understand levothyroxine treated hypothyroidism or the mathematics of TSH which has an inverse logarithmic relationship with thyroid hormone (fT3, fT4) levels. Healthy individuals tend to have a TSH between 0.5 and 2.0. When levothyroxine only therapy the TSH usually needs to be lower in order to bring fT3 levels up to normal. Additionally the inverse log normal relationship means the difference of a TSH between 0.5 - 1.0 is much greater than between 1.0 - 1.5.

Have a look at a slide rule and you can see how the numbers become less relevant as they get larger. For example, look at the 'K' scale in this picture wikihow.com/Use-a-Slide-Rul... . If you take the range '5 6 7 8 9 1 2' which starts just above the 'wikiHow' text you can see that 0.87 will be just a little below half way. So your TSH result is just below normal for the healthy population. Given that patients treated with levothyroxine usally need a lower TSH it is likely that you would do better on 125 mcg levothyroxine. Your doctor should measure TSH, fT3, fT4. I submitted a freedom of information request, fT3 and fT4 assays cost 92p. There's no reason why your doctor should not insist on TSH, fT3, fT4 being done. Don't let them reduce your levothroxine dose, you may already be on a dose that is a touch low.

[SilentDreamer in reply to jimh111]

Thank you i see what you mean using the slide rule, I will ask for the extra tests and for my previous results to compare do that I can go in well informed as I know my GP does not like to be questioned, kind of my way or go to another GP not easily done as out here in rural Wales GP's are getting scarce with the older ones retiring no one wants to come to the area, so I've been told.

[SlowDragon Administrator in reply to SilentDreamer]

Unlikely to get FT3 or all vitamins tested by NHS

Full private testing is likely needed

But push Gp first

[jimh111 in reply to SilentDreamer]

You could take someone with you for support.

[Tina_Maria]

Hi Silent Dreamer,

I too was made to reduce my levothyroxine dose based on the TSH result. My TSH was suppressed (0.001) , but yours is still within the reference range, even though at the lower end, but this should not be a reason to reduce the dose on this alone. Also, did they do a free T4 or T3 test? This will give a much better idea of where you are with regards to hormone levels.

I followed the advice from the GP at the time and reduced my dose from 100 mcg to 75 mcg every other day (I insisted on that at least) but still it made me very ill. Having since read up on this subject, I increased the dose back to 100 mcg again and never looked back.

I did private blood tests with the whole thyroid hormone range, plus antibodies and Vitamin assessment after I was on the full dose again for at least 6 weeks and am now increasing my Vitamin levels accordingly. I feel much better and would never again be put into this situation, just because a GP thinks he needs to treat to TSH levels.

Good luck and all the best!