Latest bloods- GP thinks I may be overmedicated

[salsapixie]

My TSH is 0.27 (0.5-5.4 is the range I think) and my FT4 is 19.9 (think the lab range is up to 20). G.P thinks I may be overmedicated with 150 micro grams of levothyroxine. Endo increased this from 100. Managed to persuade GP not to do anything until I see endo again in Feb. For the first time in six years, I feel normal. I’m back to exercising at the level I was years ago, and my weight is on a slow downward trend. Really hoping I don’t have to reduce my dose!

[greygoose]

Just say no. Your doctor shouldn't be dictating to you, but explaining his reasons for wanting to reduce your dose. And a low TSH is not a good reason if your FT3 is still in range. If he hasn't tested your FT3, then tell him it's the most important number, and you won't agree to reducing your dose unless it is tested, and found to be over-range. Treatment should be decided by mutual agreement and informed consent, not your GP making all the decisions for you.

[salsapixie in reply to greygoose]

He didn’t dictate to be honest. He felt I was overmedicated but it was easy enough to persuade him to leave my dose as it is. I’m a nurse and I’ve had symptoms of being hyper before so I know what it feels like. Both my bloods and how I’m feeling would indicate that the dose increase has put my hashi’s into remission. I’ll get a private blood test before my endo appointment so hopefully that will help.

[greygoose in reply to salsapixie]

Well, that's good to hear.

[SlowDragon Administrator]

Your endocrinologist is the one overseeing your treatment not the GP

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you did the test?

For full Thyroid evaluation you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Never reduce dose just on TSH and FT4

Absolutely essential to test FT3 and vitamins

As you have Hashimoto's low vitamin levels are EXTREMELY common. When were they last tested and what vitamin supplements do you take?

Are you on strictly gluten free diet? If not ask for coeliac blood test before trying it for 3-6 months.

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

[salsapixie in reply to SlowDragon]

I always have my bloods taken when fasting and before taking my meds.

I take my meds half an hour before food and caffeine.

I plan on getting a private blood test covering all of those tests you suggested before going back to my endo.

[SlowDragon Administrator in reply to salsapixie]

It's better to wait an hour before food or coffee, if you can

[Hidden in reply to SlowDragon]

We're always told 30 minutes here.

[Treepie in reply to Hidden]

You have not ben on the site for long.My recollection is one hour is mostly recommended.

[Hidden in reply to Treepie]

No, I haven't been on the site for long, but I have a been a thyroid patient for a long time. Guidelines have always - here - been 30 minutes and that's typically what I do. Sometimes more. It's harder when on NDT and a split dose as it's hard to keep food away from it twice a day, so sometimes it doesn't work. I try to be very particular about my first (bigger) dose per day and just do my best for the second. Some say it's not important with NDT, but the pharmacy said it still was because of the T4 component.

SlowDragon , the pharmacy said calcium supplements not for several (four? don't recall) hours, but weren't so concerned about dairy products - said that was okay after half an hour.

[SlowDragon Administrator in reply to Hidden]

Yes guidelines say 30minutes, but patients experience suggests longer may be better

Any calcium rich foods four hours away

See point 9 - any foods to avoid

nhs.uk/medicines/levothyrox...

Avoiding all soya including soya lecithin

[salsapixie in reply to SlowDragon]

I’m not on a gluten free diet, and I’m not convinced by the need for it. NHS don’t normally do those other blood tests unfortunately. I’ll probably get a medichecks one done before I next see my endo.

[SlowDragon Administrator in reply to salsapixie]

Yes I thought negative results for coeliac blood test meant gluten wasn't a problem. Especially as had absolutely no gut symptoms

Pity I wasted 20 years, not getting any better as a direct result. Confirmed as severely gluten intolerant by endoscopy in 2016, 24 years after starting Levothyroxine.

So just like an extremely high percentage with Hashimoto's, leaky gut and gluten intolerance and subsequent vitamin deficiencies were underlying cause of failing to improve on Levothyroxine

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first or buy test online

healthcheckshop.co.uk/store...

You'll never know if it helps, if you don't at least try it for 3-6 months. I wish my endo had suggested trying it 24 years ago

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

[Aurealis]

If you were overmedicated you wouldn’t feel well ...

Advise you not to mention the downward trend in weight ...

[Msharpe1963 in reply to Aurealis]

Hi Aurealis, can i ask why not to mention the downward trend in weight?

[Aurealis in reply to Msharpe1963]

Because salsapixie feels normal for the first time in ages and it might encourage dr to reduce dose

[salsapixie]

I didn’t mention the weight loss. It’s not enough to suggest I’m hyper anyway, 2.5kg in six months.

[Treepie in reply to salsapixie]

I have lost 10lb in a few weeks but I am trying to in order to get below the Type 2 diabetes line aa I have before.I feel better for it as well.

As to your results ,there was a recent research paper that suggested where FT4 was high ,even in range,there was a risk of atrial fibrillation. There were caveats however ,so just something to be aware about as a possibility.

[Msharpe1963]

They say you cant loose weight when hypo and on Thyroxine, but did mention my weight loss to my doctor today as i have lost 6.35kg in four months, for now, i have been told to stop my Thyroxine, feel much better after one week, and was told today to stay off them for another four before going for more bloods, how strange is this medication/hypothyroidism