greygoose in reply to Diane178844 years ago

Do you mean how I know that your conversion is poor? By comparing the FT4 with the FT3. They should both be about the same percentage through their ranges - FT3 perhaps slightly lower than the FT4. But, your FT4 is right up the top of the range, and the FT3 is only just mid-range. So, that is not right.

And, if your FT4 goes any higher, the T4 will start to convert to more rT3 (inert) than T3 (active), so your FT3 level would go down rather than up. So, increasing your levo is not a solution.

Why your conversion is poor is anybody's guess. Could be low nutrients - have you had your vit D, vit B12, folate and ferritin tested? It could be insufficient calories in your diet, or an infection, or high cortisol, or just because you're Hashi's, or any one of a lot of other things. So, fixing it is not often an option. To get well, you need T3.

SlowDragonAdministrator in reply to Diane178844 years ago

So your FT4 is not as high as it looks in this test, as you only left 12 hours between last dose and blood test

Therefore you can probably take another increase in Levothyroxine

Ask GP to increase dose of Levothyroxine, initially by 12.5mcg. Retesting 6 -8 weeks later

As you normally take Levo at night. If, for example doing test Monday morning. Saturday dose of Levothyroxine delay until Sunday morning. Then Sunday evening dose, take immediately after doing blood test Monday morning. You can still take Monday evening dose as per normal.

Likely you will need to increase again to 125mcg

Improving vitamins will help too

If GP is difficult about dose increase use this

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be under 1.5 when on just Levothyroxine to be adequately treated

sps.nhs.uk/wp-content/uploa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at Thyroid Uk

tukadmin@thyroiduk.org

(The Thyroid UK office is shut until Jan 3rd )

Professor Toft recent article saying, T3 may be necessary for many.

rcpe.ac.uk/sites/default/fi...

Diane17884 in reply to SlowDragon4 years ago

Thank you so much slow dragon that's really helpful and informative. I have NHS blood tests again in January so will wait till then and take it from there.

I really hope I don't need T3 as its such a blooming nightmare to get, so fingers crossed 🤞

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fibrolinda in reply to Diane178844 years ago

Good luck 🙂 grey goose gave you excellent advice on thyroid meds... Of course 🙂