Comparison of results

[LynLyn]

Thank you for reading my post. I’m on T3 only and reduced my dose at the end of August 2018 from 42.5mcg to 30mcg. I’d appreciate your thoughts on why my T3 results have increased despite being on less medication.

Sept Oct. Feb

FT3. 5.38. 3.82. 5.14

FT4. 0.66. 1.25. 1.97

TSH. 0.28. 2.05. 1.81

I’ve been hypothyroid for 21 years since age 22. I was on 50mcg thyroxine for 8 years then 1.5 grains of NDT for 10 years. Never felt well. Feeling the best I’ve felt in years. Hope you can help with my query.

Thank you

[diogenes Remembering]

Your journey will be never ending on T3 only. It's clear you have some thyroid function left, but very small; hence your measurable FT4 value which comes from the remains of your active thyroid. It may be that this remnant keeps changing its output and you simply have to balance this against what you take. It looks that recently your thyroid remnant has expressed itself a little more. The increase in TSH is due to reduced T3. You are an individual responding in your unique way to medication. If you feel well now, fine, but do realise this isn't and will never be a firm and final destination; feelings of wellness may change and need subtle adjustments throughout life.

[LynLyn]

Thank you for your message 😊

[greygoose in reply to LynLyn]

LynLyn, on this forum, people won't see that you've replied unless you click on the blue 'Reply' button under the comment concerned.

I'll notify diogenes for you.

[LynLyn in reply to greygoose]

Thank you. I didn’t realise!

[greygoose in reply to LynLyn]

No, I know. It often happens.

[SlowDragon Administrator]

You need to regularly retest vitamin D, folate, ferritin and B12

These need to be optimal for good thyroid function. Extremely common to be very low, especially if you have Hashimoto's diagnosed by high thyroid antibodies

Your TSH is creeping up.

No wonder you felt dreadful on just Levothyroxine, 50mcg is only a starter dose.

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2. Many people need TSH under one.

Most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

You might consider adding in 25mcg Levothyroxine especially If your TSH goes above 2. Retesting bloods 6-8 weeks later

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose 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)

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

NHS guidelines on Levothyroxine including what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)

nhs.uk/medicines/levothyrox...

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

[LynLyn]

Thank you so much for your reply. My tsh has always been close to 0, suppressed, even on 50 mcg of Levi and also on 1.5 grains of NDT. I’m quite shocked that my thyroid is doing anything at all - I thought it would be shrivelled up after all these years (21 years of being suppressed!).

Yes I always take bloods in morning as early as possible (8am) and don’t take my morning dose until I get home. My previous dose would be 6pm the day before. I’m consistent with this as I like to refer back to previous results.

I will ask to get my vitamins done when I next see the doctor - I haven’t had them done since last summer when folate was low. Thank you so much for your advice.