Hi, I started on Levothyroxine 75mcg 6 weeks ago, my antibodies were at 522 and although my TSH was not overly elevated at 3.9 it came under the abnormal bracket and taking into consideration my associated antibodies and after other vitamin deficiencies were corrected (Vit B12 and Folate) and I felt no better - my GP started me on Levo.
I have just had blood test results back, as you can see my TSH and T4 are abnormal - and presumably, I am now in hyperthyroidism - I don't actually feel much different, no associated symptoms of having an overactive thyroid. My T3 remains in the normal bracket at 5.7.
Is this normal when first commencing on Levothyroxine, or is this because my TSH was never really that high in the first place? I'm rather disappointed as I feel this GP will suggest I come off the medication altogether, but then I feel I'm taking more of step backwards.
Any help would be greatly appreciated, thanks.
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Well, to begin with, if you are taking levo, you are hypo - you have an under-active thyroid. If you are hypo, basically, you cannot become hyper - over-active thyroid - it doesn't work like that. But, you can be over-medicated, which is not the same thing.
Your FT4 is well over-range, it's true, but your FT3 isn't. And the reason for that is that you cannot convert T4 (levo) to T3 very well, and you need a high level of T4 to get enough T3.
Unfortunately, doctors only look at the TSH - which is totally wrong of them, because the TSH on its own, doesn't tell you very much. And, when your TSH is low, like yours, they tend to assume that you are over-medicated.
But, you are not over-medicated, because your FT3 is only just over mid-range. If you were really over-medicated, your FT3 would be over-range. It's the FT3 that is the most important number, but they all need to be looked at together.
So, if your doctor suggests coming off levo - or even reducing it - refuse. He is not supposed to dictate to you, he's supposed to advise you. And, when you know all that I've said above, you know that coming off the levo - or even reducing it - is not in your best interests - which he is supposed to take into consideration.
(NB If your antibodies were high, you have Hashi's - or Autoimmune Thyroiditis, as UK doctors like to call it - and that does complicate things. I'm just telling you that in case anybody else says anything about Hashi's, so that you know that the Hashi's complications do not apply here. Here, your problem is your poor conversion.)
I'm not sure I've explained that very well, so if you have any questions, please don't hesitate to ask questions.
Thank you for your reply! Yes i completely understand what you mean about the T3 conversion, however; if my dosage is not reduced, surely my TSH will stay the same or go even lower and can that in itself not cause problems for me? And is there a solution for the T3 conversion? thank you!
Well, the problem is that if you reduce your dose of T4, your FT3 will drop, too. And, it's low T3 that makes you hypo and causes symptoms.
TSH itself has two jobs:
* It stimulates the thyroid to make more hormone. But, if you're hypo, it's not going to be able to do that job, anyway.
* It stimulates conversion.
But, it's a vicious circle: if you're a poor converter, you need to take enough T4 to give you enough T3 to keep you well - and that can be quite a lot of T4, which of course suppresses the TSH. But, if you lower the T4 to get the TSH to rise to help with conversion, you're not going to have enough T4 to convert. If you see what I mean.
So, you have to make a choice.
Apart from that, it's pretty certain that the TSH doesn't do anything much. So, it's not a problem per se that the TSH is low. It won't affect your health.
Why you convert poorly is another question. There are all sorts of things that affect conversion: infections, low-calorie diets, low nutrients, or just the fact that you have Hashi's - and there's not much you can do about that! But, I would suggest you get your nutrients tested: vit D, vit B12, folate, ferritin. If these are deficient or sub-optimal, you need to supplement them for your body to be able to absorb and process thyroid hormones.
But, if those four are low, others are likely to be low, too. For good conversion you need good levels of magnesium, selenium, zinc, copper, and a few others. No point in testing magnesium because the only test we have is not fit for purpose, due to the way the body handles magnesium. It would be good if you could get selenium tested, but tests are expensive and doctors are reluctant to do them. Most people just try taking selenium for a while, see if it helps.
As for zinc, you more than likely to be low in zinc because you're hypo and hypos are low in zinc. Just take some, see if it helps. But, you're likely to be high in copper (because the zinc is low) so don't take any of that without getting tested first.
Optimising your nutrients, making sure you ingest enough calories, may help improve your conversion. But if your conversion is poor just because you're Hashi's, as I said, there's not much you can do about it. So, in an ideal world, people would be prescribed T3 to take along with their levo. But, our world is far from ideal, and an awful lot of doctors are anti-T3 (due to pure ignorance) and won't prescribe it. Plus, if you live in the UK, it's horrendously expensive, so that puts them off even more. A lot of people buy their own T3 on-line and self-treat with it. But, it's getting harder and harder to obtain.
There are no easy answers, I'm afraid. We just have to take one step at a time and do the best we can. So, your first step should be getting tests for nutrients. When you get the results, post them on here, with the ranges, and people will be able to advise.
Did your GP start you on 75mg straight away as that is high for a starter dose? Usually they will start you on 25-50mg and then retest and if needed up it in 25mg doses. This could be why the change in your levels are so drastic. they may suggest reducing by 25mg to 50 and seeing how you are on that level but it would not be recommended to stop altogether as it will only cause an onset of more severe symptoms and mess with your levels further. if your GP asks you to stop altogether just suggest the 25 reduction for 6 weeks and then get retested and see where you are.
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