Overmedicated?

[bubblesmcgee]

Morning all,

I had a blood test this week and foolishly woke up and took my levo as normal before I woke up properly and realised it was blood test day. The results came back as follows: TSH 0.06 (0.27-4.2) and T4 23.5 (12.0-22.0). My GP now wants me to reduce to 50mcg 1 day and 100mcg the next from taking 100mcg daily. The thing is I feel the best I've felt since this horrible disease took over my life! I'm not perfect but I certainly have more energy and don't feel completely drained when I get up in the morning. The GP didn't ring me with this information just left a note on my file which was read to me when I rang up for my results. I'm getting married in 4 weeks and I really don't want to slide back into the state I was in before. What do I do?

[Hidden]

Some people on levothyroxine feel best when their FT4 levels are at the top of range or slightly above.

Do you have Hashimoto's disease (autoimmune thyroiditis)? When I was on T4 only drugs, my doctor wanted my TSH between 0.05 and 0.09. He said that would calm autoimmune attacks down as the TSH is what triggers the attacks...anyway, I always felt better with a suppressed TSH compared to a normal one.

The TSH is basically useless once on thyroid hormone replacement. It's a pituitary hormone, not a thyroid hormone, and does not tell you how much thyroid hormone you have available ON CELLULAR level.

If you feel well and hypo symptoms are resolving, that's a sign you're on the right dose of levothyroxine FOR YOUR NEEDS and you should not agree to lower your dose just because your TSH is low.

[bubblesmcgee in reply to Hidden]

Thanks, I will ask for the GP to give me a call today I think. I'm headed back to sea for two weeks at the moment so I can't get an appointment until I get back.

I thought I'd read that some people do better slightly overmedicated. I am both a hashis and graves sufferer for my sins so I sort of know when I'm hyper and I really don't feel it at the moment I just feel like the curtain of constant fatigue has been lifted.

[Hidden in reply to bubblesmcgee]

Yes, there was an article posted here recently (by Shaws?) by Anthony Toft, MD, who stated that some people need slightly above-range FT4 levels for optimal symptom-relief. I'll see if I can find it.

[Hidden in reply to Hidden]

This is from the article mentioned (this is a copy + paste from another post here which referred to the article in question; however, I cannot find the original article but maybe one of the moderators will know which one I'm referring to and copy a link to it here as I think the whole article would be more useful to you if you want to show it to your doctor):

"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).***

[helvella Administrator]

How long between your last dose and the blood draw?

Also, you are about 7% over on Free T4. Yet he is suggesting a massive, huge reduction of 25% in your dose???

No, you can't translate a dose change directly into an expected Free T4 result. But that dose change is extremely heavy-handed. That reduction is nothing to do with your needs - it is based on what tablet he can see. If I were convinced you did need to reduce your dose (and I am not), I'd consider the smallest dose change. Maybe 100 one day and 75 the next?

Have a look here at what can be done:

dropbox.com/s/sllu21khbeyth...

(I prefer the same dose every day.)

[elicarol]

I had this same situation at one time. If you are feeling good with what your on I would ask dr. about waiting till next month. When I was changed my levels went off had palpitations and then he changed again Tell him that you took medicine and you think the test reading is off ask to repeat the test .It took me awhile to straighten out after the changes Good Luck this is only my case everyine different

[greygoose]

I think he's probably reducing due to the low TSH, rather than the over-range FT4, and that will have nothing to do with you taking your levo before the test, that will be down to his ignorance. He should not be dosing by the TSH;