Advice please (bit worried)

[Foggyk]

Hi wise ones

My GP changed my thyroxin from 75 to 109 mg in February. I've just had a new blood test results today and my TSH is now at 0.18. my GP has requested to see me but can't get an appointment or phone appointment until 5th July.

I'm not an expert but does this indicate I. Over medicated?

My last blood TSH levels were 2.49

I'm bit worried and not sure whether to revert back to my old level of 75mg

Any help grateful received

[MissSusan]

Was it just your TSH they tested?

[Foggyk in reply to MissSusan]

I presume so, just GP surgery. She said serum levels were normal.

I've had private tests before.

The receptionist didn't really know. !!

[shaws Administrator]

Your GP, I think, is going to tell you to adjust your dose to a lower one.

They make the mistake of believing that a low or very low TSH will cause heart problems but that isn't the case. TSH if from the pituitary gland and rises if our thyroid gland is struggling. When we're taking replacement hormones the aim is a TSH of 1 or lower. Unfortunately they seem to think that 'somewhere' in the range (up to 5) is better than a TSH of 1 or lower.

If you feel well on your dose refuse to adjust and also you could give doctor a copy of the following. The more they are informed, the better for us - the patient.

thyroiduk.org.uk/tuk/thyroi...

[Foggyk in reply to shaws]

Thank you. My T4 level was 19.1 just checked

I actually feel over medicated that's why I went for a check.

Worrying me that I can't discuss with GP until 5th July

[greygoose in reply to Foggyk]

Your FT4 might be near the top of the range - although don't really know without the range - but that doesn't mean that your FT3 is at the right level. In what way do you feel over-medicated?

Just out of curiosity, why a dose of 109 mcg levo? That's a very odd number.

[Foggyk in reply to greygoose]

Sorry 100 mg not 109

I can hear heart beating loudly in my ears and I'm irritable

[greygoose in reply to Foggyk]

ah, I did wonder. lol Actually, I get irritable when I'm under-medicated. But, you really need your FT3 tested to know if you're over-mediated. Or, you can just experiment with your dose, as shaws suggests below. It's all trial and error to find the right dose.

[shaws Administrator in reply to Foggyk]

You can adjust your dose down, if you wish, by quartering a tablet and decrease by a 1/4 every 2 weeks until you feel less symptomatic. Always take note of your symptoms and if you develop more, you might have to increase dose slightly.

Also whenever you give results you always have to put the ranges too. Comments cannot be made accurately unless ranges are also given.

[Foggyk in reply to shaws]

Thank you.

Receptionist didn't have much info

[Treepie in reply to Foggyk]

You are entitled to a copy of your results .

[shaws Administrator in reply to Foggyk]

From now on, always ask for a print-out of your results and make sure ranges are also stated. Some surgeries may charge a nominal sum for the print-out but mine doesn't.

Initially the surgery may be surprised you ask for a print-out but by Law we are entitled to them.

They will get used to us asking for a print-out but they will get used to it. They are unaware that we have to learn what our results are to enable us to get the TSH to 1 or below and the FT4 and FT3 in the upper part of the ranges. I doubt they even know this basic fact as the FT4 and FT3 are rarely tested.

We have to educate ourselves with help from the members as it seems to be rare that an Endocrinologist knows exactly how best to treat us and to restore our health.

[Foggyk in reply to shaws]

Thanks. I usually do but I got a phone call yesterday from reception, she didn't understand and can't get appointment for 3 weeks.

[shaws Administrator in reply to Foggyk]

You should be able to go to the Reception Desk and ask for a print-out of your results with the ranges. You can say you are going to have copies of your blood tests from now on. She can always check with the GP but we are entitled to copies.

I think some surgeries are going onto 'online' and it may be easier if results/ranges are also within it.

[Foggyk in reply to shaws]

I'll pop in later thanks

[SlowDragon Administrator]

Just testing TSH is completely inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Is this how you do your tests?

If GP can't/won't run full testing Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

[Foggyk]

Thank you. Yes, iv had private tests done. This was just my regular GP test and she's requested me to see her but no appointment until 5th June

[Marz in reply to Foggyk]

Can you post the results with ranges of the Private Tests you had done ? Maybe there's a clue there. 😊

[Foggyk in reply to Marz]

Yes 6 week ago T4 16.3 now 19.1

TSH wS 0.43 now 0.18

Antibodies 35.6 (same)

T3 3.5

[Marz in reply to Foggyk]

... and the ranges are ? FT3 looks low even without the range ... No need to reduce dose if Doc suggests 😊

[Foggyk in reply to Marz]

TSH 0.27- 4.2 mine is 0.18

T3 3.1-6.8 mine is 3.4

T4 12-22 mine is 19.1

[Marz in reply to Foggyk]

Do you have results for B12 - Folate - Ferritin - VitD ? They need to be optimal to improve your conversion of T4 into the ACTIVE T3 - which is currently too low. I would not lower your dose without asking the GP WHY ?? Relying on the TSH once medicated is wrong ...

[Foggyk in reply to Marz]

I am on B12 , folate and ferritin and GF diet 🙄

[Marz in reply to Foggyk]

VitD ? Was your Ferritin low then ?

[Foggyk in reply to Marz]

A little

[Marz in reply to Foggyk]

Oh !