I've written War And Peace on my Profile (when I had energy).
Summary: Feel crap, fat and barely functioning (although ever so slightly better than I was).
Paid for the TSH FT4 & FT3 tested by Devon & Exeter NHS (cost £29), cost Dr wouldn't do them.
TSH 0.14 mu/L (.3-4.5),
FT4 17.9pmol (13 - 24.1),
FT3 4.3pmol/L (3.9-8)
I think that FT4 and FT3 still a bit low, but I still don't really know what I'm looking at (the NHS test thing does come back with notes, but it's worded as if not currently medicated)
I take 100mc of Levo. (Going by my weight alone, I think it should possible be 150)
All opinions welcome. Going to bed now. All this concentrating...!
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Wetsuiter
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Have you ever had both TPO and TG thyroid antibodies tested?
Likely you have Hashimoto's - levels going up and down
Have you considered trying strictly gluten free diet?
Ideally you need FULL Thyroid and vitamin testing
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?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
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
Yes I suspect need vitamins etc tested. And suspected Hashis. Not started on GF yet, as can only cope with one thing at a time. I can see on my records that antibodies have been requested a few times, but it just says N/A. Would struggle paying for private testing. I do fasting blood tests as suggested. Take other meds at other end of the day. And now always leave more than an hour before drinks/food after levo.
Thanks again for you reply. It reassures me of my understanding
yes your T4 and your T3 are a bit low and you might benefit from an increase, however B12, vitamin D, folate and ferretin are all needed at good levels for your body to be able to make good use of any thyroid hormones or any hormone replacements so if an increase does not help it is worth looking at these.They should be taken routinely with thyroid bloods. You might find going gluten free helpful.
I managed your war and peace, and have my own history.
I think you need to get the vitamins and minerals tested as if not optimal they can compound the issue of conversion within the body of metabolising the T4 - Levothyroxine into T3, which is the hormone the body runs on.
I would guess your doctor is managing you on only a TSH blood test which shows you as under, or suppressed, which medics assume means you are optimally medicated.
Your TSH is 0.14 in a range of 0.3 - 4.5 - below reference range, which Dr's. don't like.
Your T3 is 4.3 in a range of 3.9 - 8.00 - is this range correct ?
You're under 10% though the range ?
( 4.3 = 4 digits into a range of 41 digits as a % = roughly 10% ) .
Your T4 is 17.9 in a range of 13 - 24.10 - and shows you under 50% through the range.
So, it's obvious that you are not effectively converting the Levothyroxine into T3.
Could any other medications be compounding conversion ?
Most people feel better when both their T3 and T4 are in the upper quadrants of their relevant ranges so yes, you could have an increase in T4 and it might help to put your T3 higher in the range, but personally, I think the disparity between the two hormones may mean that you need a little T3 as well as T4.
This is currently a hot potato as doctors are not allowed to prescribe T3 but maybe a referral to an endocrinologist might be worth a go for you.
I'm with Graves Disease and had my thyroid ablated with RAI back in 2005.
Last year I was refused a trial of T3 by my NHS trust and so now I am self medicating and buying own hormone replacements and doing a lot better than being on monotherapy with Levothyroxine.
Thanks PennieAnnie. good to hear that you 're doing better
Yes will try to get Dr to test vitamins ect, and try that route first for T3 conversion b4 trying to get T3 prescribed. (Cant manage too many battles at once). I just double checked the test ranges. It's tricky to see as it's displayed on a graph, but I think I have numbers correct, and yes I sort of worked out those % too.
Overall I'd say you're undermedicated. Your problem is that doctors often look only at TSH, and yours is now below the range. Most people need below range TSH to feel well, so it's a bit of a Catch-22.
For the free hormones, a person with a healthy thyroid would have these right in the middle of the range. But once on treatment we tend to need it higher. Your freeT4 is in that middle of the range kind of place, but you'd probably feel better with it near the top.
All the T4 we take has to be converted by the body into T3, which is the active form, before we can uses it. Some of us, especially when we've been ill a long time, aren't very good at conversion. Your freeT3 is very low, suggesting you aren't converting well.
In a perfect world you'd have a 25mcg increase in T4 today, then hold for 6 weeks, have a blood test and adjust again, and so on. Initially it would be good to see that freeT4 high in range and see how you manage. If conversion still looks poor, start swapping out some of your T4 dose and replacing with T3. Unfortunately you may struggle with every step of this with a doctor You may be able to convince them you have a conversion problem, but its v hard to get prescribed T3. You may be able to find a doctor who doesn't just look at TSH and will raise you're dose because freeT4 is quite low. Its often a case of changing doctors.
What you can do yourself is work on the things that can impact conversion. Get your vitamins tested and sort out any deficiencies, try gluten and maybe dairy free.
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.
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You may be able to convince them you have a conversion problem, but its v hard to get prescribed T3. You may be able to find a doctor who doesn't just look at TSH and will raise you're dose because freeT4 is quite low. Its often a case of changing doctors. 
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