Over treated results?

[HollieBerry]

Recent blood results-

TSH 0.08 (0.30-4.20)

FT4 21.5 (20.00-42.00)

Previously on 150 Levothyroxine

Doctor has now reduced to 100 as he says I am over-treated, is this right?

[Marz]

Is that FT4 range correct ? Looks huge

[HollieBerry in reply to Marz]

Haha sorry you’re right! It’s (11.00-22.00) thanks for pointing that out x

[Marz in reply to HollieBerry]

The FT4 is a storage hormone doing very little in the body. It needs to convert into the Active T3 needed in every cell of your body - so without testing it is impossible to know if you are converting. As SS has mentioned your GP is going by the TSH result which is completely WRONG ! You do not have to reduce your dose ...

[SeasideSusie Remembering]

CrazySexyFool

I agree with Marz, that doesn't look like any range for FT4 we've ever seen on the forum.

But whatever it is it would seem that your GP is looking purely at your TSH and because it's below range wants to reduce your dose. Unfortunately, most doctors seem to think this is the right thing to do once on Levo, it's not. The important tests are the actual thyroid hormones - FT4 and FT3. We are only overmedicated if FT3 is over range.

So before agreeing to a dose reduction based on TSH, ask your GP to test FT3 at the same time as FT4.

The following article is useful when a GP wants to dose by TSH alone:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):

"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).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at:

[e-mail]

print it and highlight question 6 to show your doctor.

[HollieBerry in reply to SeasideSusie]

Thank you Susie. I am currently gathering information to go to my next appointment armed!

I am also wanting to know whether I have Hashimoto type or not. My doc said it doesn’t matter which type I have as I will be treated the same way anyway. Is this correct?

Thanks for your advice x

[SeasideSusie Remembering in reply to HollieBerry]

Your doctor is correct in that when Hashi's is present then the treatment is the same. Hashi's destroys the thyroid and causes hypothyroidism, so it's the hypothyroidism that's treated.

As for the Hashi's, some members have found that adopting a strict gluten free diet can help, although there is no guarantee.

Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.

You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies so it's essential to test Vit D, B12, Folate and Ferritin.

[HollieBerry in reply to SeasideSusie]

Thank you. I think I just wanted to know for sure, so I can then research more into food and supplements (as you’ve mentioned) x

[HollieBerry in reply to SeasideSusie]

Oh! Just noticed he also did -

Vitamin B12 324 (180-640)

Serum folate 6.4 (3.00-20.00)

[SlowDragon Administrator in reply to HollieBerry]

So both B12 and folate are on low side

You need vitamin D, ferritin, both TPO and TG thyroid antibodies tested plus FT3 tested at same time as TSH and FT4

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

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

Just testing TSH and FT4 is completely inadequate

[SeasideSusie Remembering in reply to HollieBerry]

HollieBerry

Vitamin B12 324 (180-640)

Is that pmol/L or pg/ml or ng/L (pg/ml and ng/L are the same).

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

So if it's 324pg/ml then it's low.

If it's 324pmol/L then that equals 439pg/ml and it's still low.

Serum folate 6.4 (3.00-20.00)

This is low and folate is recommended to be at least half way through range.

To raise both B12 and folate you could supplement with a good quality B Complex containing methylfolate and methylcobalamin (not folic acid and cyanocobalamin). Good brands are Thorne Basic B or Igennus Super B.

However, if it's 324pg/ml and you have signs of B12 deficiency then you should discuss this with your GP so that further testing for B12 deficiency/pernicious anaemia can be carried out. In this case do not supplement for the time being as it will mask signs of B12 deficiency and skew results.

Check for signs of B12 deficiency here: b12deficiency.info/signs-an...

[SeasideSusie Remembering]

He is saying that most people feel well when their TSH is 0.2 - 0.5 and also acknowledging that not everyone does so it is OK to have a suppressed TSH.

What is missing from that article is that not everyone converts well. He has since rectified that recently with a new article which acknowledges that T3 may be helpful for many patients

rcpe.ac.uk/sites/default/fi...

I was in CrazySexyFool's position for many, many years - below range TSH with high FT4 (and very over range at times) but I never, ever experienced symptoms of overmedication, it was never my problem. What was, which I had to discover myself, was poor conversion. This is why we always suggest that people have FT3 tested as well when in the OP's situation.

[jimh111]

See how you are on 100 mcg. Most patients would be a little over-treated with these results but each patient is different. It may be that reducing to 100 mcg is going too far, I would have thought 125 mcg would have been more appropriate.

How do you feel? Do you have any symptoms?

[Angel_of_the_North]

Your free T4 is in range so you are not overmedicated. It would be helpful to have a free t3 result to be sure, as free T3 is the active hormone