Tomorrow I am heading to the GP to request an increase in my dose of Levo and to suggest that out treatment goal should be FT3 right at the top of the range EVEN if that means a suppressed TSH and an over range FT4. My latest results are low but in range and am anticipating my GP potentially being reluctant (but thankfully open to discussing) as to why I feel an increase is appropriate and what my ultimate goal is. I've spent some time compiling some quotes that I think address what I think her concerns might be. It occured to me that sharing them might help someone else in a similar boat and save them some time trawling. So feel free to copy and paste the below if you think they might help your case with your GP/Doctor:
•Many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the ft4 range or a little above. Source: Thyroid UK
•The appropriate dose of Levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5 mU/l. In this case, free thyroxine is likely to be in the upper part of it’s reference range or even slightly elevated – 18-22pmol. Most patients will feel well in that circumstance, but some need a higher dose of Levothyroxine to suppress serum TSH and then serum FT4 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 T3 around 1.7nmol/l (reference 1.0 2.2 nmol/l) Source: Dr Toft via Pulse magazine
•T3 (as made by the body) is about four times as strong (as T4) and is thought to cause most, if not all of the effects of thyroid hormones. Source: Labtests Online
The following are all direct quotes from “Thyroid hormone Replacement – A counterblast to Guidelines. By Dr AD Toft. Published in Journal of the Royal College of Physicians of Edinburgh – 2017
•Guidelines have assumed a clinical and legal importance far beyond that which was ever intended
•We cannot afford to underestimate the level of frustration among patients, exasperated by the “one size fits all” philosophy
•Flawed evidence a suppressed TSH is a risk factor for cardiovascular disease and reduced bone mineral density as serum T3 concentrations were not measured
•Restoring serum TSH concentrations to normal in patients taking LT4 is not the answer for everyone
•A dose of LT4 which restores serum TSH to it’s somewhat wide reference range is associated with lower serum T3 and lower T3:T4 ratios (and) associated with adverse objective and subjective parameters such as increased BMI, lipid profile and feelings of poor health.
•Guidelines (……) have inevitably diminished the importance of listening to the concerns of the patient. One of the foundations of clinical medicine.
•Little attention has been given to a study, important in retrospect, which showed that it was difficult to increase serum T3 into the hyperthyroid range with LT4 unless serum FT4 concentrations were markedly elevated at around 35-40 pmol/l
•Low serum TSH levels in patients taking LT4 did not necessarily indicate overtreatment
•The facts of the matter are that the current guidelines for LT4 replacement therapy in primary hypothyroidism are not fit for purpose.
•We can prescribe doses of LT4 which do result in TSH suppression but are associated with unequivocally normal serum T3 concentrations, as I am unaware that this combination of results has ever been proved a risk factor for atrial fibrillation or reduced bone mineral density, and why should it if the level of the active hormone is normal?
lost in translation...
Help with Blood test results
