TSH below low reference level

[nigelm]

Hi, My doctor has said I need to reduce my thyroxine by 25mcg - I'm currently on 125 per day. This was after another reduction from a year ago, I was first diagnosed three years ago.

My concern is that my Free T4 is currently in mid range 18.6 pmol/L

(range 12-22), and T3 at 5 pmol/L (range 3.1-6.8) however my TSH is only 0.03 (range .027-4.20). This has always been low and my T4 high whilst on Levothyroxine and have been told here that it should be on the high side if being treated. So I am a bit concerned that the T4 has got lower, it was at 27.3 at the highest test, which is why I was happy to lower the dose at that time. Is it because of the TSH that he has said lower it again, that has always been low for me, since taking medication have only been tested as high as 0.13?

The blood results for others are in range thanks to advice from here and now taking supplements for them all Vit D is 76nmol/L

range 50-120 taking 1 25ug per day, B12 668ng/L range 197-771 taking 1000ug every other day, Ferritin 78ug/L range 30-400 taking 14mg iron tablets per day.

They also do a Bone Profile check and all good apart from inorganic phosphate

which is below range at 0.69mmol/L range 0.87 - 1.45

- this has been slowly getting lower was at 1.10 when I first started the Levothyroxine. Is this related in anyway or another issue I should ask about?

I will do as my doctor advises and re test in two months. Although I have not actually seen him for two years as all correspondence is by text messages.

Any advice would be most welcome.

[SlowDragon Administrator]

If your FT4 and FT3 are both within range you are not over treated

Vitamin D needs improving to at least 80nmol and around 100nmol may be better

[DippyDame]

This paper re TSH might be of interest

bmcendocrdisord.biomedcentr...

[greygoose]

Tell him to take a hike - politely, of course. He should NOT be dosing by the TSH, which he obviously is.

[jimh111]

Doctors should not be monitoring and treating patients by text messages. You can try reducing your levothyroxine and see how you feel, put it back up if you get problems. I'm not sure if this is the same doctor who was quite happy with these and higher levels over the past three years. Looking at your earlier posts you seemed to have fT3 and fT4 that were creeping up. It's quite possible you had too much hormone at some time and this can knock back the TSH which does not always recover. In these cases you have to go by signs and symptoms assisted by the blood tests. It's possible over the past few years you still had some residual thyroid function and the thyroid can be erratic in its secretion whilst it is dying away, leading to altering hormone levels.

I would make sure your doctor sees you in person and does basic checks like examing you, taking your pulse, observing your signs and asking about symptoms. You can't monitor hypothyroidism by text messages.

[m7-cola in reply to jimh111]

And/or monitor your signs and symptoms yourself. I take my own pulse, basal temperature and blood pressure and keep careful note of symptoms.

[jimh111 in reply to m7-cola]

Very much so, gives you a full record which can be helpful in the future. Nonetheless we shouldn't let doctors get away with bad care, they have to treat the patient not the numbers.

[m7-cola in reply to jimh111]

Quite right. Unfortunately I have lost faith that they will!

[shaws Administrator]

It's such a pity that doctors believe that the TSH gives them all the information they need and if TSH is low assume we're now hyPERthyroid, so they reduce dose to increase TSH. The fact too is that the TSH is from the pituitary gland and rises if the thyroid gland is struggling. Doctors shouldn't reduce dose according to the TSH alone but rarely test the FT4 and FT3. The aim is a TSH of 1 or lower.

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

[SlowDragon Administrator]

FT4 is 66% through range

FT3 only 52% through range

Helpful calculator for working out % through range

chorobytarczycy.eu/kalkulator

If anything you need small dose increase

Looking through previous posts couldn't see that you have ever had TPO or TG thyroid antibodies tested?

[nigelm]

Thanks for all your replies and giving me the confidence to challenge the text. Good new he is happy for me to continue on 125mcg Levothyroxine with another test in two months.

And with advice from here I will up my Vid D to two tablets a day (especially as it's winter and I've not been out in the sun for a while!).