Help with Dosage of levothyroxine

[Bollieforme]

Hi just wondering if any of you are experiencing significantly different TSH levels after every blood test? I vary from under to now over medicated. I cannot achieve a result of 2.0 which I’m aiming for. Most recent test Tsh was 0.16 and 8 weeks ago it was 15.6 was on 75 levo raised to 100 then asked to return to 75/100 alternate days. I felt ok when on 100 the past two months but blood test was over medicated with Tsh of 0.16. I’m at a loss what dose to be on, been up and down for months. GP asked me what I wanted to take!

[greygoose]

Why are you aiming for a TSH of 2? That's too high for most hypos.

But, you shouldn't be dosing by the TSH, anyway. You are never going to be stable doing that. It will always swing one way then the other.

The most important number is the FT3, because that is the active thyroid hormone, but failing that, the FT4 at least should be tested. TSH isn't even a thyroid hormone, it's a chemical messenger from the pituitary to the thyroid.

A TSH of 0.16 does not automatically mean that you are over-medicated, it just means that the pituitary is satisfied with what it's got. But, just because the pituitary has enough hormone, it doesn't mean the rest of the body has. You are only over-medicated if your FT3 is over-range.

But how do you feel?

Two important questions:

a) Do you have Hashi's?

b) Do you always have your blood draw before 9 am and fasting, leaving a 24 hour gap between your last dose of levo and the blood draw?

[SlowDragon Administrator]

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Do you have high thyroid antibodies?

Ask GP to test vitamin levels

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

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

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

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

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

nhs.uk/medicines/levothyrox...

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

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

Add results and ranges if you have them or come back with new post once you get results

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

[Ellie-Louise]

Has someone somewhere told you it should be 2?

[Bollieforme in reply to Ellie-Louise]

Yes, a Professor of Endocrinology. Who only goes by TSH even though I have Hashimotos. Felt better for being on 100 levo for the past two months had a test and Gp who says to me results abnormal and I should drop dosage. I’ve never been stable and reducing the dose has thrown me.

[greygoose in reply to Bollieforme]

You never will be stable dosing by the TSH. It's totally wrong. And for a Professor of Endocrinology, it's almost criminal! I think you should drop him and see someone who knows something about thyroid, because he will always keep you unwell.

[shaws Administrator in reply to Bollieforme]

Considering that TSH (thyroid stimulating hormone) is from the pituitary gland and rises to try to flag up a dysfunctional thyroid gland to produce more hormones, why do the professionals persist on a TSH result to be in range.

Once upon a time - long gone now - doctors used to know all the clinical symptoms and diagnosed patients upon them. If the doctor held your hand, he/she was interested in your body temp, i.e. was it too cool, etc and took an interest in their clinical symptoms and patient got a trial of NDT (natural dessicated thyroid hormones). If patient began to improve they were hypo and continued on NDT which was slowly increased until patient felt well. (NDT = natural dessicated thyroid hormones made from pigs' thyroid glands which contain all of the hormones a healthy gland would do but withdrawn in the UK due to False Statements being made by those who you'd imagine would know better.

Nowadays they only look at the TSH result (which is from the pituitary gland) and adjust medication (when diagnosed) according to the TSH alone without considering whether or not if symptoms were beginning to be relieved or ensuring sufficient increases in levo was reducing the TSH and increasing FT4 and FT3 (i.e . Free T3 and Free T4) . Many doctors - once TSH is somewhere in the range will stop increasing dose but we, the patients, remain symptomatic when we need it around 1 or lower.

[vocalEK]

Your blood test may have been "over medicated", but your body wasn't. You said you felt well on that dosage.

You might want to read this article: ncbi.nlm.nih.gov/pmc/articl...

Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment

Better yet, whoever is treating you should have read it.