Latest TSH FT3 FT4 results

[80-10]

I'm in a bit of a quandery as to know exactly what to do with my levo medication. I posted results of tests done beginning of May:

TSH 0.176 (0.27 - 4.2)

FT3 4.24 (3.1 - 6.8)

FT4 18 (12 - 22)

The reason I had these tests was because I was experiencing symptoms which I associate with OVER active thyroid, and had experienced for many years (heart missing a beat and a tense feeling in the body) until a total thyroidectomy in August 2018.

Living mainly in Italy, I had a scan done on my neck about 18 months ago, after the thyroidectomy, (scan? never offered one of those in the UK), and the endo said that he could see residual remains on each side of the thyroid. I began wondering if perhaps these residual remains may have been contributing slightly to the test results??

Up to the point of the May tests, I had been taking Levo, 4 days 100mcg, and 3 days 75mcg, and experiencing the above symptoms. I did receive replies to this post, and the consensus of opinion seemed to feel I am under medicated, as these symptoms, I gather, can also indicate that.

I decided, rightly or wrongly, to reduce my medication, and since those May results, have been taking 75mcg every day, still experiencing the same symptoms. So I have just had further blood tests, results received yesterday, as follows:

TSH 0.763 (0.27 - 4.2)

FT3 3.58 (3.1 - 6.8)

FT4 15.9 (12 - 22)

The FT3 and FT4 results would indicate under medication I think, but I don't understand the slight improvement of TSH.

It could of course be that the symptoms I am experiencing are not associated with my thyroid (or lack of it), but they do come and go which makes me think they are more likely to be thyroid related.

I would really appreciate some views on this, and thank you in advance for taking the time to read this.

[tattybogle]

TSH rising is what is expected with the lowering of FT4/FT3. think of them on opposite end's of a see-saw.

TSH is a signal from the pituitary to the thyroid saying please make some more T4/T3. When T4/T3 drop TSH rises, and when T4/T3 rise TSH drops.

~ although obviously your feedback information system has been interfered with by removing your thyroid (or most of it?)

If i had your results i would try going the other way (slowly) and see how it feels.

the risks for low TSH don't start until TSH is below 0.04mUI/L, and even then they are 'relative'. As long as FT4/FT3 stay within range you are not technically overmedicated, So you have room to increase dose on your current results , and you did have room on your previous results when taking 4x100 /3x75 .

[80-10 in reply to tattybogle]

Thanks tattybogle for your swift reply. I'm very grateful. I think I'll probably go up to 100 a day. What would you reckon on that?

[tattybogle in reply to 80-10]

I would agree,try 100/day , but whether to go there in one go , or whether to go back to 100x4/75x3 first , and then go to 7x100 in not sure.

I have only been on here a few months, (but i have been on levo many years), so maybe see what others recommend.

Usual advice unless elderly or with existing heart problems is to raise 25mcg and hold for 6/8weeks than re-test bloods. So i don't see a problem with going from 75/day to 100/day. But it may be easier to adjust to change if you do it in 2 stages,or maybe i'm being too cautious ?

In my recent experience of lowering /raising dose from 125/112/100/112 over 9 months or so , i have found i need to wait at least 8 weeks to settle down on new dose. so make sure you try it consistently for long enough.

[80-10 in reply to tattybogle]

Thanks again. All food for thought.

[greygoose]

Your TSH hasn't 'improved', it's risen slightly. But that is neither here nor there. The important thing is that your FT3 has descended to rock-bottom, and that's what's causing your symptoms.

75 mcg is only a small dose - not much more than a starter dose - and, considering you were under-medicated on your previous dose, decreasing your dose was bound to end in tears. And, on top of that, you are a poor converter, so you're going to need quite a hefty dose of levo to bring your FT4 up high enough to convert to a decent level of FT3. And, even then, it might not be enough. You'll probably need T3 added to your levo.

There are many reasons for poor conversion. One of them is nutritional deficiencies. Have you had your vit D, vit B12, folate and ferritin tested?

[80-10 in reply to greygoose]

Thanks for your reply. I didn't have the vits tested this time, but in May they were:

Vit D 72.4 (needs to be over 75 to be sufficient?)

B12 112 (>37.5)

Folate 7.3 (>3.89)

Ferritin 125 (13 - 150)

Will recheck next time.

Thanks again for your help.

[pennyannie]

Hello 80-10 :

Once on any form of thyroid hormone replacement the TSH, looked at in isolation is of little value, and a TSH will rise as the T3 and T4 decrease, which is how this feedback loop works so, in itself, this is nothing to worry about.. If however you need to be keeping a low suppressed TSH because of the health issues you have, this may have some relevance.

Your previous results show a higher level of T3 and it is T3 that gives you the symptoms :

Too high a T3 equals hyper symptoms - possibly from over medication - too low a T3 equals hypo symptoms - possibly from under medication :

There's a fine balance and it's a bit like Goldielocks and the porridge, as we all have our own " sweet spot " and it's your T3 level that is important and your ability to convert the T4 into T3 which is the active hormone that the body runs on.

Your conversion of the T4 into T3 can be compromised if you don't maintain ferritin, folate, B12 and vitamin D at optimal levels so you need to keep your core strength strong and solid.

Most people feel well on Levothyroxine when their conversion ratio comes in at around 3.5-4.5 : with T4 being around 4 times that of theirT3 : and if we look at your results above in both May and June your ratio is consistent at around 4.3 - 4.4 :

However your T3 was higher in May and I would think you were better placed then than now. There is room to increase your thyroid hormone replacement and might I suggest you try 88 mcg T4 daily, by halving a 25 mcg as having a consistent dose might just help you.

You might like to read a book " Your Thyroid and How To Keep It Healthy " written by a doctor who has hypothyroidism. Barry Durrant - Peatfield writs in an easy understand manner and though we don't now have this amazing little gland we do need to know what it does so we can try and compensate accordingly.

P.S, I thought I remembered writing you before, and yes, everything I said then still stands ;

[80-10]

Thanks again. Yes you did reply to my previous post. This time I shall heed your words!!

Very grateful for your help.

[pennyannie in reply to 80-10]

IMHO - nothing is a quick fix and I wasted a couple of years, as even armed with the information, and copies of the evidence, I was still referred to as a conundrum and abandon by the NHS.

Educate yourself so if all else fails you too can take back control and sort yourself out. There will, no doubt, be a possible bump or two along the road but better to be on the road going somewhere than left in the layby.

[80-10]

Thanks so much for your encouragement, I so appreciate it.