Just got my Free T3 blood result. Your comments please:
FREE TRIIODOTHYRONINE 2.6 pg/mL (2.3-4.2)
TSH and Free T4 which I had posted earlier, as soon as those came out:
TSH 3.41 uIntUnt/mL (0.55-4.78)
FREE T-4 1.1 ng/dl (.67-1.52)
To request a higher dose of levothyroxine from my Primary Care Physician in the U.S., based on the Free T3 (Free Triiodothyronine) blood result, I would need a reference for a document showing that my Free T3 is too low. Without that, she might tell me that since the Free T3 is within the reference range, it is fine
Thanks very much!
Written by
rjb112
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Most of us only really feel well when free T3 and free T4 are in the top third (often the top quartile) of the reference range. It's also worth checking how the free T3 and free T results sit in their reference ranges. If they're balanced, that's great. If not, it's a good sign that you don't convert well and so may need T3 meds as well as T4.
Your free T4 is 50.59% through range and your free T3 is only 15.79% through range, so I'd be wanting more meds if it were me!
To request a higher dose of levothyroxine from my Primary Care Physician in the U.S., based on the Free T3 (Free Triiodothyronine) blood result, I would need a reference for a document showing that my Free T3 is too low.
You need a higher dose of Levothyroxine based on TSH - it's way too high for a treated Hypo patient.
I sent you a link via PM to what Leeds NHS hospital say, i.e.
>2 = likely under replacement
and I quoted the Dr Toft article which states
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.
This is your ammunition at the moment - your TSH is too high. Bringing your TSH down willl increase your FT4 and FT3. The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges - sorry I don't have a reference for that other than it's patient experience.
I just found this statement by the American Thyroid Association:
"In most patients on thyroxine replacement, the goal TSH level is between 0.5 to 2.5 mU/L"
That also suggests to me that the average TSH should be about 1.5
And since mine is 3.41 I think my Primary Care Physician will have to take this seriously.
So what you said is right on target.
"This is your ammunition at the moment - your TSH is too high."
That's exactly how I'm going to approach it with my Primary Care Physician, based on the statement by the American Thyroid Association, which I don't think she can dismiss.
It's good that you have found some evidence that's come from the ATA, that will probably be more acceptable than something from the UK. Good luck, I hope you get your increase.
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
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