Hello all, still feel like I’m new at this after 5 months! Latest bloods are below, this is on 100mcg and following all advice prior to testing (biotin, last dose of thyro etc) and GP wants to lower to 75mcg (which changes brand of thyroxine again) but I felt really good on 100, no adverse feelings (changed to Aristo on last prescription and didn’t feel as good but that’s not necessarily about dose). Should I be fighting to stay on 100? GP said people who are over medicated tend to feel great - not sure that’s true reading around on here. Many thanks x
TSH 0.05 (0.3-4.5)
T3 4.8 (3.1-6.9)
T4 20.3 (10-22)
Written by
Ejc124
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Your GP is making the classic mistake of dosing by TSH rather than looking at the actual thyroid hormones (FT4 and FT3). Yours are in range so no need to reduce dose. It's actually the FT3 that tells us if we are over medicated. Show your GP the following:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):
"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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Your FT3 is only 44.74% through range. Your FT4 is 83% through range so your Ft4 and FT3 aren't well balanced. The aim of a treated patient on Levothyroxine only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. You could point out to your GP that with your current FT4 and FT3 levels they actually show poor conversion of T4 to T3, and it's T3 which is the active hormone which every cell in our bodies need.
Overmedication is when your FT4 and/or FT3 are over the top of the range.
You are not overmedicated. You need that high level of FT4 to have enough FT3 and you feel well on 100mcg.
I would say things such as your body no longer processes T4 efficiently so you need a higher level of levo to ensure that your FT3 is adequate. This is demonstrated by your current blood results where FT4 is 86% through range to obtain an FT3 result only 44%through its range. If your body was processing efficiently and one was high in range then you would expect the other to be at least over half way through its range and towards the top.
And we can't be having that now can we , people walking around , feeling great , having a life ..... honestly , this is not the first time i'v e heard of this comment from GP's. And you would think that if they'd all noticed this, they might get curious about WHY..... oh well.
The real measure of overmedication is FT4 /and more importantly FT3 Teats that are over range...... yours are not even close.
And symptoms of overmedication, Fine tremor in fingers, fast heart rate , frequent bowel movements etc (same as symptoms of Hyperthyroid)
The GP will be looking at your below range TSH and because of small statistical 'risks ' related to Heart and bone problems with Low or High TSH will want you to reduce dose.
However everything has risks, and you should look at the detail and make your own mind up;
If you click on the links and read the old posts and research studies that i have put in my answer to this post you will see what i mean ;
Depends what feeling great means. People taking cocaine say they feel great. There’s insufficient research to assess whether abnormally high ft4 and abnormally low TSH have long term and or hidden health effects. I for one would prefer my bloods to look normal so long as this is consistent with minimal or no hypothyroid symptoms. This would probably mean taking levothyroxine to give normal ft4 and liothyronine to top up any shortfall from conversion to give normal ft3 - that’s what a healthy thyroid does. It seems madness not to emulate healthy thyroid activity in every way when replacing and that includes split dosing levothyroxine. Also... justifying or accepting a TFT result because TSH FT3 & FT4 are somewhere in the lab range is a kind of old school error, there’s more than enough data to enable everyone, with or without the help of a decent physician, to get all three vital indicators almost bang on normal for the relevant peer group and only than deviate from these if needed to address any residual symptoms (to accommodate the less common outliers from euthyroid normality). All this guff about being ok in the upper part of lab range under levothyroxine because it’s needed for sufficient t3 production completely misses the point that nowadays, with modern medicine and pharmaceuticals, treatment for hypothyroidism would be better from the starting point of replacing both of the main thyroid hormones T3 & T4 together in physiologically relevant proportions .... like nature intended! Levothyroxine alone is medieval.
You’re definitely over medicated! But that’s not the whole story and it’s too complicated for your too simplistic GP.. Your tsh is telling you that there’s more than enough ft4 although it’s likely this how you’re getting enough or slightly more than enough ft3. It’s quite possible dropping a full 25% of your current dose Will be insufficient and will make you suffer sub-optimal ft3 in a few days. Maybe try alternate days 100/75 levothyroxine and see what happens. You could well do better on 75 levothyroxine and 5 liothyronine.....
Hi Hashihouseman, have i understood your reasoning correctly;
Try and reduce by the smallest amount so it hopefully doesn't reduce current well being, but might raise TSH slightly , with the aim of increased TSH driving better T4 to T3 deiodinase conversion ?
or is there a different reason for your suggestion.
its not clear that TSH drives conversion, it stimulates t3 production/conversion in the thyroid as I understand it but in the cells, where it really does the work that is more controlled by the demand and supply with the amount of T4 providing control by negative feedback i.e more excess T4 reduces conversion rate and vice versa. My reasoning was more that the FT4 level is high enough and TSH low enough to reduce it and see the effect o ft3... if ft3 drops too low with a more normal ft4 level then liothyronine is probably needed....
Seems like a good analysis of poor conversion. Interesting way to look at it - I’m going to revisit my records and crunch those numbers. Thanks. Also there’s this... thyroidpatients.ca/2019/06/... Which links to a really nifty little application to show, scientifically and objectively based on detailed professionally constructed algorithms whether someone is a poor converter....
Thanks , that 's interesting. I'd heard of Spina -thyr, but nice to read more about it.
After reading this and your earlier answer ,i think i've been underestimating how much conversion happens in thyroid tissue itself, i'd been thinking it was more in the end organs, but seems not.
P.s if you play with my numbers ignore the TSH of 7- it was an experiment (by removing levo for 10 days followed by 2 days normal dose before test) to see if was capable of moving , It moved more than i was expecting.
I wish i had ft3's for my recent ft4's of around 200+%, but sadly not done. Curiously this is on 12.5 mcg less levo than the 111% result..... i cant explain this
well yes in the thyroid but that's just because that's how all T3 is created in vivo, our thinking seems to regard it as de novo but T4 is the precursor. ... However what is more special about thyroidal T3 is that its secretion seems to have a very specific and nuanced feedback control mechanism which suggests that some thyroidal (or exogenous/replaced) T3 is absolutely essential and the body is evolved to use this to add to intra-cellular/peripheral conversion all the time and more especially in times of additional need that cannot be fine tuned by intra cellular feed back pathways e.g. poor converters/transient poor conversion/growth/metabolic stress. Yes 70-80% comes from outside the thyroid conversion but it isn't controlled by the system wide feedback loops, its more what does the particular do with x amount of ft4...... and increasing ft4 reduces conversion rate so we should take care not to try and manage hypothyroidism by dumping too much T4 into the hypothyroid body because its a) cheap b) cheerful c) easy to use d) the focus of a doctors very basic grasp of the condition!!!!
GP said people who are over medicated tend to feel great
If that was really true it makes you wonder why people who are hyperthyroid ever seek treatment.
In people who are truly hyperthyroid TSH is very low e.g. <0.005 (for example) and their Free T4 is often around 40 or more, and their Free T3 is around 30 or more.
Please don’t give a second thought about the TSH, you just can’t use it to accurately bring about health or balance, you’re past that. Once you interfere with the natural feedback loop it’s useless and I’m sick of hearing GP’s site it as gospel! You feel good right now and that’s what should be looked at. Tell them to sod off! Lol
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Increase Dose (but not telling GP) 
GP won't increase dose
GP dose increase it’s that time again 
