Levothyroxine Dose and stable levels - help with results

[Thyroidnewbie84]

Hi,

Looking for some advice to help me manage next catch up with GP.

TT - end July due to Goiter, hormone levels normal. Initial dose 125 Levo

First bloods post Op 3rd Sept - normal range but was feeling awful symptom wise

TSH - 1.35 (range 0.27 - 4.2)

T4 - 18 (range 12 - 22)

27th Oct - still on 125 Levo, agreed to move to alternating 100/125 and test in 4 weeks as symptoms eased but doc wasn’t happy with my levels below.

TSH - 0.04 (range 0.27 - 4.2)

T4 - 22.5 (range 12 - 22)

T3 - 5.7 (range 3.1 - 6.8)

18th Nov - to discuss this week with GP, symptoms wise I feel much more myself bar a few palpitations.

TSH - 0.03 (range 0.27 - 4.2)

T4 - 17.1 (range 12 - 22)

T3 - 5.0 (range 3.1 - 6.8)

My question... if my symptoms feel better at these levels. Is there any risk of keeping my TSH that suppressed health wise? I know people often speak about those with no thyroid feeling better at a TSH of 1 or below, however I believe the above counts me as Hyperthyroid?

Also a little confused at how my T4 has changed... is this a worry / cause to tweak my current dose to get back up near 20’s?

Thanks for any advice - all still new to me.

For info I have optimized my vitamins with doc, so this is all in place too.

[SlowDragon Administrator]

Sorry we always need the ranges on all results (figures in brackets after each result )

What were test results BEFORE thyroidectomy. Was goitre caused by autoimmune thyroid disease also called Hashimoto’s?

Did you have thyroid antibodies tested?

Which brand of levothyroxine are you currently taking

Do you always get same brand

For full Thyroid evaluation you need TSH, FT4 and FT3 tested.

Please add actual results and ranges on vitamins.

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)

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/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

[Thyroidnewbie84 in reply to SlowDragon]

Sorry! Forgot to pop ranges in. These are now added.

Tests results pre TT were similar to my first set after removal. No previous hormone problems/ autoimmune suspected (no test done). Removal due to rapid growth of goiter post natal. Pushing on windpipe.

Levothyroxine brands been different each time I get prescription. Latest is Wockdart & Aristo.

Test wise - yea last dose 24 hrs. Blood test done in morning and Levothyroxine not taken until after blood drawn.

Hope that helps you with info.

[SlowDragon Administrator in reply to Thyroidnewbie84]

So how do you feel?

Ft4 is dropping, if continues to drop you will need dose increase in levothyroxine

What vitamin supplements are you currently taking

What were actual results and ranges on vitamin results?

[Thyroidnewbie84 in reply to SlowDragon]

I feel very well just now symptoms wise - close to pre-Thyroidectomy.

I found it odd that my T4 is dropping but expect it must be the drop in Levothyroxine meaning there’s less for my body to convert or I need a higher dose at 125 to get the higher ranges of T4 conversion -as seen by my test outcome of T4-22.

Is there any risk in my TSH staying below range at the 0.03 range? Does it only really matter what my T4/T3 results are? I was worried about low TSH indicating ongoing issues with osteoporosis etc. Bit confused it a low TSH makes you hyperthyroid or all ok as long as T4/T3 are within range.

Vitamin levels are on my docs records - don’t have them to hand. I’m taking Vit D, C with zinc, Iron, B12.

[SlowDragon Administrator in reply to Thyroidnewbie84]

Never accept an opinion that vitamin levels are “ok”

Always get actual results and ranges

After thyroidectomy you can NOT be hyperthyroid

When optimally treated, with high enough Ft4 and most importantly Ft3, then TSH is almost always very low.

The trouble is, medics are TSH obsessed and frequently want to lower dose to bring TSH into range....then Ft4 and Ft3 drop too low

High Ft3 or low Ft3 can cause osteoporosis

What we need is optimal Ft3

[Thyroidnewbie84 in reply to SlowDragon]

Thanks - this is really useful to know. I had assumed that if I was over medicated or under medicated I would essentially have symptoms of hyper or hypo symptoms. From the above you are saying I can only ever be Hypothyroid.

I will ask about my vitamin results.

[SlowDragon Administrator in reply to Thyroidnewbie84]

Make sure that iron supplements are at least four hours away from levothyroxine

[Thyroidnewbie84 in reply to SlowDragon]

I take Levothyroxine am and all my vitamins just before bed to ensure enough space between everything

[SlowDragon Administrator in reply to Thyroidnewbie84]

You want to take iron well away from other vitamin supplements

[Thyroidnewbie84 in reply to SlowDragon]

Thanks! I wasn’t aware of this - will adjust

[tattybogle in reply to Thyroidnewbie84]

In regard to the relative risks of low TSH;

If you look at the first reply to this post; healthunlocked.com/thyroidu...

and click on the links contained in it , you'll find useful discussion and evidence on the subject.

hope it helps you make your own mind up . i think GP's just get the 'headlines', not the full picture.

[SlowDragon Administrator in reply to Thyroidnewbie84]

Interesting you are on Aristo ...that new version only recently available

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Teva, Aristo and Glenmark are the only lactose free tablets

dropbox.com/s/6h3h0qi4eqwi6...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[pennyannie]

Hello Thyroidnewbie

There's little to add to this very comprehensive reply from SD but just to say you haven't a thyroid now and so cannot " go hyper " :

You are now hypothyroid and maybe said to be over / under medicated according to the guidelines but more importantly it is essential that you are dosed and monitored of your T3 and T4 blood test results.

In primary care it does seem that many people only get monitored and dosed on a TSH blood test result irrespective of the medical history - I know, it happened to me - crazy.

This is totally wrong and as you can see with your results, if only a TSH were run, you would probably have a dose reduction rather than an increase as you would be " seen " as overmedicated with a suppressed/low TSH, with the computer flagging you up for "action".

T4 is a storage hormone that needs to be converted by your body into T3 the active hormone that the body runs on. T3 is about 4 times more powerful than T4 and read the average person uses about 50 T3 daily just to function.

Your ability to convert the T4 into T3 can be compromised if your core strength vitamins and minerals, ferritin, folate, B12 and vitamin D are not maintained at optimal levels, which does not mean just somewhere in the range.

Ideally T3 and T4 should be balanced and we seem to feel at our best when both these vital hormones are in the top quarter of the ranges with a conversion ratio of about 1 / 3.50 - 4.50 - T3/T4 with most people preferring not to go above a ratio of 1/4.

Your T3 is currently at 5 and your T4 at 17 - so just dived one into the other and your conversion ratio comes in at 3.4 - so if this is where you feel at your best, this gives you some basis on which to build from for your continued good health.

[Thyroidnewbie84 in reply to pennyannie]

Thanks! This is really helpful and clearly explains what I was looking to know. I feel much clearer on next steps for managing my levels.

Feels like I’m in the right dose and no risks to leave as-is.

Appreciate feedback from this forum. It’s been hugely helpful in enabling me to learn about my new condition.

[pennyannie in reply to Thyroidnewbie84]

Hey there again,

Can I just was the goitre due to Graves Disease ?

[Thyroidnewbie84 in reply to pennyannie]

No, it’s post natal growth. No hormone issues or autoimmune problems. It was pushing significantly on my windpipe and rapid growth over 12 months