Advice on a letter from my endocrinologist

[Eimear78]

Hi everyone.

I have just received this letter from my endocrinologist. We are supposed to be trying to increase my FT4 levels by slowly increasing levo and reducing the Tiromel. He asked me to do a blood test. Never called to see if my symptoms had changed and I have received this which is a brush off. I know they are under pressure at the moment as he has been working on wards but I don’t know when my next appointment will be or if we are shelving our plans to balance my hormones.

What do I do? I am still having some problems so I feel like I have been fobbed off.

Thanks

Eimear

[SlowDragon Administrator]

How much levothyroxine are you currently taking and how much T3

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test and last 1/3rd of daily T3 taken 8-12 hours before test?

Ft4 is only 40% through range

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

Do you always get same brand of levothyroxine

Are you on strictly gluten free diet or dairy free diet

[Eimear78 in reply to SlowDragon]

Thanks Slow Dragon. All done as above and all tested in September. I take the better you vit D amongst other things.

This test was to see if we should increase my Levothyroxine and it’s the same level as September. I wanted to know if I am being rubbish my following up this email with a load of questions about the protocol we were following and when we were going to have an appointment?

[SlowDragon Administrator in reply to Eimear78]

Well if you Ft4 is static and not changing and you need/want Ft4 to increase you’re going to need an increase in dose levothyroxine

[Eimear78 in reply to SlowDragon]

Exactly and this is what we were working towards. I wanted to go to 125mcg and he was cautious so said 125 three days a week and 100 four days a week and monitor it and symptoms before increasing it. Nothing has changed on my results except my ft3 has gone from 5.8 to 5.9. Saying my results are in the normal range is insulting after what we discussed and problems I have been having. I also understand they are busy and feel like a cow by replying

[SlowDragon Administrator in reply to Eimear78]

So when did dose increase to 100/125?

Can you increase to 125mcg daily, or would you need new prescription

You need to test vitamin levels yourself

Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results

[greygoose]

Frankly, I cannot see the point of trying to 'balance' your hormones. Especially not if it means lowering your T3 dose. What exactly do you think that is going to achieve? OK, I know your FT4 is low, but that is to be expected when taking T3. Raising your FT4 level is hardly likely to get rid of your remaining symptoms. I would have thought that raising your FT3 slightly would have been more likely to do that.

I presume you're aiming for a euthyroid ratio of T4:T3, but that is not the aim of thyroid hormone replacement. The aim is to find the levels that make you feel well, and, comparing your levels with euthyroid levels is not going to be helpful. When you're hypo, you need what you need, and ratios have very little to do with it. Just my point of view.