Low FT4

[foxglove]

My recent results from monitor my health :-

TSH 2.08 (level0.27-42)

FT4 8.6 (level(12-22)

Ft3 5.7 (level3.1-6.8)

Any idea what these results mean? I'm taking 0.75 thyroid-s and feel very tired but at the same time restless and "naggy!

[SeasideSusie Remembering]

Foxglove

I still think, as I've mentioned previously, the ratio of T4: T3 in NDT may not be right for you, you may be better with separate Levo plus T3 to give a better balance.

You've reduced your dose of NDT a couple of times and although your FT3 is at a pretty good place you have ended up with a TSH that is too high and below range FT4. I think you probably need a higher FT4 to go with the current FT3 and you can't achieve that with NDT. NDT doesn't suit everyone.

[foxglove in reply to SeasideSusie]

Thanks for reply and advice, I am giving up on NDT as I can't seem to get it right, perhaps as you say it just doesn't suit me. I think I was tempted to try because of all the glowing reports about it on TUK- silly me. I may try again, meantime going back on prescribed levo dose (25mcg)

[SlowDragon Administrator in reply to foxglove]

Well you’re likely to need significantly more than 25mcg levothyroxine

That’s not even standard starter dose

What were results after minimum 6-8 weeks on 25mcg levothyroxine

Bloods should be retested as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Essential to regularly retest vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

Levothyroxine

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[foxglove in reply to SlowDragon]

On 25mcg levo, TSH 2.42,FT4 10.7,FT3,3.7..Not ideal but better than any on NDT!!!

[SlowDragon Administrator in reply to foxglove]

Far too low

GP should have increased by 25mcg and bloods retested 6-8 weeks later

Obviously will likely need several dose increases

Unless very petite most people are on at least 100mcg levothyroxine per day

Aiming for Ft4 in top third of range and Ft3 at least 60% through range

All four vitamins need to be optimal. Frequently requires supplements

Also frequently necessary to always stick on exactly same brand of levothyroxine at each prescription

Which brand of levothyroxine have you tried

[foxglove in reply to SlowDragon]

I get on well with Wockhardt but quite often cant get it. My vitamin levels all fine last time tested (but some time ago). I was put on 50 mcg levo but FT3 rose to 9 (that was in the days when NHS tested) so gp reduced to 25 mcg and I went with it as I didn't want to take any higher dose than I needed. That was before I knew anything about being hypo and didn't realise that 50mcg was still a low dose ..No explanation from gp I'm thinking now of maybe taking a combination of NDT and levo as suggested by some others on TUK.

Partly I confess - vanity_ as when shortly after starting NDT a "bald" space in my right eyebrow filled in. I have NEVER had this and didn't want it to go! I know I'm a silly old woman Sorry for long post - not too good at explaining

[SlowDragon Administrator in reply to foxglove]

I was put on 50 mcg levo but FT3 rose to 9

This was likely due to temporary Hashimoto’s flare, not due to over medication

Early stage Hashimoto’s levels often hop about before becoming increasingly hypothyroid

On 25mcg levo,

TSH 2.42

FT4 10.7

FT3,3.7

Obviously these show very hypothyroid and under medicated

[foxglove in reply to SlowDragon]

Thanks again for knowledge, I am going to try a combination (levo , NDT) and hopefully when the present situation eases will get appt. with gp to discuss - lots of things to discuss generally! Hope you are well

[Lalatoot]

As you have symptoms I would suggest your ft4 is too low. Some folks manage with low ft4 but others need it over half way through the range. Have you thought about adding some levothyroxine to your thyroid s dose to raise your ft4? This in turn will also raise your Ft3 depending on how well you convert.

[foxglove in reply to Lalatoot]

Thanks for reply to be honest I have got fed up of NDT - can't seem to get it right. I may try again but meantime going back on prescribed levo dose (25mcg)

[foxglove in reply to Lalatoot]

Thanks again for reply, I've had a rethink and will try your suggestion just have to work out the amounts.

[Peanut31]

Hi

I’ve not looked at your full history, but as suggested you could try adding some levo to your NDT.

This is what I had to do as increasing my NDT pushed my T3 results over range and I felt terrible, my T4 was below range.

I only take small amount of levo and I’ve managed to find my sweet spot.

For two days I take 25mcg of levo with my morning dosage of NDT, and the remaining days 12.5mcg of levo. I use a craft knife to cut my levo.

Hope that helps.

Best wishes

Peanut31

[foxglove in reply to Peanut31]

Thanks for advice and help, I have got wearied of trying to get dose of NDT right, As SeasideSusie says perhaps NDT just doesn't suit me!

[Peanut31 in reply to foxglove]

Hi

Like you I tried all sorts of NDT dosages, couldn’t get it right, levo alone was a nightmare, but, as said try a little of Levo with NDT.

I take 2 grains of NDT a day, 1 grain with my levo in morning and another grain of NDT at 2pm.

Best wishes

Peanut31

[foxglove in reply to Peanut31]

Thanks for reply, I'm just to fed up with NDT meantime, I'm back on my dose of 25mcg levo now!

[foxglove in reply to Peanut31]

Thanks again for reply, I've had a rethink and perhaps a combination of levo and NDT might work. Just have to work out the amounts!

[foxglove in reply to Peanut31]

Thanks again, I've had a rethink and perhaps a combination of NDT and levo. might be the answer, just have to work out he amount of each! I had just been taking 0.75 of NDT. Any ideas?