I recently had blood drawn in the doctor´s office, around 11 am. I told him that
1. I had taken levo around midnight the previous day (so about 11 h earlier);
2. I am on a vit B complex containing biotin.
He said it wouldn´t matter as levo (unlike lio) results in stable levels 24/7 and that he had not heard of biotin affecting results.
The thing is that I feel good on my current dose: 200 mcg of levo daily. I have always needed a higher than average dose of levo but, when I am allowed to take that, I do fine on levo only and don´t seem to need extra T3. I also feel much better since going off Euthyrox since the new formula did not at all agree with me.
My new results:
TSH 0.005 (0.42-4.2)
FT4 24.5 (12-22)
FT3 5.7 (3.1-6.8)
anti-TPO 11.6 (<5.6)
anti-TG 4.2 (<4.1)
Diagnosed with Hashimotos in 1999 and on levo since.
The doctor emailed me and told me to decrease levo to 175 mcg daily. His treatment goal is to get my TSH to 0.03-0.3 (he says that is where most Hashi patients need to be when optimally treated) and get my FT4 levels in range.
I don´t know how much leaving only 11 hours between levo and blood draw affects the results, but I have read that biotin can raise FT levels and that some people have even been misdiagnosed with Graves when on biotin. So I imagine that my results would have looked different had I left 24 h between levo and blood draw, and also stopped biotin at least one week in advance...?
Given my FT3 levels, I am not sure I should cut back on levo...?t
Making sure you stop vitamin B complex a week before test
(You can take separate folate supplement in week before test)
When were vitamin D, folate, ferritin and B12 last tested
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
cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
Vit B12, D and ferritin also tested:vit D 80 ng /mL (30-100)
vit B12 851 ng/L (250-883)
ferritin 103 ug/L (60-250)
I believe vit B12 and D levels are good (I now take vit D all year round). Not sure about ferritin...it´s been difficult getting that up by eating black pudding every week so maybe I also need iron supplements.
doctor say's "most patients ....." Well you are not most patients , you are you, and you have your own experience of feeling well at this level , which is much more informative and relevant to your treatment decisions than statistics from 'most patients'
If he hasn't heard of biotin affecting results, he could go and look it up and he will find it is 'a thing' probably not as much of 'a thing' in most cases as many people think... bit it's still 'a thing ' and one he should update his knowledge to be aware of.
You TSH test was done at 11am , if it has been done at 8am it would probably have been a bit higher anyway. TSH is naturally highest in the middle of the night and falls to it's lowest around 2pm. He could look this up to if he chose to.
Veterinary's are taught to take the time of the last dose of T4 into consideration when interpreting fT4 tests . If it stays the same 24/7 then all the veterinary colleges in the world must be doing it wrong...
I wouldn't put too much emphasis on the 'biotin may have raised t4 levels idea',
Stick with what you can prove . which is that TSH was measured near to low point in day , and also that your ft3 is comfortably within range , so NOT showing overmedicated, despite TSH being low. And you have no symptoms of overmedication , but you are aware off them and would of course get tested/reduce dose if you felt any.
And most importantly you feel well at the moment on this dose and need to balance the risk of feeling unwell on lower dose against the 'risks of having over range fT4 and low TSH.
It is good that he is saying (0.03 -0.3)is OK, which shows he's more enlightened than most
This is what i found when i researched too . the evidence of risks of loe TSH doesn't really start until TSH goes below 0.04, and even then it's all relative, and fr some things is still less of a risk than TSH above 4, and we all know that they don't get frightened by that as a risk factor.
and click on the links within it , you will find discussions , and a link to evidence that convinced me that it doesn't really present a problem until TSH is below 0.04 and even then , it's all relative.
Great, thank you for your useful input!I remember reading an article recently stating that in thyroidectomized rats (not sure if applicable to humans, though), full euthyroidism was not restored on cellular level until the TSH was between 0.03-0.3, so maybe this doctor has read the same article...he is more enlightened than most conventional doctors and does not freak out at the sight of a low TSH...but, no doctor is perfect...at least he´s much better than the ones who forced me to stay undermedicated for years to keep the TSH well in range and did not even measure free Ts...!
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