I thought I would start a new post as I am at my wit's end and totally confused with my GP. Most of you I'm sure will have had about my skin rash post I wrote about yesterday. I thought I would try one more time to get any sense out of the GP about both the rash and why my TSH level had halfed in three months to 0.22 or something like that whilst T4 and T3 were ok. He blamed this on my epilepsy meds which is rubbish because I have been on them for five years and haven't changed them. He has now told me to drop my levoythroxone from 150 mg to 100 mg a day is that right and proper. I don't know anymore. If there was a closer GP i would swap but there isn't one. He still blames the rash on my leg as drug related too.
Had anyone ever heard of epilepsy meds interfering with absorption of levoythroxone
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Brumhoy68
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Your doctor is insane. The last thing you need is a reduction in dose - and certainly on by 50 mcg! Changes in dose should be by a maximum of 25 mcg. But, no way are you under-medicated because your FT3 is only mid-range. So, no, it's neither right nor proper to reduce your dose by 50%. This man is going to make you really ill.
It is of absolutely no importance that your TSH has dropped like that - it isn't even suppressed. Dosing by TSH is very wrong. And a low TSH will do you no harm. You're not likely to get any sense out of that GP because he doesn't have anything to give. He knows nothing about thyroid, I'm afraid.
A drop in TSH from 0.5 to 0.2 is in my opinion not very significant, it is quite possible that for example if you'd tested the TSH on the same day but half an hour later you could have had a similar difference in TSH result . If it had gone up to say 2 or down to 0.002 them it might be worth taking into account , but really 0.5 to 0.2 is near as dammit the same TSH.
I also don't think that 0.2 is low enough to give any concern about 'overmedication' unless you have symptoms of overmedication to go with it.
Your fT4 and fT3 (the more important measurements) certainly do not indicate overmedication.
If you felt the need to try a slightly reduced dose, i personally would not want to reduce by so much as from 150 to 100, on your results. i'd reduce by 25mcg at the most, (personally i only adjust by 12.5 mcg at a time nowadays, for me 12.5mcg is enough to alter how i feel , and also enough to move TSH slightly.)
I'd expect you to feel a big difference if you removed a third of your current dose ( and not in good way)
The only symptoms I have is my rash and not being able to sleep . Shall I call him back and argue my case that it is too much too drop. The problem these days is that the doctor has full control after you are released from being an outpatient from the hospital after Rai treatment
seems to me that GP does not think thyroid levels are what is causing the rash, so if his only reason for reduction is your only slightly low TSH i'd ask for clarification why he suggests such a big drop in Levo.And then suggest you'd prefer to first try a more subtle adjustment if he still believes a reduction is really necessary.
(and personally , whatever he say's, i'd still not reduce to 100, i'd take 125 and have the next blood test done on that )
edit... then come clean about the 125 when the results are in,
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"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)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
I'm not taking magnesium or another supplements. I have just started taking vitamin d yesterday 20000iu or 500mcg, once a week.. I only sleep for about 3 hours them wake up. I will try 125 of levithyroxine. My vitamin d was 14.2 B12 ok and Ferritin ok
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