I’ve just got my recent blood results back and my dr says my free T4 is significantly elevated and my TSH is too suppressed.
fT4 23.2 (7.7-15.1)
fT3 5.6 ( 4.3-6.8)and m
TSH 0.01.
He says this indicates overtreatment and wants to discuss my levo dose, I’m terrified. I had a terrible time the last time he reduced it and ended up with low B12 and folate. Is he right to want to reduce?
For reference my results from last August when I was feeling absolutely awful on my reduced dose were
T4 14.4
T3 4:7
TSH 0.05
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Ab1J
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No, you're not over-medicated, you have a conversion problem. You need all that levo (T4) in order to get enough T3 to make you well. If he reduces your levo, your T3 is going to drop, too. And, that's what makes you feel awful.
And, you can't have a TSH too low. A low TSH does not mean that you are over-medicated, it means that you now have enough hormone in your blood that the pituitary has decided you don't need TSH anymore. Thyroid Stimulating Hormone. The pituitary produces it when it finds there's not enough thyroid hormone in the blood. If there is enough, it's logical that the pituitary is not going to produce TSH anymore.
Tell your doctor that if he wants to reduce your levo, he must replace it with some T3 if he doesn't want to make you ill. And that you're only over-medicated if your FT3 is over-range. I don't know if I explained that very well, but please ask questions if I didn't.
Well, GPs can't prescribe T3 anyway, under the NHS. So, you'd need to see an endo and convince him that your conversion is rubbish. I think the numbers speak for themselves, though, so maybe you won't have too much trouble. Fingers crossed! In the meantime, refuse any reduction in levo.
You would be much better off with some liothyronine. Your T4 14.4, T3 4:7, TSH 0.05 result shows your pituitary is under-preforming and this leads to your subnormal fT3. Usually TSH is a good indicator of thyroid status even when on tablets but if the pituitary isn't working properly TSH becomes useless.
You have a few different routes for discussion with GP.
Previous dose gave blood results that he could live with , but not a state of function that you could live with ,
... but current dose gives extremely over range T4 that he doesn't feel comfortable prescribing , He's already had a note from your previous endo to tell him not to worry too much about your TSH being low, but he is now bothered by your fT4 level. (and probably TSH)
But ,it seems from previous 'bottom of range' T3 level on the lower dose ,that you need this much Levo in order to get enough T3 for you to feel well.
So he has 3 choices :-
1) discuss what he sees as the 'risks' of over range T4 ( + low TSH) with you, and if you understand and accept them , put a note in your records to this effect ,and continue to prescribe Levo at current dose.
( this is the 'arrangement' i currently have with my GP, somewhat against his wishes )
2) find a way to get you this level of fT3 without going so far over range with T4... to which the obvious answer is refer you to an endo for trial of T4 /T3 together, which will cost him a fortune when it comes back to him to continue the prescription, and get his head chewed off by the practice manager.
3) discuss a compromise. How much did he increase Levo by since the August result (was the previous dose 150 and currently 200 ? ). would you both be willing to try a dose somewhere between the two to get fT4 down a little and TSH up a little.
There ARE some increased risks on Levo only once TSH goes below 0.04, so it's worth considering , and it may be an easier fight than insisting absolutely on staying on the same dose.
Your fT4 is currently showing VERY over range .. if you can get him to let you trial a very slight reduction and retest in 3 months you might find that fT4 is lower anyway. maybe this was just an unfortunately timed spike in fT4 levels
( What about trying 175mcg or 187.5 mcg ? )
If you want to see the research for 'risks' below 0.04 let me know and i'll link it .
I would be happy to reduce a little, but only if he will let me do it in small increments as I just don’t feel like I can go through feeling like I did last year again. I will suggest doing that for now as I’m not happy about T4 being too high either, but I am going ask him to refer me to endo and ask to be trialled on T3, I’ve been battling with this for 15 years now and the levothyroxine obviously isn’t working for me. If money is an issue for the gp could I not have a private prescription if the trial goes well, or is it mega expensive?
I 'm out of touch with what's happening with private prescriptions for T3 at the moment. It used to be simple/affordable if you got a private T3 prescription from an Endocrinologist , to get it filled and posted from a German Pharmacy . But Brexit has very recently put a stop to that. So you'd have to ask people here what they are doing now and what the cost is, i think it's a bit of a mess at the moment.
I was just assuming you're taking 200mcg now , so ignore the 175/187.5 suggestions if not relevant . I Just meant a reduction of eg. 12.5 mcg/day might be enough to help the results , without leaving you on the floor.
I'm sure Doctors just adjust in 25's cos that's what the tablets come in and they're too busy to do the maths for any other dose. But even 25mcg is too big change for some of us.
Yes I’ve been back on 200mg since just after those results last August. Recently I’ve not felt great tho so maybe that’s due to the high T4. I’ve just emailed the Dr asking for an endo referral and to say that I will reduce the levo but very gradually in the smallest increments possible. And I said I definitely will not lower it as for as 150mg .
sounds like a good plan.. but be careful which Endo you get referred to , many/most are fundamentally unwilling to prescribe T3 and would be a waste of time to see.
I wonder if height of weight of patient requires a higher or lower dose of Levo. How tall are you and how much do you weigh Ab1J please? I am 5'4 and weight 64kg and currently on 100mcg (will see results on after 14 Feb 2022 as just restarted on Levo)
I’m 5’5 and 58kg. I’m still on 200mg and plan to stay on it as it seems to be the only dose that enables me to feel well, regardless of what blood results say.
I’m currently on mercury-pharma, sometimes Aristo. My weight is pretty constant but I don’t eat much, before I got Hashimoto’s I was lighter and could eat what I liked, but my appetite is much less now. I have always been on the skinny side though. When I first got sick nearly 16 years ago I’d just had a baby and couldn’t lose the weight after birth, but since being on levo weight hasn’t really been an issue, it’s more hair skin, mood and fatigue that I have issues with. I hope you find your perfect dose, you are lucky to be able to try TruS tho.
The first TruS I got from Thailand suited me well but they stopped producing when Covid hit. I moved onto another Thai company's TruS and that didn't work at all and my thyroid made me very ill. So TruS is not always reliable.
Ah I see, I don’t think I would trust taking anything bought online. If weight has been an issue for you on Levo but not before it sounds like your dose might be too low, have you tried slowly increasing your dose?
Before Levo my weight was right for my height.Once on 125mcg Levo I piled on 10kg in 1 month.
Currently on 100mcg Levo Accord brand and so far not much more weight increase.
Another issue is that same time I was diagnosed with Hashi, I also became menopausal. so that might have also contributed to weight gain?
Been on HRT for 1 year now too so it's a fight between HRT meds and thyroid meds competing with each other hence taking me time to find the right balance.
That is strange, I can’t think why Levo would cause weight gain so maybe it is linked to menopause. I feel for you having to deal with that alongside thyroid- I’m dreading menopause. I’m not sure how much the different brands differ in effect, I do find Aristo brand horrible to take though as they sometimes dissolve in your mouth 😖
What issue are you having with your hair? I find I have lost most of mine and now can feel my scalp when I pat my head. When I wash hair so much is in the plug hole. I am on liquid iron and B12 tablets and my bloods for those are fine.
I am hoping a brand of Levo will work for me, without piling on the weight, so I don't have to resort to relying on buying TruS type medications from abroad (costs a fortune and cannot always be relied on).
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High TSH but normal T4?
Low TSH High T3 Normal T4 Total Thyroidectomy
Does it make sense... still fatigue and joint pain when T3 is high-normal but T4 very low?
Does the dose of T4 and T3 sound too high
T4 equal to what t3
