Time to increase Levo?

[Newmummy82]

Just got my Medichecks results through and noticed my T3 was lowest it had ever been. It’s 27% through range whilst my T4 is 40% through range.

I’ve been prescribed 75mcg of levo since I was diagnosed in 2018 although I have started adding a little more by cutting at 25mcg tablet into thirds and taking that over the course of 3 days so probably taking roughly 83mcg.

Do you think I would benefit from a small increase? I’ve given up seeing my GP and know I would get no where trying to get an increase with these results but I could increase myself by taking an extra 25mcg every couple of days instead of over 3 days?

Generally feel ok, just get very tired sometimes but do have a job with silly hours so could just be that?

[SeasideSusie Remembering]

Newmummu82

You are way undermedicated.

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges.

Your TSH is way too high and your FT4/FT3 far too low.

You could do with a 25mcg increase in your dose of Levo and retest in 6-8 weeks.

Your GP should be increasing your dose, if you do it yourself you will surely run out of tablets eventually. Show the following to your GP:

From GP Notebook

gpnotebook.com/simplepage.c...

Target level for TSH during thyroxine therapy

Fine tuning of the dose could be necessary in some patients

* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

From the British Thyroid Foundation:

btf-thyroid.org/thyroid-fun...

How can blood tests be used to manage thyroid disorders?

.....

Occasionally patients only feel well if the TSH is below normal or suppressed. This is usually not harmful as long as it is not completely undetectable and/or the FT3 is clearly normal.

There are also certain patients who only feel better if the TSH is just above the reference range. Within the limits described above, it is recommended that patients and their supervising doctors set individual targets that are right for their particular circumstances.

.....

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"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).*"

You can obtain a copy of this article from Dionne at ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP.

[Newmummy82 in reply to SeasideSusie]

Thank you seaside Suzie, I suspect I am a little under medicated although I feel surprisingly not too bad, I’m aware that low levels of thyroid hormone can have long term effects which I want to avoid. I have to admit be being a bit apprehensive about upping by 25mcg in one go as I can feel angsty easily and get palps when I have too much thyroid hormone in my system.

I’ve ordered a cholesterol check as well so may wait for these results before speaking to tue doctor as they may also paint a picture of being under medicated if that’s high.

[Buddy195 Administrator in reply to Newmummy82]

When I increase I only do so by 12.5mcg as I have had tremors, palpitations & fast pulse in the past. I only add another 12.5mcg after a few weeks on the lower dose. This works well for me, although I know other forum members are fine adding larger doses.