Help please with results from today and May 18th

[Dizzy444]

Please can anyone advise me on these latest results

Since reducing my dose from 100 to 75 I’ve not felt well, tiredness and very lethargic

[SeasideSusie Remembering]

Dizzy444

The reason you're feeling tired and lethargic is because your TSH has risen from below range to 2.1 (0.27-4.2), your FT4 has reduced from 83.33% through range to 59% through range and your FT3 from 46.67% to 5.41% through range.

Presumably your GP adjusts dose by looking at TSH only, this is wrong as TSH is not a thyroid hormone, it's a pituitary hormone. The FT4 and FT3 are the thyroid hormones and these were not over range in May so there was no need to reduce your dose. Your GP has probably achieved his aim - getting your TSH back into range, but by doing so your FT4 and FT3 have plummeted to levels where you are now experiencing hypothyroid symptoms. Low T3 causes symptoms and your new result has barely scraped into range, no wonder you feel unwell.

I would ask your GP to reinstate your 100mcg Levo and use the following to support your request and as to why you can have a low or suppressed TSH as long as FT3 is normal:

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.

Also your folate level is very close to deficiency at 4mcg/L, see

cks.nice.org.uk/anaemia-b12...

Folate level

◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.

◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.

Your GP may or may not prescribe folic acid. If he doesn't then you can buy some methylfolate and do it yourself, possibly best to buy a good quality B Complex such as Thorne Basic B.

[Dizzy444 in reply to SeasideSusie]

Thank you for the information, so helpful as always

[Dizzy444 in reply to SeasideSusie]

Thinking about it the endo suggested the dose reduction, not my gp. Also Medichecks mentioned my high ferritin level, it’s been higher but I’m confused as I don’t take iron supplements

[SeasideSusie Remembering in reply to Dizzy444]

Dizzy444

It doesn't really matter who reduced your dose, it was still the wrong thing to do. Most endos are diabetes specialists and know little to nothing about treating thyroid conditions.

Elevated ferritin level can be due to inflammation or infection. What was your CRP level, that's an inflammation marker.

[Dizzy444 in reply to SeasideSusie]

Crp was normal

[Dizzy444 in reply to Dizzy444]

Think I need to find a new endo 🤨

[SlowDragon Administrator in reply to Dizzy444]

Vast majority of endocrinologists are diabetes specialists and useless with managing thyroid levels

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2

When adequately treated, TSH will often be well below one.

Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

[Dizzy444 in reply to SlowDragon]

Thanks I’ve emailed thyroid U.K. for a list. My vitamin D looks low so I’ll carry on with supplements

[murelbrush]

Why are you lowering it as you must need the higher dose. That is why you are getting those feelingsYour body needs the higher dose it is saying. Go back to 100 or as your doctor send you for check up with the hospital to ensure you are on correct dose. I was 200 went down 150 and feel difference docs kept telling me still too high but my body needs high dose hospital said would love back to 200. Good luck

[Dizzy444]

Thank you