Lab results - dosing query

[Chrssy58]

Hi. I’m just wondering if my lab results show that I should increase levothyroxine. I am taking 100 mg and half of a 25 and my latest bloodwork is as follows: T.S.H. - 2.00 (.4-5.00), Free T3 - 4.6 (3.4-5.9), Free T4 - 17 (11- 23) I had talked my doctor into prescribing an 25 mcg as well as my usual 100 in February because I had extreme fatigue, muscle weakness, etc. After taking this amount for 3 weeks, he tested my TSH and it was already at .46 so I ended up splitting the 25 in half because I was afraid to become hyper. I’ve been on this amount since March and I don’t feel too bad but still have some fatigue and have recurring flu-like symptoms monthly (which I’ve had for a very long time) After, hearing these results, I wonder if I should try 125 again. Any advice would be appreciated. Thanks.

[tattybogle]

hi . i'd take the opportunity to test again before increasing. If you don't want to get GP involved , TSH/fT4/fT3 from Monitor My health is only about £29 .

Testing at 3 weeks was too soon to be sure the TSH level would have stabilised. GP should have waited 6 weeks at least.

So 0.46 may not be where TSH is now on 112.5mcg dose .

I take 112.5mcg (125 was possibly too much, at least sometimes, but 100mcg was definitely too little)

But i wouldn't necessarily worry about 0.46 indicating overmedication if you didn't have any symptoms of 'too much thyroid hormone' ( you definitely wouldn't go hyper.... that would need your own thyroid to be overproducing T4/3 which it isn't likely to be capable of since you have hypothyroidism)

My TSH was around 0.05 ish for many years and i wasn't overmedicated... you need to take symptoms into account too, and also the fT4/3 levels. If they are still in range , and you have no symptoms of overmedication, then you are not overmedicated no matter what TSH say's.

But it might come in handy later to have a record of what your bloods are now things have settled on 112.5mcg .

[tattybogle in reply to tattybogle]

oh ..i've just put my brain in gear .. do you mean those TSH 2 etc results are from just now ? I replied thinking they were what you had done before the increase.... if they are from just now .. then yes, i'd go up to 125mcg.

p.s what tIme of day was GP's test of 0.46 ? TSH is naturally at it's lowest around 1/2 PM ish. and would be higher first thing in AM

[Gingernut44 in reply to tattybogle]

You should have been tested after 6/8 weeks after your reduction to 112.5 mcg. Your results now suggest you need to go back up to 125 and then test again after 6 weeks. Your Doctor is obviously going by your TSH. Refuse a reduction if s/he doesn’t test FT4 and FT3 otherwise he’ll have you yo-yoing your Levo and you’ll never feel well.

[Chrssy58 in reply to Gingernut44]

It’s been at least that long since I reduced to 112.5

[Chrssy58 in reply to Chrssy58]

My dr says that my results are right where they should but I think I should go up to 125

[Chrssy58 in reply to tattybogle]

Yes, they are from July. My first blood test that showed tsh at .46 was at 9 in the morning I believe. I had taken my thyroid meds too (I take them in the middle of the night) because I didn’t think he was going text my tsh so soon after starting an increase.

[tattybogle in reply to Chrssy58]

So that blood test with 0.46 , were you taking 125 for it ? then dropped to 112mcg after 3 weeks because of low TSH ?

did you feel overmedicated at the time of that blood test ?

Tell GP that you don't accept his TSH result as representative of your response to 125mcg (because you've read that TSH should really be tested after 6 weeks to allow TSH time to adjust ) and since you have now had a private test showing TSH is 2 on 112mcg , you'd like to see how you feel with TSH closer to 1 , (where most 'healthy' people's is) so would he agree to trial a dose of 125mcg for ? 6 months (and then re-test properly :))

Hopefully that approach should get him to agree .

why did you worry about 'going hyper' .. was it something he said ?

did he reduce the prescription amount ? .. if you have enough tablets you could always do what i did .. take the increased dose for 6+ weeks, then go and ask for a blood test, telling them what you've been taking ... if TSH/ft4 comes back fine they can't really tell you to reduce cos they've got no reason, if you feel better on it .

[Chrssy58 in reply to tattybogle]

He never wanted me to go up to 125 but I persisted. Yes, I dropped to 112.5 because tsh was .46 and t3 was at high end (he didn’t tell me what it was exactly and I forgot to ask). It was only after 3 weeks which worried me because he was adamant that I didn’t need an increase. But I did not feel overmedicated at all. He told me during our last phone appt, that, in the past, doctors adjusted medications according to how patients felt and that, even though they felt great, they developed osteoporosis because they were over medicated. I didn’t argue with him but I am increasing to 125 and I will tell him when I see him in September. I just needed someone to tell me I’m making the right decision.

[tattybogle in reply to Chrssy58]

healthunlocked.com/thyroidu... /tsh-and-the-more-mature

healthunlocked.com/thyroidu... /risks-of-suppressed-tsh-analysis?

You might find these posts useful in the next round of 'low TSH' conversations with GP. They contain some interesting discussions and also links to evidence from a large long term study which found risks of TSH between 0.04 and 0.4 are *no greater than risks of 0.4 to 4 *roughly . too tired to write it out accuarately just now*

[Chrssy58 in reply to tattybogle]

Thanks!

[Gingernut44]

Sorry Tatty that reply was for Chrssy58

[tattybogle in reply to Gingernut44]

[Chrssy58]

Thank you!

[Gingernut44]

Your results are right where your Doctor wants them but he’s not the one experiencing hypo symptoms. If you felt better at 125 mcg, tell him you would like to go back to that dose. A TSH of 0.46 is not too low when you’re taking Levo. If he argues, say that you would like your free t’s tested to make sure you’re not over medicated