Anyone on this dose of thyroxine?

[annnsandell]

My new surgeon is intending to reduce my Levothyroxine to 100 one day and 75 the next to lower it slightly. Currently, T4 17 (11-22), TSH .06 (.30-4.30). I have had various heart and blood pressure problems in the last year. 12 years since thyroidectomy and radium treatment and believes I am now at a lower risk of regrowth and cancer. Anyone else on this dose?

[SlowDragon Administrator]

How much do you weigh in kilo approx

Just testing TSH and Ft4 is completely inadequate

Ft4 is well within range, unlikely to need dose reduction

Obviously essential to test TSH, Ft4 and Ft3 together

What vitamin supplements are you currently taking, if any

For full Thyroid evaluation you need TSH, FT4 and FT3 tested.

EXTREMELY important to test vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

Low vitamin levels are extremely common, especially if under medicated, poor conversion of levothyroxine (Ft4 ) into active hormone (Ft3)

Low Ft3 extremely common after thyroidectomy

Vitamin levels tend to drop as we get older too

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[annnsandell in reply to SlowDragon]

5ft. 2 ins. 70 kilos. FT3 last test 4.6 (3.10-6.80) All done without taking morning dose.Taking Vit D spray. I am obviously not undermedicated. The surgeon is hoping to improve TSH for heart health but stay in range, sounds sensible but Just wondering whether I should be concerned about dipping below 100 mg. Also insulin resistent.

[SlowDragon Administrator in reply to annnsandell]

Currently

Ft4 is 54% through range

Ft3 is 41% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people when adequately treated will have Ft3 at least 50-60% through range

Important to be testing folate, ferritin and B12 at least annually.

Vitamin D test twice year

All four vitamins need to be optimal for good conversion of Ft4 to ft3

When were vitamin levels last tested

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

[e-mail]

70 kilo x 1.6 = 112mcg as likely dose levothyroxine required daily

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Well-Well-Well]

Hi SlowDragon

I had a TT in April 2021, due to Hashimoto’s and a multinodular goitre, with an incidental finding of papillary carcinoma (cancer), which was detected at pathology, after surgery.

My endocrinologist told me that it’s best to keep your TSH under 1.0 if you’ve had the big C and it takes at least 6 months to find the right dose of levothyroxine for you.

One thing they don’t tell you is that when you have an infection in your body (in my case it was bronchitis, two weeks after TT surgery), your TSH will spike. Don’t adjust your meds for infection. I hope you’re doing well now. 😊