Drs advice on dosage

[Jelley93]

Hello there, yesterday the Dr called me to discuss my blood test results. As I am on 125mcg she was saying that I should alternate my dose so 125 one day then 100 another and so on. My TSH on the test was 0.11 and my ft4 was 23 which she said was not at the right level. At the moment touch wood I am feeling fine. I don't get why she would want me to alternate it. If I was to alternate it would it be a good idea or not.

[tattybogle]

She wants you to alternate because she want to lower the dose slightly (presumably due to your fT4 being a little over the lab range? and your TSH being a little below ? need to see ranges to know for sure), and so if you take 100 one day and 125 the next you have an effective dose of 112.5mcg/day . Many people won't feel any difference at all between the days they take 100 and 125.

However if you preferred , you could take 112.5 each day , by splitting a 25mcg in half each day. The dose would be the same as her suggestion. and you avoid getting muddled about what day it is. (They do make 12.5mcg tablets , but since they are ridiculously expensive compared to the larger sizes they are not often prescribed (also only one manufacturer makes them ,TEVA, which many people don't get on with ) and recently there has been a stock shortage of then anyway .

Make sure you get bloods retested after 6/8 weeks on lower dose.

[Jelley93 in reply to tattybogle]

So if I am to alternate it. Would my TSH then rise significantly?

[tattybogle in reply to Jelley93]

The amount the TSH rises is related to how much the total dose is reduced. It is unlikely to make any difference to the new level of TSH whether you alternate 100/125 or take 112.5 /day.

12.5mcg is a pretty small reduction , so you would only expect TSH to rise a small amount , and fT4 to fall a small amount .. hopefully just enough to get them back into range, and hopefully without you feeling less well than you do now.

But you'd need to wait at least 6 weeks to assess how you feel on the lower dose, and possibly longer .... i leave 8-12 weeks before making my mind up if a new dose is an improvement in how i feel ,or not.

(6-8 week is long enough for the blood test to be accurate, but perhaps not quite long enough to get a clear picture of how you will actually feel)

[Jelley93 in reply to tattybogle]

Okay another question. If I was to remain taking a flat 125mcg daily as I am doing would there be any adverse affects if my FT4 is a little high and my TSH a little low. What I notice when I have a dosage adjustment. Is throughout the day I feel very drowsy and drained. When I went from 100 to 125 I had this feeling for around a week or so. Very unpleasant

[tattybogle in reply to Jelley93]

If you want my honest opinion, if you feel well at the moment ....... then the only adverse effects of keeping a very slightly over range fT4 and very slightly under range TSH , are that you will probably get grief from the GP , and they may refuse to prescribe enough Levo to keep to your current dose ( and they'll tell you all about the long term health risks of low TSH, but they probably won't tell you that if you read the research properly there is evidence that those risks are not a problem unless TSH goes below 0.04)

Any dose adjustment Up or down, even if it's beneficial in the end, is quite likely to give you at least a week or so of feeling 'wrong'.. it's just a result of the natural process involved as the HPT (hypothalamus /pituitary/thyroid) axis re balances to accomodate the changed fT4 level.

They don't want you to lower your dose to make you feel better .. they want to lower it because they are concerned about risks .... ( whether you agree that those risks are big enough to be a concern, is a different question )

How far over range is you FT4 level ? (what is the lab range that came with the FT4 test.. it is in brackets after the result .. there are several , could be [12-22], or could be [7.9 -14], or something else.

[tattybogle in reply to tattybogle]

However there ARE good reasons to keep TSH a little higher than 0.1 So i'm not saying it's not worth trying the slightly lower dose, to see how it feels.

TSH drives the deiodinase enzymes ,, and they are responsible for how efficiently you convert the inactive T4 in Levo to active T3 that works on your cells.

Higher TSH also increases the proportion of T3 your own thyroid produces (assuming you still have one)

And T3 is much more important to you than T4.

[Jelley93 in reply to tattybogle]

Sorry range was 9-25 mine was 23. So was in range. TSH 0.11 (0.3-5)

[Jelley93 in reply to tattybogle]

FT4 was 23. Maximum i think is 22

[tattybogle in reply to Jelley93]

So fT4 was 23 [9 -25 ] ?

Maximum is 22 , who said that? There's no reason fT4 can't be 24.9 on that lab range.

But they may still ask you reduce dose because your TSH is below range.

[Hylda2]

Last test my TSH was as always 0.01 and T4 22.3 on 125 Levo. Dr rang but managed to talk him into leaving everything as is.