Apologies if this is in the wrong place.
I have central hypothyroidism and am taking 150 mg levothyroxine per day.
Mental and physical fatigue are pretty much constant. My GP wants to reduce the Levo. Is this correct?
Results from early August. ( I am having the tests done again next week.)
T4: 19.8 pmol/L (11 - 25)
T3: 4.7 pmlo/L (3.1 - 6.8)
TSH: 0.06 mU/L (0.27 - 4.2)
strawberryflower
My GP wants to reduce the Levo. Is this correct?
On what basis is he reducing the Levo dose?
Your FT4 is 63% through it's range, your FT3 is 43% through range, so both are well within range.
Your TSH is below range but with Central Hypothyroidism you can't use TSH as a guide because the feedback loop between the pituitary and the thyroid doesn't work so you ignore the TSH altogether. Presumably your GP doesn't understand Central Hypothyroidism, in which case maybe he should liase with the endo who presumably diagnosed CH or, God forbid, do some research himself so that he understands CH.
Here are a few clues so that your GP can learn about CH:
BMJ Best Practice
bestpractice.bmj.com/topics...
and another article which explains it:
ncbi.nlm.nih.gov/pmc/articl...
and another here:
endocrinologyadvisor.com/ho...
and another one:
academic.oup.com/jcem/artic...
Even if you didn't have CH your results do not suggest a dose reduction, if anything you could do with a dose increase.
(Not sure if you've guessed by I'm pretty intolerant of clueless doctors today 🙄 )
I have central hypothyroidism
Is that diagnosis an official one? i.e. is it recorded in your medical records anywhere? Do you know who made the diagnosis?
If your diagnosis is official you really must get a copy of the correspondence from your medical records so that you can wave it at a doctor each time you see one. Otherwise they will look at your low TSH and tell you that you must reduce your levels of thyroid hormones.
The other reason for having a copy of that correspondence is that every time you have a Thyroid Function Test it must be made clear to the lab by the doctor ordering the test that you have central hypothyroidism - otherwise the lab is likely to just do TSH and possibly T4 and say they don't need to do the whole test. But with little or no TSH your treatment must be judged on your levels of Free T4 and Free T3. TSH is, and will always be, irrelevant to you.
Unfortunately, central hypothyroidism is vastly under-diagnosed in the UK and many doctors won't have come across it. [Edit : Or won't have recognised it when they saw it.] Doctors all assume that the TSH is absolutely 100% accurate and reliable. But anyone with central hypothyroidism can't produce adequate levels of TSH for their needs. Doctors think that central hypothyroidism is as rare as unicorn's teeth so they dismiss it, and don't know how to treat it.
T4: 19.8 pmol/L (11 - 25) 63% of the way through the range
T3: 4.7 pmlo/L (3.1 - 6.8) 43% of the way through the range
TSH: 0.06 mU/L (0.27 - 4.2)
Your levels of Free T4 and Free T3 are too low for many people with hypothyroidism. There are people on the forum who need Free T4 to be about 70% - 80% of the way through the range and Free T3 to be similar or possibly a little bit lower.
If your Levo is reduced you will end up very under-medicated.
Presumably you have an endocrinologist who oversees your care with central hypothyroidism
GP should not meddle with dose
Do you always get same brand levothyroxine at each prescription
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Assuming yes
If anything you have room for small dose increase in levothyroxine to 162.5mcg daily
Essential to test vitamin D, folate, ferritin and B12 at least annually
What vitamin supplements are you currently taking
When were vitamin levels last tested
Noooo! Definitely don’t let the GP reduce your dosage. You aren’t over medicated. Sadly, it’s yet another doctor who doesn’t understand how thyroid problems work—and definitely doesn’t seem to have thought about what happens when you have central hypothyroidism. (Or rather, what doesn’t happen…)
Thank you all for your replies. I will quote chapter and verse to GP.
I was diagnosed as central by a private endo ( Gatwick ) after being told I had chronic fatigue and to go for a walk in the sunshine by my local endo ( Hertfordshire ).
I was seeing the consultant in Gatwick privately and as my choice of endo on the NHS. Am I still under his care as an NHS patient, despite moving to Wales?
Blood test results - advice please
Blood test results - advice please.
Blood test results advice
