Levo - weight or over range: Hi Interesting to... - Thyroid UK

Thyroid UK

121,729 members142,077 posts

Levo - weight or over range

Jeppy profile image

Hi

Interesting to see post of 5 days ago re weight-levo ratio as new to me ( is it relatively new ?)

So if your t4 goes over range with this, do you allow it to or stop when t4 is at top? Mine would for sure

Thanks 🌸

105 Replies
helvella profile image
helvellaAdministrator

You might find some interest in these two documents:

helvella - Estimation of Levothyroxine Requirement in Adults

A discussion about the use of formulas to estimate levothyroxine dosing.

From Dropbox:

dropbox.com/s/gzeknihf815rb...

A spreadsheet with several active formulas which work out possible levothyroxine requirements including NICE NG145 guidelines. These formulas are referred to in the document above.

This is an Excel spreadsheet but is likely to work in other spreadsheet software.

From Dropbox:

dropbox.com/s/aciho6m7x6f1e...

Jeppy profile image
Jeppy in reply to helvella

A lot to think about there. So do you keep producing t4 when you take Levo Helvella? In my ignorance I have thought you stop producing as taking it orally takes over🤔. Will it produce again if stop levo and gland is intact? Is that an unknown?

Ive considered taking tiny t3 if my gland produces. ….Gather quite a journey back to find out but as I had a good t4 level iv not understood why im taking levo if it shuts down your own

helvella profile image
helvellaAdministrator in reply to Jeppy

My belief is that although most of my T4 comes from tablets but having a complete thyroid I am convinced it does still produce some T4 and T3.

It could well take over again but we have the problem about getting from here (taking tablets) to there (not taking tablets but having adequate thyroid hormone). How do you do that? I certainly wouldn't like to stop taking tablets and see what happens. Certainly not without the ability to have frequent blood tests to check how it is going. And I know I start to feel hypothyroid if my dose is slightly too low.

helvella profile image
helvellaAdministrator in reply to Jeppy

Meant to say, I take less levothyroxine than weight alone would indicate.

Jeppy profile image
Jeppy in reply to helvella

Sorry. Do you mean ‘ If ‘ you take less

helvella profile image
helvellaAdministrator in reply to Jeppy

My dose is always less than weight alone would dictate. I think I'd feel very unwell if I took the doses that formulaic prescribing imply.

At the same time, some people need far more than the formulas imply - typically if they have absorption issues.

Jeppy profile image
Jeppy in reply to helvella

Yes. So true Its individual and absorption

Thanky!!!!

Jeppy profile image
Jeppy in reply to helvella

…but for those like me our t4 would be over the roof if went by weight🤔

Tell me please. I know im simplistic at times but what say hypothetically ( funny its hypo -thetically lol )

….What say we just took T3 and reduced levo slowly

Surely its the t3 that brings wellness anyway, yes may have to up t3 slowly too i guess.

What is point of taking levo on top of a good natural t4 level is my question if its that you dont convert t4 well?

Because it does get into the mitochondria gut and absorption side of things too doesnt it

helvella profile image
helvellaAdministrator in reply to Jeppy

I am like you - my T4 would be over the roof if dosed by weight. The important thing, though, is that I would feel awful from being over-dosed. It sounds like that is not the same for you.

I do not take T3 so have no personal experience.

If you are not converting adequately, then it might be appropriate to take T3.

Jeppy profile image
Jeppy in reply to helvella

Same. I do feel awful on levo Yes vertigo stopped and crying for nothing, but no wellness So just starting t3 slowly

Summer64 profile image
Summer64 in reply to helvella

I can't open these, probably because I'm not in dropbox. I will try and find the original post. I am curious about dosing and weight as I have in the last 3 months lost a stone due to a gastric illness. My endo last month picked up the weight loss and said it might be that my dosage needs adjusting. I explained it was my other health issue and due to the fact that I haven't been able to eat much but he said next time we may have to reduce it. Would losing weight mean I need to?

helvella profile image
helvellaAdministrator in reply to Summer64

No - you do not have to be on Dropbox. But whatever you are using might be silently downloading it but not opening, or similar.

I have slightly altered the links - could you try again?

If my Levo dose equated with my weight (64kilo) I’d be way over medicated on T4. My current Levo dose is 70mcg a day. This dose takes me to the top of the T4 blood range if I take my dose prior to a blood test without leaving the recommended time gap. If I leave the time gap it’s about mid way on the blood test.

Jeppy profile image
Jeppy in reply to McPammy

Thankyiu both Gosh McPammy iv done both as in early draw and later, for me t4 is high on both just a little difference in range

But query is do you go over range regardless by taking levo/weight ratio

I’d never want to be over range. It makes me feel ill. Poor sleep. Agitated. Our TSH is designed to alert when we are over or under medicated. There must be a reason for this. Drop your dose slightly to see if you feel any better. I wouldn’t go over medicated. The only situation that a person may have to is if they’d had thyroid cancer when your TSH needs to be suppressed constantly to avoid the cancer returning. This is my sisters situation.

PurpleCat71 profile image
PurpleCat71 in reply to McPammy

I am personally not convinced that is the case. The role of the TSH is to stimulate hormone production from the thyroid gland, which is why more TSH is made when T3 and T4 levels drop and less when they rise...in a HEALTHY PERSON, that is. Once we are hypo and on thyroid hormone replacement, things change. I know most doctors go by the TSH and consider an in-range TSH indicative of optimal thyroid hormone replacement, but why then do so many patients remain symptomatic?

In a healthy person, the FT3 and FT4 levels are much closer than in people on levo who can have high-in-range FT4 levels and mid-range or lower FT3. You would not see that in a healthy person. Both their FTs are around midrange. But midrange FT4 levels in someone on levo would most likely result in too low FT3 levels. That person would remain hypo, even with a normal TSH.

So, I don´t think you could say that the TSH tells you if you are on enough, too little, or too much thyroid hormone replacement. The TSH can be in range even if your free Ts are low. If a normal TSH was all that mattered, we would all recover on levo once that happened.

Jeppy profile image
Jeppy in reply to PurpleCat71

Thanks. YES. true iv felt rubbish getting tsh down to 2 just on levo and t4 remains goood number and t3 remains in bottom third.

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

The problem is that the TSH is not a thyroid hormone, it´s a PITUITARY hormone designed to regulate thyroid gland function in HEALTHY individuals. The TSH is useful in diagnosing hypothyroidsm, but much less so in treating it. Once on thyroid hormone replacement, it is more important to keep an eye on the actual thyroid hormones - T3 and T4. You can measure either total T3 and T4 or free T3 and T4. "Free" means unbound so immediately available to the body.T3 is the truly active hormone. T4 needs to be converted to T3 to be metabolically active. If that is not happening, your FT3 levels will remain low and you will be hypothyroid, even if your TSH is low in range or even below range.

Where you need your free Ts is individual. Many people on levo need their FT4 high in range in order to convert enough T4 to T3. If conversion is impaired (which is common due to vitamin and mineral deficiencies, dieting, inflammation...), they will have high FT4 levels and low FT3 levels so they will most likely remain symptomatic. Some need their T3 levels around 60% through range, some higher.

But it is your free T3 levels that tell you if you are a good or poor converter . The TSH has nothing to do with that. And, if your free T3 levels are too low for your needs, you will remain hypothyroid, regardless of your TSH.

Jeppy profile image
Jeppy in reply to PurpleCat71

👍🏼😊. Thanku

McPammy profile image
McPammy in reply to Jeppy

Sounds like you could do with some T3.

Jeppy profile image
Jeppy in reply to PurpleCat71

Surely i ma have just took t3 and no levo as t4 was good level without levoTaking levo to top hadnt brought wellness

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

Sorry, I am not sure what this means. That you are not on levo? Have you been on levo and stopped it?

Jeppy profile image
Jeppy in reply to PurpleCat71

Sorry!!! Yes i take levoWas making point badly that i Do take levo but before I did i had a good level of t4 anyway

So begs question why take levo

Jeppy profile image
Jeppy in reply to PurpleCat71

Then its all about the vits too.

greygoose profile image
greygoose in reply to McPammy

What wouldn't you want to be over-range? TSH? FT4? FT3?

TSH is not designed to tell you when you're over-medicated - I totally agree with PurpleCat71 - because being medicated is totally unnatural. So how could nature have designed for it?

It is designed to stimulate the thyroid when the pituitary senses that there is not enough thyroid hormone in the blood. But only in the blood, one should remember that. The pituitary does not know how much is getting into the cells.

Once the pituitary senses that there is enough thyroid in the blood, it reduces production of TSH, and usually maintains it at about 1. If thyroid hormone levels increase, it lowers production even further until it gets to zero. But it can't drop it even further after that. However, that might be when taking 125 mcg levo only, or 75 mcg levo and 10 mcg T3. But, either might be enough exogenous hormone to get the TSH down to zero but still not be enough to get the hormone into the cells. And if it doesn't get into the cells, our dose will still be too low, and we will still be hypo, even if the TSH is zero.

Absorption in the gut, conversion and absorption at a cellular level can all be totally different in a hypo person, but the TSH remains the TSH - i.e. a chemical messanger disigned to stimulate the healthy thyroid, not to police the size of the dose of exogenous hormone.

McPammy profile image
McPammy in reply to greygoose

Thank you for that information GG. I understand what you are explaining. I was going on my personal experiences really. MyT4 was just under the top of the range and my TSH was too high. My GP increased my T4 Levo I then went over the T4 range and my TSH went suppressed. If my T4 is over range and my T3 under range my TSH has been suppressed . For myself it’s like a alarm bell going off to say no more T4 please. When I then lowered my T4 my TSH went too high as my T3 was too low alarm to tell me I need more T3. Which I did as I am a poor converter only converting 8% of Levo to T3 and DIO2 gene test positive. Since introducing T3 to Levothyroxine also my TSH has remained steady at around 1.00 for many months now. I do feel that my TSH is an indicator for medication levels in my blood.

greygoose profile image
greygoose in reply to McPammy

Sounds to me more like your pituitary is not functioning too well. After all, it's only an endocrine gland, just like the thyroid. It can go wrong, just like the thyroid.

Jeppy profile image
Jeppy in reply to greygoose

..,funny you say that as ive wondered🤔 il be googling it upI always wondered if double fractured head childhood antic left its mark 🤷‍♀️ Dam lucky anyway

Jeppy profile image
Jeppy in reply to greygoose

Hi. I just asked if t4 could be over range as i still had tsh over 2 and my t4 was at top

Jeppy profile image
Jeppy in reply to greygoose

Apologies. That wasnt to me

Jeppy profile image
Jeppy in reply to Jeppy

I think id better fade away into sunset. Iv taken too much tine up but it helps to throw it about and diff viewsvetc

At end of day ( when crawling lol) its about all these things that affect our bodies workings Vits absorbing hormones I guess Just getting to a place you can forget about it and enjoy life

greygoose profile image
greygoose in reply to Jeppy

No apologies necessary.

And there's no time-limit on this forum. Ask as many questions as you need. :)

Jeppy profile image
Jeppy in reply to greygoose

Shucks 🥰. TY ….

When is Dancing on Ice returning🤔. 😂😂

PurpleCat71 profile image
PurpleCat71 in reply to McPammy

This is from Dr. H. Lindner´s site hormonerestoration.com: Unfortunately, the medical profession has clung to the misleading TSH test since

some physicians decided to do so in the 1970s. Doctors are taught that hypothyroidism is a high TSH--when it is, in fact,

the state of inadequate T3-effect in some or all tissues. They are taught wrong. TSH not a thyroid hormone and is not

an appropriate guide for either the diagnosis or treatment of hypothyroidism. The hypothalamic-pituitary secretion of TSH did

not evolve to tell physicians what dose of inactive levothyroxine a person should swallow every day. A low or suppressed TSH

on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism.

Yes. Thanks well put…my tsh at 4.5 is alerting but t4 is at top

McPammy profile image
McPammy in reply to Jeppy

Would check your T3 isn’t too low!

There is an article often mentioned here, written by Dr. Toft, where he says that some people need their FT4 levels slightly over range for symptom-relief. I can never find that article when I need it but hopefully one of the administrators helvella shaws can post a link to it (Dr. Toft also says top-of-range FT4 levels are needed in many patients, and that is not dangerous as long as FT3 levels remain in range).

Jeppy profile image
Jeppy in reply to PurpleCat71

Well yes. we all tick differently so will always be small number outside what is considered a norm. Read some need tsh below 0 but think youre right the number ceases to matter once medicated. Docs try to mimic healthy folks numbers. This i hope is their learning curve my gp was petrified my t4 went over range but who can blame them Reading your insights reminds, and how even diet can set it all off maybe. As in my younger years not eating wholesomely must have been causing confusion

Im sure also pregnancies caused some havoc with the female hormones mixing as at Meno, Back to now i wish id known all this then 🙃. Amazing our bodies constantly working to fix things😊

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

Most doctors know next to nothing about hypothyroidism. They consider it easy to manage with levo because that is what they are told in medical school. The goal for most doctors is to get the TSH anywhere in range. If symptoms persist, patients are told they have nothing to do with their thyroid condition...strangely enough, many doctors seem more willing to prescribe blood pressure medication, anti-depressants and anti-anxiety drugs (all symptoms of hypothyroidism) than to raise levo...

Jeppy profile image
Jeppy in reply to PurpleCat71

Absolutely! Endo has decided i may gave chronic fatigue instead 🤦‍♀️ Tsh 4.5!?Although says he wil give me Armour privately if wish ( for £100s). Officially given up

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

If yourTSH is over 5 on levo, you are undermedicated. You should increase levo and try to improve T4 to T3 conversion before trying Armour IMO. Not only is Armour very expensive, but you may not even need T3. There is no way of knowing until you have a TSH of 1 or lower, and have corrected any vitamin and mineral deficienices you might have. If your FT3 levels remain low at that point, you can start considering adding T3. But your TSH is too high for someone on levo so you are not on a high enough dose.

Jeppy profile image
Jeppy in reply to PurpleCat71

But it is at very top when i take 125

Jeppy profile image
Jeppy in reply to PurpleCat71

Plus i felt awful. Wired grumpy fatigue. Crawling upstairs

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

That is not a sign of hyper but hypo!

Yes, but the fact that your TSH is too high means that you are under medicated. You need to know how well you convert T4 to T3 by having your free T3 levels tested. If your lower levo now, your TSH is bound to rise even higher.

McPammy profile image
McPammy in reply to Jeppy

So he’s offering T4/T3 combination privately. But won’t on the NHS! If your T4 is at the ceiling of the blood test and your TSH is 4.5 it indicates you are not converting to T3 very well and need some T3 medication.

PurpleCat71 profile image
PurpleCat71 in reply to McPammy

Wouldn’t you need to know her free T3 levels and vitamin+mineral labs before recommending T3?

Jeppy profile image
Jeppy in reply to McPammy

Yes. Merrygoround. Im not angry now gp wrote him to do the trial as was shocked when saw me at surgery to how i used to be. Endo replied to him that nhs no longer do it but said some respond better on ndt and wrote me he had private clinicWhen did it stop ? is just cheshire is it just his hosp🤔

Jeppy profile image
Jeppy in reply to PurpleCat71

Thanks. Helpful

Im just batting on here

But do you need to take levo (which is t4 )if you have a good level of t4 as it doesnt make sense that you take more when its the conversion side thats lacking

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

I am not sure I understand your question. You do not need to take levo if your FT4 levels are good without medication. Normally, a doctor would not prescribe levo if your free T4 levels are well within range.If you are on levo, on the other hand, your free T4 levels are good thanks to the medication, and you cannot stop it because your free T4 levels would drop. Levo is T4.

So not sure which scenario you are referring to?

You do not need to take levo if your FT4 levels are good without medication. Normally, a doctor would not prescribe levo if your free T4 levels are well within range.

not so ... plenty of us need and are prescribed levo (by NHS ) long before our fT4 gets low enough to go below range .. this is done on the basis of just TSH going over range.

Some people can be very symptomatic with apparently 'good enough' levels of fT4 .

but their TSH is starting to rise to ask for more .. so if there are symptoms and especially if they find raised TPOab to confirm autoimmune damage to thyroid , then many people can be prescribed levo at this point at the GP's discretion...

I was...... they didn't do a freeT4 test for me , but did do TotalT4 and that was well within in range , but shown to be falling .

This is classed as 'subclinical hypothyroid' meaning " TSH over range , but fT4 still in range ".. and it doesn't matter where in range FT4 is . prescribing decision is based on TSH level , symptoms and presence of antibodies (indicating increased probability of progression to 'overt' hypothyroid~ eventually )

'Overt hypothyroidism' means TSH over range AND fT4 under range .

Ok, but then the TSH signals a thyroid problem. It was not clear from the question I replied to, but I later saw in another post that her TSH is 5.4 so hypo.

i see :)

That I also why I suggested to OP there is room to increase levo rather than start Armour at this point as TSH still too high.

I agree , much simpler (and cheaper) to try higher Levo dose first to see if it improves things. But obviously ,it may be hard to get a GP to agree if fT4 is already at top of range..as it's unusual to have fT4 top of ( over ?) range with TSH still so high .. that would seem to suggest conversion of T4 to T3 is currently rubbish.. so looking for ways to improve conversion would also be a good idea.

Jeppy did your fT4 actually go over range when your TSH got down to 2 ? , or was GP just afraid it would if they increase Levo any further ?

Jeppy profile image
Jeppy in reply to tattybogle

Afraid yes. She made me promise to retestBut had no well-being.

Jeppy profile image
Jeppy in reply to tattybogle

I said i need to know what under 2 or a one feels like and she was really hesitant as i was one off the top of range so then endo was given and she made no more decisionThat endo pleasant man just adked me everything and didnt get any answers so ten months later i got endo this time on phone who said i was to increase tiny bit but lockdown came and nothing more

Jeppy profile image
Jeppy in reply to PurpleCat71

If me, its 4.5. … But this is hypo surely

If endos say get under 2 and tuk say many get well around a 1, why do gps labs still put range up to 5 and gp says normal!?

Are some really well with tsh 5? Prob not they just blame it on getting older etc. Which is half of it not all

Sadly No continuity

My daughters seen me witj no energy so have cancelled hip op now which lef them to check their levels. One is tsh 0.5 but other one the slim one of them, looked on recent bloods to see hers is 2.9

So i dont want to put wrong thing out to her and her doc will say ‘fine’ you are in range

She had prem adolescence when little and has broken two bones so i am bit concerned….,,asked for her vits to be tested first but doubt she will 🤦‍♀️

Jeppy profile image
Jeppy in reply to Jeppy

Great respect. GG perused im a poor converter way back but then it was also put out you had to take levo right up firstly so it sermed right thing to do if wanted nhs. However …,,,

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

I think many patients including many clued-on doctors agree the reference ranges are outdated and too broad. They are based on a given number of people, some of whom have latent thyroid disease so highish TSH, which is why the reference ranges should be narrower. A healthy person has a TSH around 1. Usually, it is recommended here to optimise all vitamin and mineral levels (after testing for possible deficiencies), get your TSH to around 1 or even lower, and then see if FT3 levels increase. If not, chances are you are a poor converter.

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

I am sorry, but this is confusing. Is it your daughter´s TSH that is 0.5? If you want to ask questions about her thyroid condition, I think it would be better to do so in a separate post.

Jeppy profile image
Jeppy in reply to PurpleCat71

Yes. SorryThe one im concerned about is at 2.9 but as vegan esp first stop to be the vits iv explained this to her

Jeppy profile image
Jeppy in reply to tattybogle

…if you are subclinical will a bit of t3 hurt? Surely it just takes pressure off the converting side of things which is not happening. This is my thinking decision of this week

tattybogle profile image
tattybogle in reply to Jeppy

'hypo' (or not) is not just decided by TSH level . they are looking at both the TSH and the fT4 together .They usually both say the same thing , but not always.

In your case your TSH 4.5 is saying ' still definitely hypo'

But your fT4 (when it was at the top of the range) was saying 'not hypo anymore' .

...... So in that situation you could look at the fT3 to see what is actually going on.

so you are correct .. adding a bit of T3 at this point is the right idea .

So if someone will prescribe it in some form either by adding some T3 to Levo (or by using Armour which has both T4 and T3 in it) .. then that is perfectly sensible .

I had thought you were saying you couldn't afford the armour and you wondered if you could increase Levo dose to see if that would work instead ... which it might well do .. it would definitely lower your TSH , and would probably increase your fT3 .. but it would probably do it at the cost of taking fT4 over range .

Obviously if you CAN avoid this easily by getting hold of Armour (or getting T3 added to your Levo) then this is preferable to taking fT4 over range.

I only said it's 'easier and cheaper' to try higher Levo Dose first because so many people can't get anyone to prescribe T3 or Armour , I wasn't saying there's any reason not to try armour /T3 if you can get it .

What I don´t understand is why the TSH would remain high with high FT4 levels...? Does the TSH react to low FT3 when FT4 levels are at the top of range? Many people with conversion problems have a low TSH and their FT4 levels look good which is why many doctors say their symptoms are not thyroid-related. But this is the first time that I have heard that the TSH rises in response to low FT3 levels while FT4 levels remain high...this would mean the TSH is a good indicator of poor conversion. If so, this is the first time I hear about it.

What I don´t understand is why the TSH would remain high with high FT4 levels.. ? No neither do i to be honest , hence suggesting looking at fT3 levels.

Does the TSH react to low FT3 when FT4 levels are at the top of range?

I'm not sure it does , but I'm also not sure it doesn't, .... you'd think not, from looking at most peoples results , but was just trying to offer an explanation for why TSH might be high in this case even though 100mcg levo is being taken.

(And also, frankly i was getting lost trying to work out what the question was .. but i shouldn't have written "The usual reason for 'top of range fT4' but with 'TSH still relatively high' , is that fT3 is way too low ..." it wasn't a good way to try and explain what i meant. Sorry :) have edited my earlier reply now )

Is anybody else confused yet ?

Jeppy profile image
Jeppy in reply to tattybogle

Haha. Do you mean ‘deleted’

…FIO Tsh DIDdrop but was still over 2 and t4 was at top. T3 hit 4 which was midges higher

greygoose profile image
greygoose in reply to tattybogle

but their TSH is starting to rise to ask for more

No, the TSH is not asking for more. The problem is that the thyroid is so far gone that it needs that amount of stimulation to produce that amount of hormone, whatever that level is. If you start taking exogneous T4, the TSH will drop, so the T4 produced by the thyroid will drop, and you need enough levo to keep the levels up. Which is why there's a problem with taking small doses like 25 mcg.

Jeppy profile image
Jeppy in reply to greygoose

…so really to get to the chase i needed tiny t3 then as what else, once vits in order

Jeppy profile image
Jeppy in reply to Jeppy

Now i have to take the t4 but still not enough conversion happening🤔 unless i take it OTTHowever im sure id feel more wellness than this ….. i am now considering im of the type that just doesnt suit levo

Just sad i lost my ‘home made’ t4 for artificial one !

Plus why do i need it if i get t3 on board properly? This is my question

tattybogle profile image
tattybogle in reply to Jeppy

"Now i have to take the t4 but still not enough conversion happening🤔 unless i take it OTT However im sure id feel more wellness than this ….. i am now considering im of the type that just doesnt suit levo"

You said you felt better on 125mcg than you do on 100mcg ? So i don't think its the case that you 'don't suit Levo' you might have just needed more of it than 125mcg.

Plus why do i need it if i get t3 on board properly? This is my question

Well ....

* Some people on here do survive perfectly well by just taking T3 (no levo at all and so they often have extremely low fT4 )

* But some people feel really awful with low T4 .

* and usually , as soon as people take T3 (even a small amount) their TSH goes very low .. which means their own T4 production will be less than it was before they took T3.

* one benefit of having at least some T4 /Levo is that it lasts MUCH longer in the blood than T3 does , so there is always some T4 available to convert to T3 (even if that conversion isn't brilliantly efficient)

But as greygoose say's , in order to answer questions well ... what is needed are actual results with ranges /dose of Levo / dates .. because everyone is very different .. so talking in general terms about what happens to T4 T3 etc is difficult and just becomes confusing for everyone.

Jeppy profile image
Jeppy in reply to tattybogle

Yes it did rather escalate from the weight original query 😄. it wasn't blood tests query which results i havnt got here to be fairBut sure good points were raised although varying and helped others

… yes its what you put about ‘conversion not being brilliantly efficient’ that you have to live with every day, as endo said, some just feel better on combination.

tattybogle profile image
tattybogle in reply to greygoose

but their TSH is starting to rise to ask for more

No, the TSH is not asking for more.

agreed . your explanation is far more accurate. (was just attempting to simplify as this post was already going in circles.. as was my head)

( i believe Jeppy is actually taking 100mcg Levo at moment, but i think you were making a general point and not saying she only takes 25mcg ? .. )

Jeppy profile image
Jeppy in reply to tattybogle

Thanks again yes circles. For moi cest quatre ans!!! 🤪. Patience aye

greygoose profile image
greygoose in reply to tattybogle

No, I definitely wasn't say she was only taking 25 mcg. It was a general point - i.e. why it's wrong to start on too low a dose. Well, one of the reasons, anyway. :)

Jeppy profile image
Jeppy in reply to greygoose

I read it like that

greygoose profile image
greygoose in reply to Jeppy

Read what like what?

Jeppy profile image
Jeppy in reply to greygoose

..that 25 was an example

greygoose profile image
greygoose in reply to Jeppy

OK :) But, that should have been a reply to Tattyboogle, not me.

Jeppy profile image
Jeppy in reply to greygoose

Lol. And its good night from me

Take care all

Jeppy profile image
Jeppy in reply to greygoose

😂😂 how to digress from original post

Jeppy profile image
Jeppy in reply to greygoose

…but why keep these t4 levels up if its not bringing t3 up?

Is it right that both t4 and t3 should be at similar place in range? …Not t4 at very top and t3 low down there

greygoose profile image
greygoose in reply to Jeppy

Well, if your T4 level comes down, your T3 level will come down, too, even if you don't convert well. And keeping it steady is better than decreasing it.

Even with perfect conversion - if such a thing exists - the FT3 will always be slightly lower in range than the FT4. You never convert 100% to T3. A certain percentage will be converted to rT3, and the rest excreted.

But T4 should not be at the top and T3 at the bottom, that would mean poor conversion.

What's lacking in this thread is some solid numbers: blood test results and ranges on diagnosis with the date, blood test results and ranges from the most recent test with the date, length of time on 100 mcg. You'll get much better answers with the exact numbers: dates and doses/results and ranges.

tattybogle profile image
tattybogle in reply to greygoose

What's lacking in this thread is some solid numbers ....... Amen to that :)

Jeppy profile image
Jeppy in reply to greygoose

👍🏼 Your post then has ironed it outPoor conversion 👍🏼 Not bad at reading results but confusion came in re pushing the levo up

I cant do it any more feeling that way

Its how to take t3 now. Tiny 6 a.m. tgen is it same pm or do you increase a.m before bringing in p.m

greygoose profile image
greygoose in reply to Jeppy

No. I didn't say you had poor conversion. I cannot possibly know if you have poor converstion without seeing FT4/FT3 results and ranges, when tested at the same time. So far, I haven't seen much in the way of results and ranges.

Jeppy profile image
Jeppy in reply to greygoose

Sorry for misunderstandingIt was a l o n g time ago and you had complete panel at the time

Jeppy profile image
Jeppy in reply to PurpleCat71

T4 was high without levo yes and tsh was 4.6 up to 6.2. T3 renained at bottom

So waa Given levo so built it up painfully slow as felt bad ( changed 3 brands)

Lowest tsh has been is 2.4 & taking t4 to the very top and t3 nudged up slightly with eye on all vits yes. I drop quickly with D

Thanks. So much time and patience isnt it but if dont feel wellness or alive levo not for me.

SlowDragon profile image
SlowDragonAdministrator in reply to Jeppy

Do you always do thyroid testing as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Some people are fine increasing levothyroxine dose and having over range Ft4 in order to get Ft3 higher

Others can’t tolerate over range Ft4

I tried increasing levothyroxine up to 137mcg …..developed terrible vitiligo and insomnia. Reduced dose levothyroxine back down to 125mcg.

Now taking Levothyroxine plus T3 on NHS

20mcg T3 as 3 smaller doses spread through day

125mcg 5 x week and 112.5mcg 2 x week

Jeppy profile image
Jeppy in reply to SlowDragon

Pleased for you yes iv got small vitiligo, psirosis that started post natal Do wonder if any other autoimmunes?

So is it the lack of t3 causing it ?

Jeppy profile image
Jeppy in reply to SlowDragon

So t3 is on nhs in some places is it Lio?Yes. I realise the test should be early but then if reading still high surely would be higher first thing

greygoose profile image
greygoose in reply to Jeppy

The TSH would be higher early morning, not the FT4. That changes very little during the day, but the TSH changes quite a lot.

Jeppy profile image
Jeppy in reply to greygoose

Ok. Thanks. Would t3 stay same too

Jeppy profile image
Jeppy in reply to greygoose

…thought that logically would improve as ‘getting yourself going ‘ with food and movement

greygoose profile image
greygoose in reply to Jeppy

Sorry, I have no idea what you are referring to in the last two replies to me. Why are you asking if T3 would stay the same? In what context. And who talked about food and movement. And what would improve with it? I am totally lost in this thread!

Jeppy profile image
Jeppy in reply to greygoose

No worries. Not important. ( you said t4 doesnt alter throughout day so i queried if t3 the same. That was all. But thought with getting going, concersion would be happening

No reply needed. Sorry

greygoose profile image
greygoose in reply to Jeppy

Ah ok. Well, this thread is so confused now, that it's impossible to know which comment you are responding to. That is why people copy and paste and highlight the comment their responding to, so that we're all on the same page, so to speak.

No, if you're taking exogenous hormone, how could food and movement affect the level. It's the dose you take and how well you absorb that dose in the gut that defines the level. But, even with a healthy thyroid, I don't think they would have much effect on how much T4 is produced. It's the TSH that has a daily rythme. At its highest around midnight, it drops through the early morning until 9 am, then has a sharp drop and continues dropping until around midday, then starts to rise again. This pattern is not affected by movement, but could possible drop after eating - no concrete proof of that - but definitely drops after coffee.

Many, many things affect conversion, but I don't think activity level is one of them.

Jeppy profile image
Jeppy in reply to greygoose

Ok. Just thought it's a natural thing and getting body processes processing. Like burning calories etcIm wrong. I get mad ideas. 🌸

greygoose profile image
greygoose in reply to Jeppy

No, nothing like burning calories. Not at all the same thing.

Jeppy profile image
Jeppy in reply to PurpleCat71

Doc did prescribe levo when t4 was good. (18. (. 11-22)

PurpleCat71 profile image
PurpleCat71 in reply to Jeppy

Why did your doctor prescribe levo when your free T4 levels were 18?

Jeppy profile image
Jeppy in reply to PurpleCat71

I knew nothing, only how xxxx id felt for yrs. a new gp came from a hosp post and she said she was diagnosing. But thats the only thing they give. Sorry unsure what you mean as t3 isnt even tested. Its tsh/t4

My private bloods showed few antibodies over on 2 tests but been ok since changing to mostly gf diet so thats fortunate

Jeppy profile image
Jeppy in reply to Jeppy

…was 5.5 that time and then 6.2 and lots of vertigo

Here's the quote from the Toft article you mentioned :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

tukadmin@thyroiduk.org

Thanks a lot!

You may also like...