I was diagnosed with an under active thyroid in 2001. My gp wants to reduce my prescription from 75 to 50 mcg daily. He says my TSH is 0.02 and I am now overactive. My TS4 is 18 and he says this is normal. I am advised to take 50 mcg for 8 weeks and a follow up blood test has been arranged for 7 December. I am in good health and no weight issues and energetic but my gp is saying if I carry on taking the higher dosage I will be prone to palpitations, anxiety and weight loss.
I am at a loss to understand why my dosage has been reduced.
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Because your doctor knows nothing about thyroid, doesn't know what TSH is, and doesn't understand how to interpret thyroid blood tests.
He appears to think that your low TSH means you're hyper, which is utter rubbish. If you are hypo - and you must be or you wouldn't have been put on levo - you cannot suddenly become hyper. Being hypo means that your thyroid, for some reason, is incapable of making enough thyroid hormone to keep you well. It cannot suddenly regenerate and start producing too much hormone, which is the definition of hyper.
Or, maybe he just thinks you're over-medicated - in which case, he is using the wrong vocabulary, which is reprehensible because it confuses patients. But, what he doesn't seem to know is that a low TSH on its own cannot show over-medication. TSH has to be interpreted along with FT4 and FT3 results. Of course, on the NHS it is difficult to get the FT3 tested, But, your FT4 doesn't even look over-range - although you haven't given the range. (Please, always give ranges because they vary from lab to lab.) So, as you are taking T4 (levo) and your T4 is in-range, it is totally illogical to say that you are taking too much.
In reality, you are only over-medicated if your FT3 - the active hormone - is over-range. But, as the FT3 hasn't been tested, we have to fall back on the FT4 for that information. And the fact is, the FT3 is hardly likely to be higher than the FT4, ipso facto, you are not over-medicated.
my gp is saying if I carry on taking the higher dosage I will be prone to palpitations, anxiety and weight loss.
All I can say is: I wish! If over-medication lead to weight-loss, I think a awful lot of us would be striving to become over-medicated! lol
As for palpitations and anxiety, they can be symptoms of under-medication, too.
So, not only does your doctor not know much about thyroid, he lacks logic and really hasn't thought this all through. In your place, I would flat refuse to reduce my dose.
Do you always get same brand levothyroxine at each prescription
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and B12 last tested
Just testing TSH and Ft4 is completely inadequate
Refuse to reduce dose until you get full thyroid and vitamin testing done
You’re only over medicated if Ft3 is over range
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Low vitamin levels common as we get older too
Low vitamin levels tend to lower TSH
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 and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Your GP can't judge without having TSH, fT3 and fT4. It could be that your TSH is low because your fT3 is above average and you are indeed slightly hyper and would benefit from a dose decrease. It could be that your TSH is low because your pituitary is underperforming a little and that your fT3 is below average, so you might be fine, not hypo or hyper.
More important your GP needs to assess your clinical status, with a face to face consultation. Measure your pulse (strength and frequency), look for a fine hand tremor (hyper) and look for the appearance of hypo or hyper. Above all they should ask you how your are, whether you have symptoms of under or over activity.
It would be useful to know your blood test results from when you were diagnosed. Hypothyroidism is often caused by an autoimmune condition, antibodies (or rather the body's response to antibodies) attacks the thyroid damaging it. During this process secretion of hormone from the thyroid can be erratic leading to periods of under and over activity. In this case you may have to tweek your hormone dose up and down for a year or two after which your thyroid will have fully failed and you will be on a higher dose of levothyroxine.
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