New young GP saw my annual bloods and has halved my dose of levothyroxine from 100 to 50. He wanted to stop my liothyronine but I argued that only the consultant could do that.
Results in July. TSH 0.02, T4 14.9 (9.01-19.05), T3 5.2 (2.63-5.7)
Results in October TSH 3.55, T4 10.8, T3 not done
When I said the consu,tant had told me to keep my TSH under 2 he laughed and wasn’t interested in any symptoms. Said it was still settling and they didn’t like patients to have it too low.
I’m 61 and been happily on the same medication for 10 years but now I’m getting dry skin, hair loss and generally not feeling so alert. I’m trying to loose weight and worried it’s going to get even harder. Just ordered a private test including vitamin levels as my blood pressure and cholesterol also seem to have gone up.
Would welcome any thoughts from this group
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Although it is often true as you age you require a lower dose, if your FT4 & FT3 is in range the dose doesn’t need to be changed. Levo dose should not be adjusted by more that 25mcg daily and retested in 6 weeks. 50mcg is too great a drop.
Your TSH likely be low as you take Lio.
When on replacement TSH should be around 1, FT4 in top 3rd of range & FT3 at least top half. edit: applies to Levo only as said above, when taking T3 likely to be even lower. GPs looking at TSH only do not understand this.
Your FT4 is now low. Your GP sounds dreadful, see someone more civilised.
Your latest TSH of 3.55 bears no resemblance to the average TSH of women your age who are healthy, and it shows that your dose is much too low. And patient experience usually suggests that TSH should be lower than that of healthy patients, not higher.
The problem that older patients have is that a few years ago (2017) this paper was published:
Title : Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
Note when reading this paper that "Thyrotropin" is another name for TSH.
The researchers used subjects for their research with a TSH between 4.6 and 19.99, and with Free T4 within the reference range.
They dosed the patients with sufficient Levo to reduce their TSH to just within the reference range (average TSH was 3.63 by the end of the research). The patients were then asked about their symptoms. Many of them didn't feel any better because they had been under-dosed. As a result the conclusion of this pathetic research was that elderly people didn't need "subclinical" hypothyroidism to be treated at all because it made no different to the patients' symptoms.
To make matters worse, this conclusion has been allowed to spread its tendrils to all older people with hypothyroidism. Some doctors now appear to believe that older people should not be allowed to have a TSH at the lower end of the reference range. And another issue - it appears that doctors decide for themselves what age classifies a person as an "older adult", and that age seems to be getting younger. The average age of subjects in the paper above was 74.4
Note, in the Discussion section of the paper, that they do acknowledge that dosing to get the TSH lower might have been beneficial :
However, the trial also had certain limitations. First, we chose to set a thyrotropin target of 0.40 to 4.60 mIU per liter with levothyroxine treatment, which is an approach that reflects recent guidelines, particularly for older persons.7 However, some authorities have recommended a lower thyrotropin target (e.g., 0.40 to 2.50 mIU per liter).29 We cannot exclude the possibility that this more aggressive treatment approach might be beneficial. Second, since few participants had a baseline thyrotropin level of more than 10 mIU per liter, we cannot address whether there are benefits from treatment in this subgroup. Third, the symptom levels at trial entry were low, so we cannot exclude the possibility of benefit in persons with more marked symptoms. Fourth, we did not measure thyroid antibody levels. Antibody-positive patients are more likely than antibody-negative patients to have progressive hypothyroidism and therefore may be more likely to have a benefit from long-term levothyroxine treatment.7 Finally, our trial was underpowered to detect any effect of levothyroxine on the incidence of cardiovascular events or mortality. Therefore, we cannot exclude the possibility that treatment with levothyroxine may provide cardiovascular protection or cause harm.
Note the bit I've emphasised above in bold. It refers to reference 7 as the source for the comment on "older persons".
When on replacement TSH should be around 1, FT4 in top 3rd of range & FT3 at least top half.
this applies when on Levo only. When on combination hormone replacement the T3 is going to take TSH very low, probably suppress it, and it also lowers FT4. We then need to work out ourselves where we need our FT4 and FT3. Some are fine with a low FT4, even well below half way through range, as long as FT3 is in the upper part of it's range. Some of us on combo replacement need both FT4 and FT3 in the upper part of their ranges. It's very individual and not set in stone, we will know ourselves where our sweet spot is.
Your young GP and I would probably have an argument. I am 73 and I do not need less medication now that before. For him to laugh at what your consultant has said about where you need TSH and to dismiss your symptoms is disgusting. Consultant endocrinologist trumps a GP, what your endo says goes as far as your thyroid meds are concerned, it's not for this GP to go against him. I would not have altered my dose of thyroid meds at all, you should contact your endo and see what he says, if he agrees with you then ask him to write to this stroppy young GP and tell him to reinstate your original dose.
You can always point this GP to this evidence from GP online, which confirms what your endo says:
Loving the support from this group. Sadly my endo retired 4 years ago and as I was stable and well haven’t been linked to a new one. I’ve arranged to see the senior partner in the gp practice and am going to request a referral to a new endo. That could take time but I do have health insurance through work so I’m going to see if I can use that. I have confidence now for the fight - I didn’t say in my original posting that my bp is up, my cholesterol is up and I’ve been suffering from constipation too. As my husband says - the only thing that has changed is my thyroid meds
I can't help, but I feel your pain. This morning when I asked my doctor, "so do you not have any interest in my symptoms?" she answered with a resounding "No."
It’s dreadful that they say these things. I quoted Nice guidelines when they tried to take me off liothyronine a few years ago. It’s good to have data as well as our symptoms but we shouldn’t have to
I’m disgusted for you. How dare he halve your T4 on the basis of your age. I’m the same age as you and would feel awful on those blood results. Can you ask to see another GP? Perhaps complain that this new bloke was being unnecessarily ageist?
I would go further than just changing which GP I see and report this little sh*t! His treatment of you is utterly disgusting and probably negligent and he needs to be brought to account for it! This is precisely why so many of us end up self-treating and get ourselves in a place where we have some reasonable quality of life.I wish you all the best.
When "they" speak of reduced requirement as we age, I really don't think they mean even below retirement age!
Once menopausal issues are out of the way, if relevant, there should be quite a number of years of no significant change. And questions about dosing and levels even in the much older, over-80s or whatever, are still being asked. Because it is all still not fully understood and explained.
1. Dropping the dose that much is not recommended and potentially dangerous
2. Stopping the T3 is the consultants call, not his. He is trying to save the practice money at your expense.
3. With 10 years of listening to your body and coping with the thyroid, you are better qualified than the young GP who has probably done about an hour on the thyroid system when in med school.
4. You do not appreciate your ill health being laughed at.
His flippant attitude to symptoms and your health will probably mean he is like this with many patients, and he needs a "good talking to" as my mother would say!
You will not be the only patient under this GP who has had problems. The practice as a whole like to know if things are going wrong. Most people do not complain, change GP or just go home and cry, so the practice does not get to know the problem, so cannot correct it.
Your body is shouting it needs more thyroid help. Lets hope the change of GP means that he will listen to you and your body. Hug.
Thank you - I am not going to just accept this. First step is a Medicheck blood test including vitamin levels ( which I suspect will be fine). I’m booking an appointment with another GP and will be well armed for that. If no joy then it will be a formal complaint.
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Third blood test in 4 months
Endo ringing me re results, thinks symptoms not due to thyroid. Please help
Update I had a discussion with the endocrinologist today I think I need to be more assertive next time . Will I NEED T3 
Endocrinologist has reduced Thyroid meds *again* due to suppressed TSH from T3. Argh!
