Latest Blood Test. Advice Please.

[Sparklingsunshine]

Hi

Just would like some thoughts and advice on my latest blood tests. I did an Monitor My Health test yesterday. My TSH was 0.03, FT4 was 17.1 and FT3 was 4.7.

This is a huge improvement on early October's results. Question is do I stay on the dose I'm on, 125mcg of Levo, do I increase or decrease it, is there still room for improvement? Many thanks.

[SeasideSusie Remembering]

Sparklingsunshine

TSH: 0.03 (0.27-4.20)

FT4: 17.1 (12-22)

FT3: 4.7 (3.1-6.8)

Question is do I stay on the dose I'm on, 125mcg of Levo, do I increase or decrease it, is there still room for improvement?

Really only you can answer your question.

Your FT4 is 51% through range and your FT3 is 43.24% through range, so the question you have to answer is "how do you feel"?

Forget the TSH being low, although TSH is important for diagnosis, once on thyroid hormone replacement it's the FT4 and FT3 that tell us our thyroid status as those are the thyroid hormones, TSH is a pituitary hormone.

With a mid-range FT4 and slightly lower than mid-range FT3 its not likely that you need to decrease your dose. Most people would want their FT4 and FT3 higher in range than yours, so again, how do you feel? If you don't feel optimally medicated and symptom free then your FT4 and FT3 show that there is room to increase your Levo. If you feel good then stay on your current dose.

[Sparklingsunshine in reply to SeasideSusie]

Hi

I feel OK, better than I did. I am just concerned that when I next have NHS blood test the GP will freak out at my low TSH and reduce my dose. If I increase my Levo to 150mcg to try and increase my FT4 and FT3 levels then that will presumably decrease my TSH further, which I'm not concerned about, but which will flag up GP alarm bells.

[SeasideSusie Remembering in reply to Sparklingsunshine]

Yes, it's true that your GP will likely freak out at a suppressed TSH but this is where you have to push the point that your FT4 and FT3 are in range and that these are the thyroid hormones. I have this very problem, a GP who only looks at TSH and refuses to discuss FT4 and FT3. There was an Advanced Nurse Practioner at our practice who completely understood and was supportive of my in range FT4 and FT3 and ignored the suppressed TSH, unfortunately he has now left and I'm stuck with a GP who really doesn't understand.

You can refer to the article by Dr Toft, past president of the British Thyroid Association and leading endocrinologist who wrote an article in Pulse magazine (the professional publication for doctors) which said:

"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).*"

*He confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of this article from ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP, it may help.

[waveylines]

Hello....can you pop the reference ranges next to each result -they'rethe figures in brackets) labs ranges vary.... Thanks

[Sparklingsunshine in reply to waveylines]

Hi sorry, Susie has done it for me lol.

[waveylines]

Oooh no worries. I think its personal choice - if u feel an increase is needed Id do it. Ure probably right it will lower tsh further. When u see your GP take the full results and show them explaining ots the level of actual thyroid hormones that really matter & ures are in range. Thats what I did....seemed to work.