Advice please on recent blood test results..

[Sarahlouise1980]

Just a couple of days ago I had another blood test as the doctor was not happy with the fact that TSH has been suppressed on previous blood test results. My results this time are:

TSH 0.007 (0.34 - 5.6)

Serum Free T4 13.1 (7.7 - 15.1)

Serum Free T3 5.0 (4.3 - 6.8)

She wants me to reduce my levothyroxine from 125mcg to 112.5mg. What do you think I should do?

Thank you!

[SlowDragon Administrator]

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

How do you feel

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

[pennyannie]

Hello SarahLouise :

The TSH test was originally introduced as a diagnostic tool to help confirm a patient's diagnosis of hypothyroidism and it was never intended to be used to dose and monitor as once on any form of thyroid hormone replacement you must be dosed and monitored on your T3 and T4 results.

Your T4 is around 73% through and your T3 around 28% through - though have to say I've never seen a T3 range starting at 4.30 - is this correct ?

Looking back when you dropped your dose to 100 mcg T4 your experienced hair loss, among other symptoms so I don't think that is likely a solution.

Optimal conversion when taking T4 only is said to be 1 / 3.50 - 4.50 - T3/T4 with most of us feeling at our best when we come in at around 4 or under :

So if I divide your T3 into your T4 I'm getting your conversion coming in at around 2.60 so showing a faster than " so called " normal metabolism which could explain those other symptoms including that of a loose bowel.

How are your ferritin, folate, B12 and vitamin D and is anything else going on ?

The trouble is none of us know where our set point for feeling at our best so it's guess work, and maybe 112.50 mcg T4 is a compromise and worth a trial period.

[fuchsia-pink]

I certainly wouldn't if you feel well as you are - your free T4 and free T3 results show that you are a LONG way from being over-medicated, and may well feel better (if not tip-top) with a dose increase. And, at the very least, I'd want a written assurance (these days when face-to-face is practically impossible it's often easier to get emails from GPs than before) that if the drop didn't suit you, your current level of meds would be restored with no delay (or doctor resistance).

If you want to give it a try, it would be easiest (and least likely to cause you aggro if it doesn't work) for you to ask for your prescription to be kept as it is, and for you to experiment with a slight dose reduction to see what it does - if you think that would help. Then it's easy to reverse if it doesn't improve anything.

My own experience was when I was "over-medicated" [no idea if this was high free T4 or low TSH] was that a tiny reduction in meds (less than 5% of my weekly intake) was enough to make me feel absolutely rubbish and did nothing at all to influence my blood results [it was then that I finally had a free T3 test and poor conversion was discovered] - but to get to that I had to - very politely - refuse to reduce my meds further when I was already feeling dreadful

So you don't HAVE to agree - and I certainly wouldn't on the basis of TSH alone x