Good afternoon all. Please would you give me your views on the following annual blood tests. My GP is calling me on 22 Feb to discuss the results and know I will be pressured into reducing my Levothyoxine even though I feel perfectly well. I am on 175mcg daily. My results are as follows:
T3 - 4.0. ( 3.1 - 6.8 )
T4 - 22.7 ( 12.0 - 22.0 )
TSH - 0.08. ( 0.3 - 5.0 )
I know my TSH is below range and my T4 is above range.
I would appreciate you advice prior to the telephone appointment. Regards Dot
PottyDotty
Was this test done as we always advise:
* No later than 9am
* Nothing to eat or drink except water before test
* Last dose of Levo 24 hours before test
* No biotin or any supplement containing biotin for 3-7 days before the test
Thank you SeasideSusie, yes, all complied with as always. Blood test was 08.45hrs, no food or drink, no biotin supplements and Levothyoxine not taken the 24 hour prior.
PottyDotty
In that case your FT3 is very low in range considering your FT4 level, ie FT3 is only 24% through range and your FT4 is slightly over range.
So the question is - how do you feel? Could you improve or are you happy enough as you are?
If you still have symptoms then list them to discuss with your GP and say that you know that T4 converts to T3 and it's T3 that is the active hormone that every cell in our bodies need and that it's low T3 that causes symptoms. So therefore you need a higher FT3 level to feel well. This can be achieved in two ways - either lower Levo which will bring down both FT4 and FT3 but you would then need to be precribed T3 to raise your FT3 level. Second option is to prescribe enough Levo to take your FT4 even higher to increase your FT3 by conversion - this option is not ideal.
You can quote Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, who states in Pulse Magazine (the professional publication for doctors):
"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
You can obtain a copy of this article from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
Thank you so much. That is exactly the information I needed to give to my GP. I appreciate your help and advice.
Good luck Dot, I don't know how receptive your GP will be to this. One thing to bear in mind is that your GP cannot prescribe T3 (liothyronine), this can only be initiated by an endo who, if agreeable, will give a trial of 3 or 6 months and if endo agrees that you benefit and should stay on T3 then GP takes over prescribing.
Thank you. I doubt my GP will even contemplate T3, but as long as he or she allows me to stay on my current level of Levothyoxine, then I’ll be happy. I wonder if any of these GP understand the stress their decisions have on us? Mine go through the roof every year at this time!
If you feel "perfectly well" you are on the right dose - end of.
You are ONLY over-medicated if free T3 if over-range - and yours isn't; in fact at only 24% though range it's lower than I would want. You are emphatically NOT over-medicated if TSH is suppressed - and there's nothing dangerous about having a very low TSH as long as you don't have over-range free T3. Yes, free T4 is a bit over, but if that's what it takes to get a barely respectable level of free T3, that's not a problem either - you are a classic "poor converter" given the wide discrepancy between how far you are through the T4 and T3 ranges respectively. Have key nutrients been tested - ferritin, folate, vit D and B12? If not, I'd distract the GP by asking for those, and saying that they are recommended by Thyroid UK 
Please don't allow yourself into being bullied into a dose reduction x
Thank you so much for your response, although my GP doesn’t test for B12 or vit D, I do supplement with both. I will try and stand my ground then.
please see my reply to this post (3rd reply down ) healthunlocked.com/thyroidu... feeling-fine-but-tsh-is-low
It contains a link to a large long term study of patients on Levo. The study found there were no increased risks for long term TSH of between 0.04 to 0.4 , so you can use it to counter GP's claim that low TSH will lead to heart / bone problems.
(There were some increased risks associated with TSH below 0.03)
Also contains links to other useful posts discussing low TSH/risk which might be helpful in your discussion about dose.
Thank you very much for your response.
When were iron/ferritin, folate, B12 and vitamin D last tested
Really need testing annually
Restless legs often linked to low iron or low magnesium
Exactly what vitamin supplements are you currently taking
I take gentle iron every other day, B12, K2, prebiotic, bergamot, vit D, Cod liver oil, calcium/magnesium/zinc multi, magnesium citrate, turmeric and specific for breast pain as recommended by consultant at hospital, Agnus Castus, flaxseed oil and evening primrose oil. Sorry for the huge list.
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