Hi everyone, my doctor recently lowered my Levothyroxine from 125mg daily to 100mg, plus 25mg twice a week due, to my low TSH level. These are my latest NHS test results.
I'm a 47-year-old post-menopausal female and I have Hashimoto's. I have also had a private test that shows I don't convert T4 to T3. I fasted and made sure it will 24-hours since I had my last dose of Levo.
Are my levels looking low or okay now? Thanks so much in advance.
Thyroid function test
Serum free T4 level 14.8 pmol/L [11.1 - 22.0]
Please note new FT4 reference range as of 25/11/21
Only you can answer that question really. It's not about numbers, it's about how you feel, and if a doctor prioritises numbers over how you feel then he knows nothing about treating hypothyroidism and is just another one who thinks that the TSH is all that matters when treating hypothyroidism.
TSH: 0.1 [0.27 - 4.2]
This is low but not suppressed. Suppressed is below 0.1
FT4: 14.8 [11.1 - 22.0]
This is only 33.94% through range
FT3: 4.0 [3.1 - 6.8]
This is 24.32% through range
Currently your conversion isn't too bad. Your FT4 and FT3 levels aren't too badly balanced and to find your conversion ratio you need TSH 1 or below and you divide FT4 by FT3 so that's 14.8/4 = 3.7 and good conversion takes place when the ratio is below 4.
Your FT4 and FT3 are telling us that you could do with an increase in your Levo if you don't feel optimally medicated.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine 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 the article by emailing ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor if you feel you need an increase and all they look at is the TSH.
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