Symptoms back TSH optimal 0.41 but FT4 only 12. Got GP this pm. Any chance they’ll up my levo slightly ?12.5mg? Will ask again for FT3 test!

[Indiana12]

Also high serum cholesterol and diastolic hypertension.

Not sure what’s going on but symptomatic again for the last few weeks and think my FT4 needs to be higher for the fatigue to reduce.

Any advice please?

[shaws Administrator]

Just say to GP, "as I still have symptoms I know my body needs an increase in dose to try relieve all of the clinical symptoms".

GP may not want to add some T3 as I believe only Endocrinologists can do so now but there's no harm in asking.

[SeasideSusie Remembering]

Indiana12

but FT4 only 12.

What is the reference range?

If like my NHS lab the reference range is 7-17 then you'd be 50% through range which isn't bad. But if it's 12-22 (as most private labs are) then you'd be bottom of range and that would explain why you are symptomatic.

[SlowDragon Administrator]

How much levothyroxine are you currently taking

When adequately treated Ft4 and Ft3 will be at least 50% through range

What’s results and ranges on Ft4 and Ft3

Previous post shows you have low vitamin levels

Likely linked to being under medicated

Low vitamin levels tend to lower TSH

[greygoose]

There's no such thing as an 'optima' TSH, because the TSH is pretty much irrelevant. It's the FT3 - the active hormone - the most important, because low T3 causes symptoms. And, even without an FT3 test, we can tell it's low becausef your cholesterol is high. That's how it works.

T4 is basically a storage hormone that doesn't do much until it's converted into T3. But, if your FT4 is low, and you are on levo mono-therapy, then your FT3 is going to be even lower. Pity doctors don't understand any of that.

[Indiana12 in reply to greygoose]

So GP will raise levo to 75mcg but says Liothyronine ‘isn’t prescribed anymore’. More bloods in 8 weeks then review. I asked what happens if FT4 still doesn’t increase just on levo how will my T3 increase and he wouldn’t answer. Didn’t accept link between high serum total cholesterol and low T3!

[greygoose in reply to Indiana12]

Either your GP is lying or he's very ignorant. It is prescribed but the prescribing has to be initiated by an endo.

I don't suppose he knows the first thing about T3. He certainly wouldn't have learnt about the T3/cholesterol link in med school, and they are only interested in what they learnt in med school. Doctors tend to have very closed minds. Nevertheless, it is true.

[Indiana12 in reply to greygoose]

I asked for an endo referral but he just said ‘we’ll see’ in a very patronising way. Young GP registrar. Wasn’t familiar with FT4 and FT3 needing to be in top third of range. I suppose I’ll see if the levothyroxine increase for 50mcg-75mcg helps. If not will see endo privately. The high cholesterol and diastolic hypertension together worry me. I put 1.5 stone on last year pre diagnosis and have followed a really healthy diet and exercise regime for the last 3 months but can’t lose weight presumably due to my levels still not being good. I’m also just post menopausal so those hormones are also involved. The whole thing is so frustrating.

[greygoose in reply to Indiana12]

The high cholesterol and diastolic hypertension together worry me.

Don't worry about them. They are symptoms, not diseases. And they are not connected in anyway.

Hypertension is just another hypo symptom. And high cholesterol does not cause heart attacks or strokes, despite what doctors might tell you. You're not taking statins, are you?

[Indiana12 in reply to greygoose]

No not taking statins. So both the diastolic hypertension and raised serum total cholesterol should lower with correct treatment for the low FT4 and FT3. I’m so grateful for your input.

[greygoose in reply to Indiana12]

The should, yes. I've noticed the difference in my cholesterol levels on different doses of thyroid hormone replacement. And, my blood pressure, which has been high for a long time, is now 'normal'.

[Indiana12 in reply to greygoose]

May I ask did you need to take liothyronine to get good results and reduce your cholesterol? Did you see an endo?

[greygoose in reply to Indiana12]

I've seen about fine endos - each one of them more useless than the other!

Yes, I was taking T3 only, because I cannot tolerate T4, even though I didn't have a conversion problem. I didn't have my cholesterol tested when I was on T4 only. Only before diagnosis and when taking T3 only.