Advice ahead of GP appointment - test results

[Kacey12]

I have a GP phone appointment on Wednesday to discuss my recent blood test.

The results were :

FT3 3.6 (range =2.4-6.0) so less than halfway through the range

FT4 13.2 (range =9-23) also less than halfway through the range)

TSH 0.05 (range= 0.3-4.2) so below range

My main symptom is inability to lose weight despite a very active lifestyle and a healthy low-carb diet. I am on 75mcg of lovothyroxine, but according to NICE guidelines by body weight, I should be on 100mcg.

Does anyone here have any words of wisdom before my appointment? (It will be a new member of the practice that I haven't spoken to before).

Thanks in advance.

[tattybogle]

They will probably say you are overmedicated and request you reduce dose of levo due to TSH being under rage. If you feel better on 75mcg than you did on 62.5mcg, with no symptoms of overmedication, then tell them this, and point point out that your FT4 and fT3 are both well within range.

Let them know you know what the symptoms of overmedication are ( fine tremor in fingers of outstretched hand, increased frequency of bowel movements , unexplained weight loss , feeling too hot etc )

If they are concerned about the 'risks' of low TSH to 'heart and bones' , show them this paper which found the risks associated with TSH between 0.04 and 0.4 were no greater than the risks associated with TSH in rage (below 0.04 the risks did increase quite sharply, but as long as your TSH is 0.04 or above you can use this paper to support your argument to keep your current dose ) ...... academic.oup.com/jcem/artic...

Also see my reply to this post (3rd reply down)...... healthunlocked.com/thyroidu... for links to more useful posts discussing low TSH /risk /quality of life.

Let them know you are understand the 'risks ' as they see them , and that you are prepared to accept them in order to stay on a dose that gives you better quality of life... They may put a note on your record to this effect ( to some degree this lets them off the hook for 'overmedicating' you ... they are worried about getting into trouble for overmedicating patients on levo , due to the risks the NHS guidelines warn them of re. bones / heart)

p.s The 'dose by weight' calculation will probably not be very much use as an argument ... they may just say " ah ,, but that is intended as an estimate for people after total thyroidectomy... so it doesn't really apply to you " ... but it does help toward the overall picture that you're not likely to be overmedicated on just 75mcg,, especially since fT4 /fT3 are both comfortably in bottom half of range.

FT4: 13.2 pmol/l (Range 9 - 23) 30.00%

FT3: 3.6 pmol/l (Range 2.4 - 6) 33.33% ( % calculator thyroid.dopiaza.org/ )

[Kacey12 in reply to tattybogle]

Thank you very much for your prompt and full reply. It is particularly useful to know the symptoms of overmedication (which incidentally I have none of at all despite being technically 'overmedicated').

[tattybogle in reply to Kacey12]

Those are just the 'classic ' overmedicated symptoms .. in reality all sorts of odd things can happen, i have been slightly overmedicated on levo and i was getting pain that was mistaken for 'kidney stones' ,and bladder symptoms that were a bit like cystitis but without the burning ... my 'startle reflex' was through the roof .. it was dangerous to come up behind me quietly when i was washing up incase i had a knife in my hand ....lol , and if a car horn went in the street i literally jumped... but my heart wasn't having any sign of speeding up and my blood pressure was fine, and i don't think i was 'too hot' .. but might have had a few 'hot flush' type episodes.

However the "hold your arms out in front and look at your loosely outstretched fingers for a fine tremor" test is usually pretty reliable if overmedication is bad enough .

I'd been to Doctors with all these weird symptoms, but they didn't check thyroid bloods because they weren't due to be done yet....and i was sent for CT scans and endoscopy's and colonoscopies and kidney ultrasounds.... the lot ...... then in between all this i saw lovely elderly female GP who said .." has anybody checked your thyroid bloods ? .. they should have done that first.. hold your hands out ....Mmm i think you're just overmedicated " ..... and i was ..... slight dose reduction = problems all solved in a few weeks .

An easier way to see the fine tremor for yourself if your eyesight is rubbish ,is to balance a sheet of A4 on the back of your hand.. it makes it easier to see the tremor.

other classic effects of overmedication are faster heart rate, .. but this didn't seem to apply to me.

[Kacey12 in reply to tattybogle]

Had the appointment - and still on 75mcg. Put my points across, though found it more difficult over the phone than face to face. However, doctor said better to stay on same dose - which actuallyI don't mind too much as haven't currently got symptoms, apart from difficulty losing weight. Thanks anyway for your useful input which I shall keep for future reference.