26 May 2022 Thyroid lab results. You comments please:
I take 100 micrograms of levothyroxine daily.
TSH 0.04 [Low] uIU/mL (0.55-4.78)
Free T3 3.6 pg/mL (2.3-4.2)
Free T4 1.3 ng/dL (0.67-1.52)
Vitamin D 25 OH 36.5 ng/mL (30.0 – 140.0)
Primary care physician wants to lower the dose of levothyroxine. We will be discussing this Monday or Tuesday
Also, what are you comments about the TSH value being well below the Reference Range. I'm sure that's the reason the physician wants to lower the dose of levothyroxine
Thanks!
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rjb112
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what are you comments about the TSH value being well below the Reference Range. I'm sure that's the reason the physician wants to lower the dose of levothyroxine
I'm sure you're correct. Your FT4 and FT3 are very nicely placed at 74.12% and 68.42% through range respectively so if you feel well thyroid-wise there is no need to adjust your dose, lowering it will lower your FT4 and FT3 and will possibly bring back symptoms of hypothyroidism.
TSH is not a thyroid hormone, it's a pituitary hormone. The T4 and T3 are the thyroid hormones and it's these that tell us our thyroid status. The TSH is a signal from the pituitary to make thyroid hormone if it detects there's not enough. You have good levels of FT4 and FT3 so your pituitary is satisfied therefore it's not sending the signal to make more hence it stays low.
Vitamin D 25 OH 36.5 ng/mL (30.0 – 140.0)
This is of more concern. The Vit D Society and Grassroots Health both recommend a level of 40-60ng/ml, with a recent blog post on Grassroots Health mentioning a study which recommends over 50ng/ml. Your level could do with improving.
Thanks SeasideSusie. I should be able to raise up the level of Vitamin D with no difficulty.
Regarding: "so if you feel well thyroid-wise there is no need to adjust your dose"
I do feel well thyroide-wise. Personally I don't have a need to adjust the dose, but I can't purchase levothyroxine without a physician's prescription.
My physician is wanting to lower the dose from 100 micrograms levothyroxine to 75 micrograms. I'm not going to be able to convince her that it's the level of Free T3 and Free T4 that are more important than the level of TSH.
So I'm thinking about a compromise. I'm planning on suggesting to my doctor that I take 75 micrograms levothyroxine one day and the next day take 100 micrograms levothyroxine.
That averages out to a dose of 87.5 micrograms levothyroxine daily.
I know you're in the US and I don't know your rules about importing prescription medication, but it is possible to obtain Levo without prescription.
What is your doctor's problem with low TSH? Has she given you a reason?
Would your doctor be willing to consider an article written by a UK thyroid specialist which confirms that a low/suppressed TSH is fine when on Levothyroxine only providing that T3 is within range?
Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist, 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 the article by emailing ThyroidUK at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
If you are feeling well then I would suggest refusing the lower dose. There are many posts on here with links to research papers that show there is very little risk to a slightly below range TSH. If you discuss this with your GP and quote this articles it will help ( it’s what I did )I’m sure someone will reply with the links.
Hi SarahJane1471. Regarding, "If you are feeling well then I would suggest refusing the lower dose."
I am feeling well on 100 micrograms levothyroxine.
But I don't know how I can refuse the lower dose.
My doctor can just lower the dose on her own, without my say.
All she has to do is go onto the computer system and lower the dose from 100 ug to 75 ug, and it's done. Then the pharmacy will no longer fill 100 ug tablets for me.
Read greygoose post below mine and take a screenshot shot ready to explain that there is very little risk and you would rather take that ( small) risk than feel unwell.tattybogle please could you post the link to the research? ( I’m a Luddite)
rjb112 please see my reply to this post (3rd reply down) healthunlocked.com/thyroidu... .... for links to a study showing "TSH between 0.04 and 0.4 had no greater risk than TSH 'in range' ......and other useful discussions on Low TSH / Risk / Quality of life.
Asking for a compromise to 87.5mcg is a good idea ... ideally you do want to keep TSH over 0.04 IF it is possible to do so on a dose where you still feel well.
If trying 87.5mcg .... give it a long enough trial .. i found the first 5 weeks of a 12.5mcg reduction i felt undermedicated and it was rubbish , BUT from week 6 ish onwards i was beginning to feel ok again , and in the end the lower dose was fine . .
My doctor can just lower the dose on her own, without my say.
If she implies that she's going to do that, remind her that she is there to advise, not to dictate. You dose should be arrived at with informed consent from you, you have the right to refuse, she has no right to go against your wishes. Tell her that if there is any risk, you accept full responsibility. She is not god!
Make a new post, people wont see your request tucked away in this thread.
Make the heading something like "Supplier of levothyroxine without prescription to the US".
We can't discuss or name suppliers on the forum so ask for replies to be sent to you in a private message. Your post will be closed to replies to prevent information being made public on the forum. Your post will remain visible and if anyone can help they will send you a private message.
You can ask me in a private message if I have had any feedback on any suppliers that are recommended to you. I can't give you supplier details, Admin aren't allowed to do that, but if I have had any feedback on any supplier recommended to you then I can pass that on to you.
I think you need to post a new question for that. Ask in the title - Looking for levo without prescription, please - or something like that. Reply by PM only. And, hopefully people will send you links to their trusted sources.
You will need to create another thread asking just that question. The forum rules don't allow discussion of this subject, so such questions are closed to replies and all answers must be sent via the chat/private message system.
Oh greygoose, I wish When my lady GP saw me 2 yrs ago, pre-covid, she wanted to lower my levo for the exact same reason. I explained that when I'd previously agreed to do that I'd felt extremely ill..... and asked if I would have any input into the decision, I was decidedly told "No".
Thank you. It's all such a battle though, isn't it? I'm pretty sure the same issue will be raised again when another GP calls me on Wednesday re my latest results. I've done my best to prepare....but when energy levels fall and "brain hurts" arise, it's such an effort to pull an argument together. I've contacted an NHS/ private consultant endocrinologist's secretary to make an appointment to see him. He is on the ThyroidUK list, and I'll possibly be able to see him next month to discuss my low T3 and poor conversion. Bless you and others here who offer help/advice and support. Thank you all.
Your FT4 and FT3 look pretty good. According to them, you're certainly not over-medicated. In fact, if you don't feel good with these results, there's actually room for an increase.
Yes, your TSH is low, but that's because your pituitary has decided you don't need it anymore. You have sufficient thyroid hormone in your blood.
The TSH has only two jobs:
* stimulate the thyroid to make more hormone - hence the name: Thyroid Stimulating Hormone
* stimulate the production of the proteins that convert T4 to T3.
If both your FT4 and FT3 are sufficient, why would you need TSH anymore?
Problem is, doctors have been taught that a low TSH causes heart problems and osteoporosis. This is not true, but that's what they learnt in med school, and they never question what they learnt in med school, even if it is totally illogical.
Prolonged periods of high T3 may increase the risk of heart problems and osteoporosis, which, of course, would cause the TSH to be suppressed. But, it's not the TSH itself the problem. It's the high FT3. So you're only over-medicated if your FT3 is well over-range.
Any suggestions? I don't think I can convince my medical doctor to allow the TSH to be so low. I think I stand at least a 50/50 chance of convincing her to let me take 75 micrograms one day and 100 micrograms the next, for an average of 87.5 micrograms daily.
Yes, but if you reduce your dose, your FT4 and FT3 are going to drop. And, you're going to feel worse. Quite why they can't understand this, I do not know! But, you could just try refusing to reduce your dose. That's what I always did - until I got fed up with the continued battle and started to self-treat. It is just not right to have to make yourself ill just to get the numbers that please your stupid, ignorant doctor. With no other illness would you be expected to do that, so why would you with thyroid? Ask her if she would reduce the dose of insulin of a diabetic because she did not like a totally irrelevant number - and the TSH IS totally irrelevant.
I'm also in the US and I think you should seek out a functional medicine practice. I currently see a registered nurse that owns a functional medicine practice but allows patients the option of seeing her under a regular physician or functional medicine visit. They're much more open about how they treat thyroid disease. I would consider my treatment to be successful if I had levels like yours. If they lower your Levo then you'll probably just feel like crap. Don't waste your time on a Dr that's going to hassle you every time you go in for labs.
Thanks jrbarnes. I should find out by Tuesday at the latest, if the doctor accepts my request to stay on 100 mcg; or if she orders 100 mcg one day and 75 mcg the next; or if she only orders 75 mcg every day. It will be one of those 3 outcomes. Appreciate your input. I've written a new post requesting sources of levothyroxine without a prescription, which people can only reply to on Private Message. That's another way to address this issue.
I live in the Uk. I should very much like to find out sources of levothyroxine without a prescription by private message too. I may not be able to persuade gp to prescribe further and would feel happier knowing I have a back-up plan in place should that be the case. I should be grateful if you could pass on the information from any replies you receive.
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