Should I be asking for an increase in Levothryoxine?

[Blue-butterfly]

Hi all, I wonder anyone can advise whether I should be thinking of asking for an increase in medication based on last test results please? I’ve been seeing the specialist for almost a year due to symptoms pointing towards hypothyroidism but always with a TSH in normal range and FT4 either under range or very bottom end - usually between 11 and 13 (in a range of 12-22). MRI scan has shown a 6.5mm pituitary microadenoma. Endocrinologist said that these results would not usually warrant treatment however due to family history started me on low dose of 50mcg Levothyroxine to see if things improved.

After taking 50mcg Levothryoxine for some months my FT4 level rose to 17.4 and I started to feel slight improvement but as I was still getting some symptoms the Endo increased my dose to 75mg. At my next review in May, a few months later, I reported that shortly after the increase I had started to feel fantastic and whilst this feeling had tailed off I still felt much better than I had originally done. He kept my dose at 75mg however wrote to my GP saying I was now asymptomatic which was absolutely not the case. The plan was to continue on same dose with a 6 month follow up and further MRI. Since then, however, I have noticed symptoms creeping back. Last week I asked for the results of my last test in May as I had not been given them. The test in May was taken around 10am, approximately 2 hours after taking daily dose of 75mg Levothyroxine and having read other posts I know to not take it 24 hours before the blood test next time.

Results were:

TSH 1.22 mIU/L (0.27-4.20);

Free T4 13.7 pmol/L (12.0 – 22.0)

Free T3 3.7 pmol/L (3.1 – 6.8).

Vitamin D 96.0 (48-192)

Thyroglobulin antibodies 13.6 IU/ml (0-115)

Thyroid Peroxidase Antibodies 9.85 IU/ml (0-33)

I notice that my FT3 and FT4 had started to drop to the lower end of the range again so wonder whether I should be thinking of asking Endo to increase my Levothyroxine dose? I appreciate that they're all still within the accepted range but I seemed to feel at my best around three weeks after my FT4 was at 17.4 (12-22) and FT3 was at 4.2 (3.1-6.8)

Is it normal for levels to drop again even whilst on medication?

Any thoughts greatly appreciated! Thank you

[humanbean]

Is it normal for levels to drop again even whilst on medication?

Yes. When people with failing thyroids are given levothyroxine their own thyroid reduces its output of T4.

Doctors seem to think that Levo tops up the output from a failing thyroid. It doesn't. Eventually it will replace the output of the thyroid. 75mcg Levo isn't a high dose. I would suggest that you need a higher dose. Whether you need another 25mcg another 50mcg or possibly more is something you can only find out by getting the higher dose and trying it out.

There is a chance you need an intermediate dose i.e. another 12.5mcg or another 37.5mcg per day for example.

Another way of fine tuning is to take a higher dose a certain number of days a week. For example I have 50mcg tablets. I was taking 100mcg 4 days a week and 50mcg 3 days a week (i.e. 550mcg per week, an average of 78.6mcg per day).

My most recent test results suggested it would be worth increasing my dose slightly so I now take 100mcg 5 days a week and 50mcg 2 days a week (i.e. 600mcg per week, an average of 85.7mcg per day).

[Blue-butterfly in reply to humanbean]

I see, thanks so much. It's such a complicated health issue! Do you generally quickly start to feel better once you increase your dose?

[humanbean in reply to Blue-butterfly]

When people are very under-medicated or very over-medicated and go up or down in dose by 25mcg per day, that would make a noticeable difference to most people within a few days. But as the fine tuning starts and the amounts that doses change by gets smaller it would take longer to notice.

Some people have made changes to their dose and only noticed a few weeks later "Hey, I'm feeling better than I did a month or two ago."