Hi I was in having bloods at my Gp surgery for another thing but the nurse mentioned that the GP wants my thyroid levels retested in 6 weeks and that she also wanted a follow up after then. Nobody told me this from the practice but what could she be meaning? Nurse said thyroid looks low? Wasn’t sure what she was meaning.
Results I posted previously are below and the ones I question done 2 weeks ago. I had new bloods today so hopefully nurse adds thyroid in again - she’s going to speak to the GP.
I’m on both T3 and T4 - 100mcg T4 and 5mcg T3.
Results - TSH - 0.18 - range 0.23-5.6 FT4 - 24 - range 9-28 FT3 - 4.5 - range 3.1-6.8
What does nurse mean that my levels look low? Thanks for any input 🙂
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mistygrey
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Yes. Tsh is not a reliable measure of thyroid hormones particularly when you are on levo and lio. She should be looking at your actual hormone results ft4 and ft3.
No. T3 lowers ft4 slightly. According to your results your ft4 is not over range as the range you have put in goes 9 - 28 and your result is 24.If the ft4 range is a typo and your result is over range then I would lower your levo dose first by 25mcg and wait to see if that improves things.
Hi the range was correct I typed, it’s just slightly high at 24 range being 28 like you say. So if I added a little bit more T3 you think my FT4 would come lower, would that make me feel abit better less tired? And the TSH I’d imagine will go undetectable further?
Misty when you are on combo it is trial and error as to what suits you personally. You change 1 thing at a time and wait 8 weeks to see how the body adapts to the dose change. For some of us on here it can take a couple of years to find our doses od levo and lio.For me an increase in lio of 5mcg would mean that my ft4 would drop by maybe 0.5 so we are not speaking massive number jumps.
For me your ft3 would be too low and I would be trying another 5mcg lio. And yes your TSH would go lower. My tsh has been undetectable for years. There is no need to stimulate the thyroid when enough hormones are coming orally.
It I upped my T4 what would happen in that scenario? If I were to just up the T3 instead when is the best time to take 5mcg T3? Sorry I am just confused easily by thyroid meds so takes awhile for me to understand it
Hi it’s 5mcg tablets I get prescribed. The only thing with upping T3 is I used to get palps on the higher doses of T3 is this likely to happen if I upped it again slightly?
Initially just add 1/2 tablet ( 2.5mcg) dose around 3-5pm ….what ever suits you.
wait 6-8 weeks and retest thyroid levels
You might then consider adding the other 1/2 tablet (2.5mcg) at bedtime
Many people find small dose T3 at bedtime improves sleep
So you might end up on
5mcg dose T3 waking
2.5mcg dose T3 approx 3pm
2.5mcg dose T3 at bedtime
You might also consider splitting levothyroxine
Taking half dose levothyroxine waking and half dose at bedtime
Only make one change at a time and then wait 6-8 weeks to assess
Day before test
Last dose T3 approx 8-12 hours before test
Levothyroxine
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Thanks for your advice. On looking at my results I presume upping T4 would have no benefit at all then? Just cautious if I up T3 I may get some heart palpitations again
HiI take my T4 in the morning on waking so around 7 am. It’s 100mcg I am on so I’d have to take 50mcg am and 50mcg pm? I could potentially try this and see how I am and keep T3 as is. Or add the extra T3 and keep T4 the same. It’s a tricky one, I am pretty useless with all of the thyroid conversions and doses even after all these years
I found (to my astonishment) that splitting levothyroxine has been significant improvement
My TSH hasn’t moved from 0.01 ….but on 17.5mcg T3 a day I wouldn’t expect it to.
But I have very recently successfully reduced T3 from 20mcg per day. Been on 20mcg T3 for 5 years (as small split doses - 6.20am, 3pm and 11pm)
I feel much better, less stressed and more relaxed since splitting levothyroxine (6.20am and 11pm)
Since started splitting levothyroxine 6-8 months ago, I have lost 10lbs in weight …..as I stopped craving sugar….and just cut it out completely. Got at least 2 more stone to loose.
Been gluten and soy free 6 years
Very recently in last month gone dairy free on recommendation of physio (lipodema and very painful legs) …..again ….surprising improvements already and weight dropping faster
As soon as we take almost any dose of T3 it’s almost inevitable TSH will drop very low or suppressed
It’s irrelevant….as long as Ft3 isn’t over range
Was this test done as recommended
Early morning, ideally just before 9am, last dose levothyroxine 24 hours before test and last 2.5mcg dose T3 approx 8-12 hours before test
FT4: 24 pmol/l (Range 9 - 28)
Ft4 looks good at 78.95% through range
FT3: 4.5 pmol/l (Range 3.1 - 6.8)
Ft3 low at only 37.84% through range
Who prescribed T3?
Looking like you might need 5mcg dose increase in T3
Retest 6-8 week after any dose change or brand change in levothyroxine or T3
Which brand of levothyroxine are you currently taking
You might need very small reduction in levothyroxine after next test (assuming you get 5mcg T3 dose increase)
Very small levothyroxine reduction ….eg taking 75mcg once week and 100mcg 6 days a week ……just a 25mcg reduction per week ….retest 6-8 weeks later
Essential to test vitamin D, folate, ferritin and B12 at least once a year
What vitamin supplements are you currently taking
GP will only look at low TSH and likely want to reduce dose
You don’t have to do so
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
Comprehensive list of references for needing LOW TSH on levothyroxine
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