advice please

[CAK1]

my TSH LEVEL has been well below normal range for past 5 years I now realise sering results on NHS APP

Aug 22 TSH 0.06 T4 22.3 & now told my peripheral neuropathy could be linked to this. It started last month

Was told to reduce dose from 112 (taking the 25 alternate days)to 100

Seeing dr today

What should I be asking?

I have never been told the protocol for early morning testing etc though have been on thyroxine for 20 years & only once told to up dose years ago and then 2020 told to reduce

[SlowDragon Administrator]

Request GP test vitamin D

Also that they test TSH, Ft4 and Ft3 together before you consider reducing dose levothyroxine

Or if you have already reduced dose …..request full test after 8-10 weeks on reduced dose levothyroxine

Most important result is Ft3 (active hormone)

[SeasideSusie Remembering]

CAK1

B12 deficiency can be a cause of peripheral neuropathy.

Vit D deficiency can be a cause of diabetic peripheral neuropathy.

Worth getting the following checked

Vit D

B12

Folate

Ferritin

Can you add the reference ranges for your results, these vary from lab to lab and they should show on your NHS app with your results.

Doctors are unaware that time of day affects TSH, that certain foods and drink can affect TSH, that timing of last dose of Levo affects FT4 result, etc.

[CAK1 in reply to SeasideSusie]

thank you

TSH RANGE 0.35-5.0. T4 7.0-20.0

[SeasideSusie Remembering in reply to CAK1]

TSH 0.06 (0.35-5)

T4 22.3 (7-20)

So your FT4 is over range and we can see why your dose was reduced.

Did you take your Levo before the test? If so this will account for the over range FT4. We always advise last dose of Levo is 24 hours before to test to avoid a false high or false low FT4 result. Something else your GP wont know or agree with.

However, this is very unlikely to be the cause of your peripheral neuropathy, other replies have given the likely explanation for this so perhaps your GP can look into this.

What you do need is FT3 tested at the same time as TSH and FT4 to see how well you convert T4 to T3. If your FT3 is low with a high FT4 this shows poor conversion. Low nutrient levels affect conversion so it would be a good idea to tet

Vit D

B12

Folate

Ferritin

so perhaps your GP would be willing to do these tests. Come back with results and ranges for us to help further.

[humanbean]

Vitamin B6 deficiency can cause symptoms of peripheral neuropathy, and so can vitamin B6 toxicity.

Deficiency : en.wikipedia.org/wiki/Vitam...

Toxicity : en.wikipedia.org/wiki/Megav...

[Jazzw]

Aug 22 TSH 0.06 T4 22.3 & now told my peripheral neuropathy could be linked to this. It started last month

That’s actually quite unlikely. Peripheral neuropathy isn’t generally caused by slight over medication of thyroid hormones (and it is only slight—the TSH suppression in itself isn’t a worry; what matters more is where your FT3 and FT4 levels are. Your FT4 is only slightly over range and if you took your levothyroxine before the test, that’ll most likely be the reason for it being slightly over-range.

Peripheral neuropathy is far more likely to be due to B12 deficiency, folate deficiency or diabetes.

[CAK1 in reply to Jazzw]

I have just been diagnosed as prediabetic so am on almost no carb diet & also taking RALA as recommended for nerve damage but does it interact with thyroid medication? Have had conflicting views but advised to take the pills 4 hours apart

[Jazzw in reply to CAK1]

I don’t know about interactions but keeping it 4 hours away is probably enough to prevent most of any which might occur.

[CAK1 in reply to Jazzw]

thank you