My dad went to see a private endo at start of September. He increased his Levo from 100mcg to 100/125 on alternative days. His most recent bloods have shown that his TSH has reduced from 0.9 to 0.34 but his T4 hasn't changed it's actually gone done slightly from 16 to 15.3.
He's also on 5mg folic acid and b12 injections every 12 weeks. He also prescribed him some B Vitamins and Vitamin D.
I'd like to suggest to the endo that we switch to Thorne B Basic B Vitamins.
But with regards to the Thyroid - what do you think is happening here and how can we increase T4 without lowering TSH?
Is this where T3 comes in?
Any advice would be much appreciated!!
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Needleandthread44
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* Last dose of Levo 24 hours before test to avoid a false high or false low FT4 result
* No biotin, B Complex or any supplement containing biotin for 3-7 days before test
His results are so similar that the small differences could be put down to natural fluctuation. No levels are static, plus testing at different times makes a difference.
If Levo is increased to achieve a higher FT4 level then TSH will very likely go down but it's not the TSH that matters, it's not a thyroid hormone, it's a pituitary hormone that's useful for diagnosis but doesn't have much use once diagnosed and treated. The pituitary checks to see if there is enough thyroid hormone, if there isn't it will send a signal (TSH) for the thyroid to make some, if there is enough then no signal is sent and TSH stays low. Doctors are wrongly taught to dose by TSH when really they should be looking at FT4 and more importantly FT3.
Dr 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
Is this where T3 comes in?
If you mean taking T3 (liothyronine) then this will reduce TSH even more, it's just what it does. It also tends to reduce FT4 level.
The Medichecks results from August show FT3 at 37.03% through range with FT4 at 36% through range so they're well balanced and not showing poor conversion. Your dad seems to be doing OK on Levo, just not a high enough dose at the moment if he's still symptomatic.
Thank you so much! I wrongly assumed that too low a TSH would result in going hyperthyroid. Ooops. Perhaps his doc will suggest increasing his Levo, but I think as pointed out by SlowDragon below that he will need his Ft3 result before making a decision.
We didn't re-test through medi-checks as endo said he would do it today at the appointment. Those are just his repeat tests through his GP.
Endo said he likes Ft4 to be closer to 20, but if like you said his Ft3 has increased, does that mean Ft4 would be ok at that level? I know much of it is down to how he is feeling. He did say he was feeling a good bit better but then came down with Flu so difficult to know.
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