am I over medicated

[Megymoo]

just had results back from Thriva and the note from the doctor saying that my TSH is to low

[Regenallotment Ambassador]

your FT3 results would tell you for sure, was FT3 tested?

You are at the top end of the FT4 range.

How do you feel?

What dose are you on?

Did you take Levo the morning of the test?

Did you have a supplement containing biotin in the days leading up to the test?

What time of day was the test taken?

🌱

[Megymoo in reply to Regenallotment]

I feel ok I was on 75 levothyroxine but I wasn’t feeling well so my doctor put it up to 100 and I felt better. I did take the test first thing in the morning and do not take any supplements

[SlowDragon Administrator in reply to Megymoo]

How long since you increased dose levothyroxine to 100mcg

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Did you test TSH, Ft4 and Ft3?

So next step is to get vitamin D, folate, ferritin and B12 levels tested

Ask GP to run vitamin tests for you

[SlowDragon Administrator]

it’s ESSENTIAL to test vitamin D, folate, ferritin and B12 at least once a year

Thousands of members test privately

Looking at previous posts you were going to get these tested

Aching legs often low vitamin D

Government recommends everyone supplements vitamin D at least Oct to April minimum

Dizziness often low B12

Low B12 is much more common as we get older

What vitamin supplements are you currently taking

[DippyDame]

Without both FT4 and FT3 labs it's almost impossible to say

FT3 is the active thyroid hormone and generally speaking if that remains within range one is not overmedicated....we don't have your FT3 lab!

FT3 is the most important reading followed by FT4

If cellular T3 is low health suffers

TSH is a pituitary, not a thyroid, hormone....it is not a reliable marker

thyroidpatients.ca/2021/07/...

TSH reflects the overall level of both hormones ( FT4 + FT3) but it does not reflect the individual levels...and here the problem lies.

Your FT4 is high which has lowered your TSH....but that is only half of the story.....

Lack of knowledge causes medics to misdiagnose at this point because they have been wrongly trained to believe TSH is the gold standard test

Your TSH is low because the pituitary gland has sensed the high FT4 and has sent a low TSH signal to the thyroid gland to slow hormone production.....but it doesn't signal which hormone that is

That can be wrongly interpreted as overmedication.....but there may be othercreasons for the high FT4. Poor T4 to T3 conversion is a common reason

I wouldn't be surprised if your FT3 is low indicating that your T4 to T3 conversion is poor.

You say you felt a little better after increasing from 75mcg levo,to 100mcg....this is most likely because that extra 25mcg generated some of the extra T3 you need

To support conversion optimise vit D, vit B12, folate and ferritin

I'd suggest you test both FT4 and FT3 ( with TSH) before any decision about dosing is made

Test before 9am and after 6/8 weeks on a steady dose of hormone

Good luck!

[Megymoo in reply to DippyDame]

these are the rest if the results

Ok

[Regenallotment Ambassador in reply to Megymoo]

These are different to the first results you posted. fT4 is over range in these and under range in the first.

Were they done at different times?

Had you taken your daily Levo dose before the test?

[Megymoo in reply to Regenallotment]

The results were taken two weeks apart as the lab didn’t have enough blood for the TSH results

[Regenallotment Ambassador in reply to Megymoo]

Had you taken your Levo dose on the morning of the tests? ie. Levo on waking and test that morning? This could be the reason for high T4 results

[DippyDame]

What dose of levo were you taking at the time of the above ( copied) test

FT4 = 25.7 (12 - 22) ... 137% through ref range

FT3. = 4.5 (3.1 - 6.8).....38.84% ditto

Your FT4 was clearly far too high here....but I doubt your current dose would cause this so....

Those labs suggest poor T4 to T3 conversion ( high FT4 with low FT3)

It looks as if you may benefit from a little T3....it took a excessive dose of T4 to provide more T3 to make you feel ok

These labs are different to those in your original post which you say are current when..

FT4 is 21.1 (12-22)

Has your dose been reduced here?

What does show is that your antibodies are high suggesting thyroid autoimmune disease aka Hashimoto's... a common cause of hypothyroidism

This may partially account for your high FT4 result

Hashi's can cause your hormone level to fluctuate.

A gluten free diet helps.

It's a bit difficult to untangle your post but I think you might benefit from a visit to an endocrinologist with a view to having T3 added to your levo

[tattybogle]

Hi Megymoo ... had you been taking the increased dose of 100mcg for at least 6 weeks when you has had these tests done ??

if not..... let us know what you were taking for 6 weeks before them .

assuming you were . carry on reading .... if not ignore the rest .

it is not ideal to look at TSH / fT4/ 3 taken on different occasions , but i can see why that is what you have got.

They show a high level of fT4 , with a 'low but not suppressed' TSH.

Your GP may wish to reduce the dose again based on these results.

Assuming tests were done 24 hrs from last dose levo ? ....... it might be worth offering to try a very slight reduction for a couple of months to see how it feels .... ( not back to 75mcg which the GP may suggest .. as you already know that didn't feel great.)

~ eg. halfway back to 87.5mcg . (prescribed as 75mcg / 100mcg alternating daily)

~ or even smaller reduction than that , eg 100mcg 5 days /75mcg 2 days each week. (effective daily dose 92mcg)

You may find this is enough to get fT4 back into range , without leaving you feeling any less well.

There may be reasons to try and avoid a permanently high fT4 level IF YOU CAN DO SO AND STILL FEEL WELL . ( recent research shows T4 from the thyroid and/ or from Levo has an association with a receptor associated with proliferation in some kinds of cancer cells , the higher the T4 level the more association ..it's not clear yet how big an issue this is , but see posts by jimh111 if you want mare details healthunlocked.com/thyroidu... healthunlocked.com/thyroidu... )

Then, if you give a slightly lowered dose of Levo a proper try for a couple of months (the first 4/5 weeks may not feel so good , but give it time) ... and it doesn't feel as good as you do now .. then you have more ammunition to either insist on staying on 100mcg despite the highish T4, or if you prefer , push for a referral to an endo about getting a trial of adding some T3 .

Your GP will probably go on about the "low TSH increasing risks to your heart and bones" ,, but actually this is not relevant until TSH is below 0.04 , so your 0.06 is actually 'fine' from that point of view . Ask your GP to read these two papers if he says 0.06 will cause heart/ bone problems:

This one shows long term low TSH did not increase bone loss healthunlocked.com/thyroidu... longterm-subclinical-hyperthyroidism-does-not-affect-bone-density-in-patients-having-

This one showed TSH 0.04 -0.4 had no more risks than TSH in range did,, (they did increase once it was below 0.03) academic.oup.com/jcem/artic... Serum Thyroid-Stimulating Hormone Concentration and Morbidity from Cardiovascular Disease and Fractures in Patients on Long-Term Thyroxine Therapy

[jrbarnes]

If you were on 75 mcg I would have only done a small increase like 12.5 or 13mcg per day. I'm a petite woman and took only 88mcg. Age, height and weight can affect how much thyroid hormone you need. 75mcg to 100mcg is quite a big jump.

[Brightness14 in reply to jrbarnes]

Interestingly I have quite recently read about dosing ref. BMI. These latest findings suggest that people with a high BMI are being overtreated and the patients with low BMI are being undertreated. I am 5ft 8 inches tall and weigh 63 kilos BMI 21.5 so slim but not thin and never fat. These findings are suppose to be more accurate.

[helvella Administrator in reply to Brightness14]

You might find my page on this issue of interest. There is a link onward to a spreadsheet which calculates levothyroxine dosage according to several different formulas.

helvella - Estimation of Levothyroxine Dosing in Adults

helvella.blogspot.com/p/hel...

jrbarnes Brightness14

[Brightness14 in reply to helvella]

Thank you I will take look.

[jrbarnes in reply to helvella]

Thank you. That is helpful

[Brightness14 in reply to helvella]

I have looked at your blog and agree with what you are saying. People and Doctors should aim to make patients feel well. Starting at to high a dose is bad, also starting low and not increasing fast enough is bad.

[Batty1 in reply to Brightness14]

I have high BMI and I promise you Im way far away from being over treated

[jrbarnes in reply to Brightness14]

I'm just under 5'1 and slim all my life up until last March when I had to eat more and put on an extra 11kg. Suddenly my FT4 levels dropped from 80% to 20% in range. Weight definitely is a factor in dosing.

[Brightness14]

Everyone is different one size never fits all. It is not written in stone, only that I have read about this new dosing twice recently. It may explain why after my Thyroidectomy and receiving Levo for the first time. In eight months I was only on 100cmg instead of 112.5

that's nearly one month short on treatment. I never felt well and bought NDT which I have been taking for seven years.