In recent months my GP spontaneously started providing liothyronine 60mcg/day. I wasn't about to object!
I have just had a general blood test at the GP. They have asked to see me because they believe I am overmedicated. I strongly suspect the GP has seen the suppressed TSH and panicked.
Results are:
TSH <0.01 [0.35-4.94]
FT4 <5.4 [9.0-19.1]
FT3 4.3 [2.4-6.0]
Given that I had left 22 hours between my last dose and this test, these results seem completely normal to me. In fact, they actually suggest I'm a little undermedicated not overmedicated - the FT3 in particular could do with being nearer the top of the range or even a little over it. But then it would have been, had I been taking my full T3 dose (more like 80mcg than 60mcg/day).
But there's no point me trying to explain this to the GP. (Should GPs actually be allowed to prescribe medication that they clearly don't understand?!)
Could you possibly suggest some references I could present to her to stop her from reducing my prescription?
Thanks!
Written by
Coppernob
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Leaving too long between your last dose and taking the blood gives a false fT3 figure. Taking 80 mcg daily puts you on a supraphysiological dose, you may need this amout but it does carry risks.
You say your full dose is usually 80mcg....that would most likely suppress both TSH and FT4!
Your results are absolutely not "completely normal". Because of the 22 hour dose delay before testing, your results would be lower than ideal
We are advised to have blood tested 12 hours after the last dose of T3. For T4 the gap is 24 hours.
in any case when taking a supraphysiological dose of T3 we monitor principally by clinical evaluation/symptoms and signs, because blood tests were not designed for such doses.
Overdosing is clearly to be avoided.
We aim to take the smallest effective dose not the highest amount we can tolerate
I find it hard to believe that a GP would prescribe 60mcg T3. ...unless this responsibility was passed to him by an endo? Was that discussed?
I need a supraphysiological dose of T3-only to function because I have a form of Thyroid Hormone Resistance. I self medicate. But, we are all different!
Has RTH or anything else been discussed been discussed with an endo as to the reason you may need 80mcg T3
Or, have you done appropriate research into the use of high dose T3.
I expect you know that T3 is a powerful hormone and must be treated with respect and care
I'm sorry, but based on what you offer, I think both you and your GP need to improve your knowledge of T3-ony dosing.
This is a good post. Being new to these thyroid issues it's clear that knowing as much as possible before visiting the GP produces better outcomes. It's also true that GP standards vary considerably. This week I had a second GP meeting as I considered the first to be incorrect. The result was that I got my levo raised and agreement to keep raising until I felt right.
Don't disagree and that's almost what I did; always split doses. But if I'd taken dose closer to test I feared TSH would be even lower (if that's even possible!) and freaked GP out even more (if THAT'S even possible!)
I might just check whether GP has even realised I'm on T3 only! And perhaps ask her to get an endo to reassure her that TSH will inevitably be suppressed on T3 only.
Really don't need this hassle. Would probably be easier just to go back to self medicating and testing.
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