Blood test following dose change

[Lanvere]

I had a dose change in November from 100mcg levo daily to 100/75mcg alternate days because my tsh was suppressed although my FT4 was 17.5 I've now been retested and this is the result ...doctor refusing to put my dose of levo back to 100mcg because of the suppressed tsh but surely the FT4 is too low and I'm falling asleep at work in the afternoon 😴

[SeasideSusie Remembering]

but surely the FT4 is too low and I'm falling asleep at work in the afternoon

You are correct. Doctor is like most and only dosing by TSH and seemingly ignorant of the fact that it's the thyroid hormones - FT4 and FT3 - that are important once on thyroid hormone replacement and not TSH which is a pituitary hormone and not a thyroid hormone.

I have had this problem and only one medical professional (an advanced nurse practioner not a doctor) understood this. I refuse to reduce my dose of Levo and point out that my FT4/FT3 are in range therefore I am not overmedicated. They don't like it but that's there problem not mine.

You could try using the following information along with a list of your hypothyroid symptoms on the lower dose, also point out that high cholesterol is a symptom of hypothyroidism/under medication:

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 in November 2018 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(Not working as expected?)

You can obtain a copy of the article which contains this quote from ThyroidUK

Email : [e-mail]

and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.

[Lanvere in reply to SeasideSusie]

Thank you ..I have written back saying it needs to be increased and why .. I'll see what she says. Feel so rotten going yo increase it anyway just would be nice to have their support

[tattybogle]

was your TSH 0.04 or above, on 100mcg ?

if so ,you can use this paper on your GP ... it shows the 'risks' on levo for TSH 0.04 to 0.4 were no greater than the risks for TSH 'in range'. healthunlocked.com/thyroidu.... there are other useful papers on that post that show the risks of bone loss with supressed TSH are insignificant as long as fT4 is in range.

i used it on my GP when Blood were out of range .. and he (reluctantly after a bit of a shouting match ) accepted that a lower dose had made me so unwell i couldn't function properly and agreed to put my dose back up . (i had told the phlebotomist i'd be putting it back up myself anyway, regardless of the blood test results)

He has put a note on my file to the effect that i "understand the risks" , to cover his back~ which is fair enough.

Also re. the raised cholesterol results.. this post healthunlocked.com/thyroidu...

see the reference that says

* NOTE this one also clearly states that raised cholesterol is caused by hypothyroidism *

put that under GP's nose too. and ask to try 100mcg again to see if an better fT4 level will improve your cholesterol result. .

[tattybogle in reply to tattybogle]

nhs.uk/conditions/statins/c...

"If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid."