Hi, I wonder if SeasideSusie would mind commenting on my post. My bloods were taken on March 3rd. The GP didn’t want to do antibodies, or vitamins apart from B12. He wants to lower my dosage which is still alternate 125mcg and 100mcg because of the low tsh and says the ft4 is too high in the range. In the past I’ve been told I can stay on the same dose as I feel fine but this is a different GP. I said that as I felt ok on the current dose I didn’t want to change it. He knows that I have posted on this group for advice in the past and wants me to write a letter to him/ GP practice stating reasons not to change dosage which seems extraordinary.
Results (don’t know how to scan the results to the post so they’re written),
Serum free T4 - 15.9 pmol/L (9.1- 17.6)
Serum TSH - 0.10 mu/L (0.35- 4.9)
Serum free T3- 3.9 pmol/L (2.4- 6.0)
Ferritin 86ng/ml (5- 204)
Folate 5.3 ng/ml (3.1- 20)
B12 493ng/L (187-883)
Can you tell the percentages through the ranges please as I don’t know how to work them out being a bit dim!
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Jphill49
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So your percentages are (no need for a percentage for TSH)
Serum free T4 - 15.9 pmol/L (9.1- 17.6) = 80%
Serum free T3- 3.9 pmol/L (2.4- 6.0) = 41.67%
He wants to lower my dosage which is still alternate 125mcg and 100mcg because of the low tsh and says the ft4 is too high in the range.
Oh, what a load of tosh! A range is a range and if you are within the range you're "in range" so what's the point of having a range if you're going to ignore it, too high in range my eye! 80% tjrough range is a good place to be on Levo only. But your FT3 is only 41.67% and this suggests poor conversion of T4 to T3.
Poor conversion can be due to less than optimal nutrient levels.
Ferritin 86ng/ml (5- 204)
Your ferritin appears to be pretty good, some experts say the optimal ferritin level for thyroid function is 90-110ug/L and you're getting close to that. However, ferritin can be falsely raised when inflammation is present so it's always a good idea to have an inflammation marker tested (eg CRP).
Folate 5.3 ng/ml (3.1- 20)
Folate is very low in range, it's recommended to be at least half way through range so that would be 11.5 plus with that range.
B12 493ng/L (187-883)
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
So B12 could be a lot better as well as Folate.
Do you take B Complex? If not I would suggest you start supplementing with a good quality, bioavailable one containing methylcobalamin and methylfolate. Consider Thorne Basic B or Vitablossom Liposomal B Complex (also rebranded as Yipmai for Amazon):
I would certainly not lower my dose of Levo on those results. You should point out that your FT4 is well within range and as for your TSH there is evidence that there is no problem with a low TSH as long as FT3 is within range. In fact 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
You can obtain a copy of the article which contains this quote from ThyroidUK
Email : tukadmin@thyroiduk.org
and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.
There is no need to repeat antibody testing. That result confirms autoimmune thyroid disease (Hashimoto's), once it's been confirmed repeat testing isn't necessary. Even if tested and level came back low you'd still have Hashi's, antibodies fluctuate and each test could show a different level but Hashi's doesn't go away. Hashi's isn't treated, it's the resulting hypothyroidism that's treated.
Thank you so much for your reply and advice. I hope the GP will take note and not dig his heels in over the dosage, haven’t had to deal with this attitude before and it’s stressful! But they all stress the importance of the tsh result as being the only one they are interested in! I I’ve requested the article by Dr Toft to print out and show the doctor.Re the poor conversion, could that be due to being gluten and dairy free and not eating a good enough diet? I’m not taking Vitamin B supplement so will order that. Thanks again.
Important to have OPTIMAL vitamin levels for good conversion of Ft4 to Ft3
Currently your Ft3 (active hormone) is already low and reducing levothyroxine (Ft4) will reduce Ft3 further
Ft4 is NOT over range
Most important result is always Ft3…..which likely needs improving
Getting all four vitamins optimal may help improve Ft3
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
In a study evaluating tissue function tests before total thyroidectomy and at 1 year postoperatively when using LT4, it was found that peripheral tissue function tests indicated mild hyperthyroidism at TSH <0.03 mU/L and mild hypothyroidism at TSH 0.3 to 5.0 mU/L; the tissues were closest to euthyroidism at TSH 0.03 to 0.3 mU/L [48]. A normal serum TSH level consequently does not necessarily indicate a euthyroid state at the tissue level.
The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:
Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis
February 2020 Journal of Clinical and Translational Endocrinology 19:100219
DOI: 10.1016/j.jcte.2020.100219
LicenseCC BY-NC-ND 4.0
Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich
The only supplements I take are vitamin D, magnesium and vitamin K2. The GP only wanted to test B12 and said not necessary to do vitamin D again as it was done last time. And he wasn’t going to change his mind.. Thanks for the links, but I can see how he could pick out the parts which he could use to back his opinions up and not see the relevant issues to my case re the unimportance of low Tsh. etc. even with Dr Toft’s article.
as your TSH is 0.1 you will find the studies in this post..... healthunlocked.com/thyroidu.... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-as-long-as-ft4-and-ft3-are-in-range-.
........very useful when writing to your doctor , particularly the first one that shows TSH 0.04 - 0.4 had no greater risks than TSH 0.4 - 4 did.
Give them the reference to that first study ask them to read it , point out that the study formed part of the evidence base for the references to risks of low TSH / overtreatment in the current N.I.C.E guideline for Thyroid Disease Assessment and Management (so NHS do accept it as good quality evidence) and point out that your fT4 is well within range .
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