Review tomorrow after starting levo

[sa67]

I started levothyroxine 50mcg 7 weeks ago (see previous posts), and have my review with the GP tomorrow. I felt like things had been moving in the right direction and I was starting to regain a tiny bit of normality (energy at more functional levels if not great, mood and anxiety better, periods have returned, but still headachey, joint aches, light headed), until about a week ago, when strong anxiety and 'tired but wired' feelings kicked in for a couple of days, followed by classic low energy, tearful moods, dizziness, foggy head for the last few days.I had my bloods (TSH and T4) done last week, and was pretty surprised to see I was within normal range now:

TSH 2.13 (0.35-5.5)

FT4 18.8 (10.5-21) 79%

I also did a monitor my health blood test on Tuesday as I wanted to know my T3, and it turned up:

TSH 1.79 (0.27-4.2)

FT4 19.6 (12-22) 76%

FT3 4.7 (3.1-6.8) 43.2% (was 78.4% in Nov)

So it seems my TSH has come down a lot (it was around 8 on my last test), but with some room for movement towards the bottom of range, but my T3 has actually come down since it was last done in November (before I started levothyroxine). Is that common with T3?

I'm hoping to convince the GP that I need to trial an increase, even if it's 50/75 on alternating days for a start, but I'm not feeling optimistic about my chances given how far within range my TSH and T4 are looking, and how difficult it was to get on levo in the first place. I've selected the papers from the low TSH reference list which suggest getting it under 2, but any other tips for getting the GP on side?

[tattybogle]

So as for what else to say to GP.. erm .... that symptoms improved but started to return again, which is common , and trying a dose increase is usual as long as there is room in the TSH / fT4 levels.

and that the dose is still small compared to what many patients end up needing before their symptoms stay consistently improved .

7 weeks is just long enough for TSH to come down in response to the added T4 ....but perhaps not long enough for the pituitary to realise that 50 is not going to be quite enough ...so suggest to GP that as the return of symptoms is quite recent, the TSH (which is a bit of a delayed response) may well start to rise again in the next few weeks (once the pituitary realises this dose is not quite actually quite enough)

so if they absolutely refuse to try an increase now , try to get agreement that you can retest in another month/ 6 weeks.

if they won't agree to increase to 75 ..ask for a slight increase to 50 / 75 alternate days (67.5mcg ). and a retest in 6 -8 weeks

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yes it is common for fT3 to come down .. the reason being that when hypo (before you took levo) the TSH is high (because pituitary senses T4 is lower than your body wants) .

High TSH stimulates the thyroid to :

a) try to make more T4 (because T4 is low)

b) increase the ratio of T3 : T4 that it produces ~sort of a 'boost' function (because T4 is low, there won't be as much T4 available to convert to T3, so a larger proportion of 'ready made' T3 is made by thyroid to make sure the body has access to enough T3 to survive )

When you take levo , the pituitary notices the T4 went up, so it reduces TSH production.... and as a result of the lower TSH level .. the 'boost function get's turned off.

So the thyroid stops making the 'extra' T3

Well that's the theory anyway .

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before you were hypo, your T3 was probably not as high as that 78% level you had in Nov ~ in health , some people have fT3 a little bit lower than fT4 when healthy , some have it a little bit higher than fT4 , in some people both are relatively low , under 40% , and in some both are relatively high 60%+

See below . 10 healthy people's 'usual' fT4 /fT3 / TSH levels as % through range

.

[sa67 in reply to tattybogle]

Thanks tattybogle - this is hugely informative and helpful! The GP was very reluctant to do anything since my bloods looked 'normal' and he was afraid of getting my t4 'too high', but eventually agreed to try 50/75 on alternating days with a retest in 6 to 8 weeks, when he'll also retest my b12 and folate. Feels like a decent result, but also feels like I'll very soon reach the ceiling of what he's willing to do - so really hoping this makes a positive difference.