Can someone help please, I have been on 75mcg thyroxine for 8 weeks prior to this recent test, this is the highest dose I’ve been on in the 3 yrs since being medicated.
My test was at 9:45 (that’s the earliest I could get) and I didn’t take any medication or eat/drink before the test. I don’t feel over medicated. I was going to up medication because I still don’t feel well but now I don’t know whats best to do? My tsh is the only thing which has changed, the higher dose never seems to change t4?
my previous results were
TSH 2.1 [0.27-4.5]
T4 15.7 [11.0-23.0]
My vits/Ferratin/folate were low last time I tested but it’s not been that long since I’ve been supplementing most of them so will test them again in a few weeks. I will do this private, is there any things I should do to help the best results for this? Like not eat/take supplements the same day?Thanks so much in advance for all your help!
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Courtney96
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Your TSH is just under range which your GP may not like. If you can possibly persuade them to keep you at that dose with evidence from here it would be good.
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. "
I don’t feel great, maybe better than I did on 50. I just wondered why my tsh could have gone down so quickly but the t4 has stayed the same? Are the t4/t3 numbers looking good to you?
I suppose my symptoms could be down to the vitamins being low. I am taking better you spray for vit D, Spatone, and folate but can’t remember the brand, it’s defo the folate not the folic acid though. What are optimal numbers for these? My vit d is 66, folate 4.4 and ferratin 32.3. Thank you so much!
I would expect to see your FT4 in the upper quarter of the range so 75%+. Its at 40.8%.
FT3 probably around 70% and its at 51.4%
You are converting well.
So thyroid wise you could do with a dose increase but due to low TSH you will have a fight on your hands with your GP.
Likely low vitamin levels are reducing your TSH so getting vitamins right will be key.
Vit D - aim for 100.
Folate- aim for 20. Be sure to be taking 400mcg methylfolate minimum which is whats contained in a good B complex that might be better for you than just a stand alone folate. This B complex is good & 90 days supply. amazon.co.uk/Liposomal-Soft...
Ferritin - aim for 100. This can take many months of eating iron rich food, think chicken livers, pate, red meat a few times a week. Spatone is a very very low dose so diet is important.
great thank you so much, I really do appreciate your advice it is extremely helpful. One last thing, I have managed to be put down to up my dose even before these results, just because I asked to as I am gaining weight. He agreed so with my results on 75 would it be safe to continue increasing to 100? I’m due a repeat blood test in 6 weeks. Gp is being fairly helpful for a change.
There is a calculation to work out your final dose based on weight. Its really not precise at all but would give you an idea.
weight in kilos x 1.6 = dose
Your actual thyroid hormone numbers are still on the low side but if you increase further that will take your TSH quite low also. Your GP will likely not like that at all and if you did increase from where you are you would have to be very prepared with information to state your case to stay there.
helvella's calculation document and spreadsheet can be can be found by following this link:
helvella - Estimation of Levothyroxine Dosing in Adults
A discussion about the use of formulas to estimate levothyroxine dosing. Includes link to a downloadable spreadsheet which calculates several of these.
i agree..GP won't like TSH below range , but as it's only a little below , try asking them to "let you stay on 75mcg for another 3-6 mths to see how symptoms and TSH are once it's had a longer amount of time to settle in , then retest"
( they will find this idea easier to agree to,, and it is quite likely that the TSH will come back up a bit in time )
The 'lower TSH recommendations for GP's' link that jaydee gave may not help as they all recommend keeping TSH between 0.4/0.5 to 2/2.5 and yours is below 0.4
But this one could re-assure GP (and you )that as long as it is kept over 0.04 , then low TSH does not cause any increased risks to heart and bones to patients on levo , as long as fT4 is in range. 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-.
If GP is insistent on putting your dose back down, try to get them to compromise and only reduce by a tiny amount rather than go back to 50mcg :
, eg 6 days 75/ 1 day 50 (500mcg / week = 71.5mcg a day)
or 5 days 75/ 2 days 50 ( 475 mcg/ week = 68mcg a day)
or half way between , by prescribing "75/ 50 on alternate days" which gives a dose of 67.5mcg
TSH is not an accurate marker. It is a pituitary, not a thyroid, hormone. It reflects the overall level of thyroid hormone in the serum (FT4 and FT3) but not that of each one....and there lies the problem. T3 is the most important lab followed by FT4
T3 is the active thyroid hormone and almost every cell in the body requires an adequate and constant supply
Low cellular T3 = poor health
If you wish private testing...
The cheapest basic test including FT3 can be found here...
You need to read the OP remarks below the first post. The post only contains her old results. She forgot to add the new ones so she put them in a comment below. And they include the T3.
your TSH would probably have been a little higher if you had managed to get blood taken before 9a.m, as it can drop after this time. You could try explaining that to your GP or asking for another, earlier blood test, while you trial a dose increase?
yes I did think this could have been the problem, I have a private test ready to use just trying to up my vits and Ferratin to get a better picture of everything and will then do this at 9am. Thanks so much for your advice!
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