Medication review

[Catlady125]

i had a thyroidectomy many years ago and my dr has not been doing my blood tests regularly, my last blood test results were TSH 0.06 and T4 21.9

I was on 125mg of levothyroxine but after the above blood results it has been increased to 150mg,

i feel with the love TSH my medication should have been reduced not increased, any thoughts??

Thank you

[PurpleNails Administrator]

Doctors almost always lower dose when TSH below range. 

What is range of FT4? it looks good (top part) of most ranges.

FT3 was not tested? So you won’t know how well levo is working.

How do you feel?

Do you have symptoms suggesting under / over replacement? 

[Catlady125 in reply to PurpleNails]

thanks for your reply, I’m very tired atm, the range of T4 is 11.0 to 26.0, I went to the doctors to discuss the increase of thyroxine as I was sure it should have been decreased but the dr said TSH is low so need to increase

[PurpleNails Administrator in reply to Catlady125]

Your FT4 is 21.9 pmol/l (Range 11 - 26) 72.67% which is good for most but FT3 is the active hormone most need this to be good but it can be low even when FT4 good.  

FT3 is converted from the T4 and can be reduced if key nutrients are low for example.

.I recommend you arrange a private test to establish your FT3 level.  

thyroiduk.org/help-and-supp...

There’s many testing options offering different groups of tests, most can be by  finger prick sample, or you can arrange venous draw at home or clinic for additional fee.  

For a complete picture Medichecks advanced thyroid  is good option - which include thyroid funtion including FT3, TPO & TG antibodies. Key nutrients folate, ferritin, B12 & vitamin D. Also include CRP an inflammation marker. 

Test this before making any changes as testing should be when you have been on a unchanged dose for at least 6 weeks. 

Recommend on forum testing if arranged for close to 9 in morning. Fast overnight. Delay dose until after draw. Cease supplements containing biotin 3 days prior. Biotin can interfere with test.

If FT3 is good you might want to leave on current dose, if it’s poor & nutrients are poor you can prioritise improving nutrients. 

Do you always get same brand, this can sometimes be changed especially around dose changes. 

[SlowDragon Administrator in reply to Catlady125]

dr said TSH is low so need to increase

GP incorrect. Most important result is always Ft3 (not tested)

Suggest you stay on 125mcg and get FULL thyroid and vitamin testing before considering changing dose

ALWAYS test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we need good vitamin levels

What vitamin supplements are you taking

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£32 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

Only do private testing early Monday or Tuesday morning. 

[SeasideSusie Remembering in reply to Catlady125]

Catlady125

the dr said TSH is low so need to increase

And that shows that your GP is totally ignorant of how to treat hypothyroidism.

Hypothyroidism is when TSH is high and FT4 is low. TSH is a signal from the pituitary to the thyroid. The pituitary checks the amount of thyroid hormone the thyroid is producing. If FT4 is low then the pituitary sends the thyroid a message to make more hormone, that signal is TSH and it will be high. When the pituitary is satisfied there is enough thyroid hormone there is no need to send the signal so TSH will be low as FT4 is higher in range. Your doctor doesn't seem to understand this.

Your FT4 is 72.67% through range which is a good level so your TSH is low. Absolutely no need to increase your Levo. But it doesn't follow that you need to have your Levo dose reduced because of your current TSH level. Go by how you feel and the FT3 result, FT3 should remain in range.

[Catlady125 in reply to SeasideSusie]

I will arrange for a FT3 test

Thank you

[Hookie01]

Dr shouldn't be going by tsh especially as you no longer have a thyroid!

[tattybogle]

Note for GP:

"GO TO SCHOOL.

Go Directly to School.

DO NOT PASS GO

DO NOT COLLECT £200"

[Bearo]

I would be tempted not to mention to your GP that he is wrong to increase your Levo - if he discovers he’s made a mistake he might lower your dose instead!

I would try to get the increase as a separate tablet, then you don’t have to take it, but can keep it in reserve. You could say you want to take part of your dose at a different time of day as splitting the dose can sometimes raise TSH.

My own dose is a bit high for me - my FT4 went slightly over range and FT3 was high in range - but I just skip a tablet once a week which has brought my frees down - but not enough to raise my suppressed TSH.

If , in the future, a GP wants to lower my dose I have some room for manoeuvre.