Hi everyone.
It appears that I have been over medicated with Levothyroxine for years and now pre Hyper
TSH 0.038
FT4 18.4
FT3 4.3
Calculator =
TSH -5.9%
FT4 64%
FT3 32.43%
My Gp is not aware of the blood test timings re not to take meds for 24 hrs prior to a blood test.
I know this is often said here but can anyone advise where I can obtain this within a document so I can show him.
Many thanks
Can you supply the ranges for your blood test results, as these can vary between laboratories. Are you experiencing any symptoms of being over medicated Haddockfishface, or just concerned about a lower TSH reading? As long as FT3/ FT4 are within range (and you feel well on your current dose), I wouldn’t be worried at a lower TSH (although some less knowledgeable GPS might have alarm bells ringing as TSH is a common marker). It is impossible to be pre- hyper when you have hypothyroidism. You may show ‘hyper like’ symptoms however if over medicated.
How do you feel?
I'm not sure that the spacing of Levo before blood test is written down but it is a patient to patient tip which likely GPs won't be aware of, like many things that help us get well.
You certainly don't look over replaced to me. Just because your TSH is low doesn't mean you are taking too much Levo. Both your FT4 & FT3 are below 50% so you really need a dose increase.
What may well be keeping your TSH low are low vitamin levels.
When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...
Haddockfishface
now pre Hyper
It is not possible to be hyper when you have a diagnosis of hypothyroidism and take thyroid hormone replacement. Your thyroid can't regenerate and start producing excess thyroid hormone but you can be overmedicated. If your GP says you're hyper then maybe you can educate him.
My GP is not aware of the blood test timings re not to take meds for 24 hrs prior to a blood test.
The timing of Levo before a blood test only affects FT4 result, it doesn't affect TSH, it's the time test is done that affects TSH as TSH is highest early morning and lowers throughout the day. Explain to your GP that your thyroid hormones are well within range (show him the percentage through range) so you can't possibly be overmedicated. TSH is a pituitary hormone not a thyroid hormone .
Previous post 5 months ago
healthunlocked.com/thyroidu...
As per this previous post
Your results show poor conversion
Likely low vitamin levels
ESSENTIAL to test and maintain GOOD vitamin levels
Please add most recent vitamin results
Hello HFF - sorry, but I can't refer to you as the name used :
Can you see another doctor as I think this doctor is only looking at the TSH and jumping to the wrong conclusion :
There is no need to work out a % for a TSH - once on any form of thyroid hormone replacement the TSH is the least important of the blood test results, but understand that in medical school the training seems to be centred around this very unreliable reading.
Once on any form of thyroid hormone replacement you must be dosed and monitored on your Free T3 and Free T4 readings and generally speaking we feel at our best when our T4 is in the top quadrant of its range as this should produce a decent level of T3 at around 1/4 ratio T3/T4.
So you have worked out the percentages so presume you have the ranges for the T3 and T4 and can see for yourself that you are range - so neither heading hyper nor hypo BUT showing poor conversion of T4 into T3.
The accepted ratio conversion if on T4 monotherapy is said to be - 1 / 3.50 - 4.50 T3 / T4 :
With most people people feeling best when they come in this ratio at 4 or under.
So if we divide your T4 - 18.40 by your T3 4.30 we get 4.28 showing your conversion slightly wider than where most people feel at their best:
How are you feeling ?
Do you have any readings there for ferritin, folate, B12 and vitamin D as I understand these need to be up and maintained at optimal for any thyroid hormone replacement to work well.
I know now I need my ferritin up at around 100 : folate around 20 : active B12 75++ ( serum B12 500++ ) and vitamin D at around 100.
can I just say your penname is 👌🏻 I have massively enjoyed watching people sincerely address you as HaddockFishFace 😂❤️❤️❤️❤️
🤣
😆🤣Thank you for the reply. I find it funny as well. Always good to make people smile.
It was said by Dr. Wheat-something during cross examination at a hearing of the late Dr. Skinner. He was only talking about T4. He admitted (under duress I believe) that taking T4 less than (cannot remember exact words but could be) 12 - 24 hours can make up to 15% difference in the test result. Sorry I cannot be more helpful but Thyroid UK may have a transcript on their files.
Thank you Lillian15 That is most helpful. 🌺
HaddockFF.....for evidence relating to timing of last dose levo on fT4 results ... see 2nd reply to this post:
healthunlocked.com/thyroidu... suggested-thyroid-hormone-test-timing-protocols
Also this page put together by helvella helvella.blogspot.com/p/hel... helvella-scheduling-blood-draws.
Thank you🙂
Hello Haddockfishface, I recently watched Part 1 of a webinar on the Thyroid Trust site. An Endocrinologist, Simon Pearce, makes this point. Perhaps this will help. Your results are very similar to mine. The GP says I must be retested in 6 weeks and if still “high” she’ll make me reduce my Levo. I know that will increase my fatigue. So a battle ahead for both of us. Good luck.
HaddockFF and Kazania .. 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-.
this post has a paper which be useful to show no long term increased risks for heart / bone fractures as long as TSH is 0.04 or above on Levo .
Also has a paper that is useful to show no increase in bone loss when TSH is supressed long term on levo .
plus links to some other useful posts discussing long term low/ supressed TSH ~ Risks vs Quality of life .
😄👍 thank you so much.
Kazania
If your Ft3 is not over range you’re not over medicated
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. "
LEVO DOSE SHOULD NOT BE DETERMINED BY TSH
Diogenes/Toft paper:
bmcendocrdisord.biomedcentr...
healthunlocked.com/thyroidu...
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
LlINK TO PAPER:
ncbi.nlm.nih.gov/pubmed/320...
sciencedirect.com/science/a...
And quote by Professor Antony Toft
healthunlocked.com/thyroidu...
from PULSE magazine for GP's... The article is available from ThyroidUK
If you want a copy of the article then email tukadmin@thyroidUK.org
and ask for a copy of the Dr Toft article in Pulse magazine. The quote is in answer to question 6.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine:
"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)."
wow! Slowdragon. Thank you so much for all that information. So helpful, especially at the moment when trying to concentrate on complex subjects just makes my head hurt and grind to a halt. 😃👍
In a similar situation here. Will get results on Wednesday. Would be interested to know how you get on
Recent blood test after t3 was stopped. 
NHS not testing blood correctly
Interpret thyroid blood tests
Early morning blood test 
Most recent blood test 
