guidance please about raised level T4 blood result.

[levogirl]

Hi, I would appreciate some guidance please - my GP has said i need to reduce my levothyroxine because my T4 is 23 GP said it should be below 22. TSH is 0.82. I take 87.5 mcg most days, then 93.75 about 12 days of the month. This has kept me quite balanced for some time, but every now and again I have to tweak it. I have done this myself, as the GP usually suggest larger adjustments which don’t suit me. I made a mistake this time, however and went without the extra 6.25 five times in succession. I have ended up feeling exhausted, drained and legs like lead. Amazing what a difference that extra small amount makes! GP had told me to cut out six of the 12 extra doses, but I did it all in one go! I realise now that I should have done it spaced out over the month. Can you interpret my readings please? How much should I be reducing by to get the T4 back in balance? I am currently now back on my original dosing in the hope that I will feel better after a while.

Many thanks in advance – I would really appreciate some guidanc. 🙏

[Jaydee1507 Administrator]

Welcome to the group. If you could complete your profile it helps members understand your thyroid journey. Click on your image icon to start.

So the most important thing here is to find out when you last took your Levo before the test. We recommend taking last levo the day before if you take it in the morning, leaving 24 hours before the test. If you took it just before your test you will literally be measuring what you have just taken and your FT4 nuber will be higher than it should be. The idea is to test the stable blood level of T4.

The day of the blood test take Levo after the blood draw.

It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

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...

Do you know if you had positive thyroid antibodies? Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.

[levogirl in reply to Jaydee1507]

Hi Jaydee, Yes, I have done all that you suggested including sticking to the same brand. Yes, I have Hashimoto's and I am on a 99% gluten free diet but I do drink milk, to help with my acid reflux. When I last had my D3 tested, it showed insufficient. I struggle with both tablets and liquid supplements as I have digestive problems and everything I've tried so far gives me acid reflux. Does insufficient vit D cause an absorption problem with Levothyroxine? Not sure if I have been tested for the other minerals you mentioned. Thank you so much for replying. I appreciate it.

[Jaydee1507 Administrator in reply to levogirl]

For a proper assessment you need: TSH, FT4 & FT3 plus ferritin, folate, B12 & D3 tested. If you are deficient or low in any of these your thyroid hormone will not be working well. See link above for private tests available.

Reflux is usually due to too little stomach acid and under replacement/low FT3/low vitamin levels. If you would like to move forward then do get the blood tests and post results when you get them.

Insufficient vitamin D does not cause any issues with absorption or levo but it won't work as well as it should do plus of course the detrimental side effects of vitamin D deficiency.

Symptoms of vitamin D deficiency may include:

Fatigue

Not sleeping well

Bone pain or achiness

Depression or feelings of sadness

Hair loss

Muscle weakness

Loss of appetite

Getting sick more easily

Pale skin

Link to a post by SeaSideSusie on Vit D supplementing: healthunlocked.com/thyroidu...

[SeasideSusie Remembering]

levogirl

When did you take your last dose of Levo before the test? Last dose should be 24 hours before test to avoid a false high or false low FT4 level.

Do you take a B Complex or any supplement containing biotin? If so did you leave it off for 3-7 days before the test to avoid any false results?

Are you in the UK?

Taking a month as 30 days, you taking 93.75 x 12 days and 87.5 x 18 days this gives 2,700mcg Levo every 30 days, averaging 90mcg daily.

What dose Levo tablets are you prescribed? Can you cut your tablets so that you get nearer to the 90mcg daily, it might be better if you can take as close to the same amount every day.

[levogirl in reply to SeasideSusie]

thanks for your reply, Susie. I couldn’t find it for awhile! Yes, I did leave 24 hours and no I don’t take B vitamins. I will think about trying to take the average dose every day. Thank you.

[SeasideSusie Remembering in reply to levogirl]

Did you not get an email notifying you of the reply with a direct link? There should also be a yellow dot beside the Alert icon (bell) at the top of the forum page notifying you of replies and clicking on that takes you direct to a reply.

[levogirl in reply to SeasideSusie]

I am not very techy! I never noticed email replies before, but saw one today. I can see the bell, and a number 1 beside it, but no yellow dot. Thank you for letting me know about these things.