I would be very grateful if any of you lovely people can give me some advice. I have received a text from my GP surgery to book my annual medication review appointment, I can stretch this out for about 5/6 weeks if I need to.
I was started on 50 mcg of Levothyroxine in December 2022 and had it increased to 75 mcg in March 2023 by a very stroppy begrudging GP. Since the increase I can say I feel so much better in myself and happy to continue like this, weight and hair still not great but work in progress.
My problem is I recently had a Medicheck test and my TSH was 0.047 (0.27 - 4.2) so when I have my review I expect the blood test will be a similar result. I am assuming that the GP will use this to reduce my dose.
I was wondering if I should try 75mcg for 5 days and 50 mcg for 2 days a week in an attempt to raise my TSH to appease the GP and try to avoid a reduction in dose.
Latest results at top of post (blood taken at 9 am no Levothyroxine for 24 hours and no Biotin for 7+ days). I am now back on Thorne Basic C Complex (missed a couple of weeks before test) and Vitamin D + K2 spray.
I appreciate any responses you may have, thank you.
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Karen234
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Your free numbers are still on the low side and your FT3 not above 50% even. Despite your TSH being what it is you probably need more Levo.
You could always accept responsibility for your low TSH as per NICE guidelines.
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. "
Regarding your folate, you are deficient. You could ask GP to retest having shown them this result and they may prescribe 5mg folic acid. You could also buy a separate 400mcg methylfolate and add that to the B complex daily.
I can't see that you posted these results at the time you received them.
Do you realise that your high in range CRP shows some inflammation and this will have affected your ferritin result as ferritin rises with inflammation?
Also, your folate is below range. Even though you take Thorne Basic B and left if off for two weeks (not needed, 3 days would have been enough with a B Complex containing just 400mcg methylfolate), that wouldn't have made your folate level drop dramatically so it looks like you either need to discuss your folate result with your GP as it's quite close to deficiency, or you need to consider supplementing with methylfolate as well as B Complex for a while to get your folate level up to at least half way through range.
Hi SeasideSusie, thank you so much for responding. These results are quite recent (5th of June).
I have always had a high ferritin results, the GP now takes the tack that "your ferritin is high but that's usual for you" 🙄.
I didn't mean to stop taking the B Complex for 2 weeks but I went on holiday and forgot to pack them, when I got home I had a blood test booked for the week after, I am now taking them religiously every day. I will look at adding methylfolate to my daily dose.
The high CRP could be due to an infection I probably have, I need to bite the bullet and speak to the GP.
Ah yes, the infection would cause the high CRP (I realise now it's over range, I was thinking of my usual range of <5 but I can see yours is <3) so would cause ferritin to show higher than normal.
TSH was 1.1 [0.2 -4] after 3 mths on 50mcg , (GP test)
now 0.04 0.27 -4.2] after 3 mths on 75cmg. (medichecks)
it's impossible to know how much TSH might rise if you reduced dose to 5 days 75 / 2 days 50.
and you'd need to do it for a few weeks at least.
but my gut feeling is that such a small reduction for just 4/5 weeks is not going to be enough to get TSH back into range anyway .
i don't think it's a good idea to try and 'massage' your results at this point in the journey ... it will make things very messy , knock you off course from feeling better , and you have no way of predicting what numbers you'll get.
maybe better to test properly on 75mcg and just have the argument ( you'll have to have it at som point anyway) .... use the evidence in here : healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk
Be clear how much better you are able to function on 75mcg .
GP will probably want a reduction anyway and may well refuse to continue prescribing 75mcg /day , in which case compromise , and offer to try 62.5mcg /day (75 / 50 alternate days ) for 6/8 weeks .... but don't agree to go back to 50mcg.
that way , GP will have have record that 75mcg makes you feel well with TSH 0.04 and fT4 in range .
and if you feel less well after 6-8 weeks on 62.5 mcg ..then you have a much stronger argument to have it put back up to 75mcg.. and you can back it up with strong evidence that 0.04 isn't a significant problem anyway.
(if you did want to lower dose to try to raise TSH just for this current GP test to keep prescription at 75mcg ,and then put it back after you would probably have to lower it by much more that you are thinking of , and since TSH is still likely to take a few weeks to move .. so still end up feeling pants for quite a few weeks anyway ... so you might as well do the experiment WITH the GP , that way your are building evidence for the fight , rather than clouding the picture)
In the 3-5 days before blood test, when you stop vitamin B complex, you probably want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)
I am in a very similar position. GP wants annual thyroid test. My TSH is 0.01 or 0.02. 0r it has been for the last two years.
Two years ago I was slightly over medicated on 100mcg Levo and I started to lose weight. That was my only symptom of being over medicated. My FT4 was slightly over range and FT3 high in range. On the advice of people here I reduced my dose to 84mcg by skipping one tablet per week. This brought my frees down to 60% and 50% (using MMH. ) My TSH was still low but I got away with the GP blood test because the GP was going to retest and include FT4 (with a view to a dose reduction if my FT4 was high - which I knew it wasn’t ) but she never did get around to the retest.
I couldn’t decide what to do this year. I haven’t put any weight back on and I’ve had to replace most of my clothes as I’ve dropped a size. I feel well but I’ve never been very symptomatic.
I’ve decided to skip 2x100 per week for six weeks to reduce my dose to 71 for the annual test to see if my TSH will come up off the floor. (I think it was 0.9 when I was last on 75mcg. ) I’ll get a private test to see where my frees are, but I suspect they’ll be too low on 71. If the GP is happy, then I can either put my dose back up to 84 or I may choose to stay at 71.
If my TSH doesn’t move then I’m sure I’ll be told to lower my dose - which the GP thinks is 100 every day. So I could negotiate alternating 100 and 75 - which will be similar to my dose of 6x100 = 85.
I know messing about with dosing like this wouldn’t be tolerated by many on this forum who are very sensitive to dose, and it may backfire on me in some way.
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Annual NHS Blood Test
GP review - low TSH on NDT
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new test results and dose review advice.
Can I push for an increase in medication.
