Recent thyroid bloods-too far the other way?

[Underactiveclare]

Hi. Apologies for my absence from the forum.

I eventually managed to get my go to up my thyroxine to 112.5 from 100 to see if it would make a difference.

Here are my before and after results:

before:

TSH 1.06 (range 0.35-5.5)

Free T3 4.68 (range 2.8-6.5)

Free T4 16.6 (range 11.9-21.6)

after

TSH 0.09 (range 0.3-4.5)

Free T3 5.2 (range 3.1-6.8)

Free T4 20.6 (range 10-22)

Am I right in thinking that the dose is now too high and I’m leaning more towards hyperthyroidism?

Thank you in advance. As always, I really appreciate your time and advice.

[SlowDragon Administrator]

No …not at all

Unless you feel over medicated

FT4: 20.6 pmol/l (Range 12 - 22)

Ft4 is 86.00% through range

FT3: 5.2 pmol/l (Range 3.1 - 6.8)

Ft3 only 56.76% through range

Were both tests done early morning, ideally just before 9am, only water to drink between waking and test and last dose levothyroxine 24 hours before test

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

What vitamin supplements are you taking

Maintaining Optimal vitamin levels can improve conversion rate of Ft4 to Ft3

[Underactiveclare in reply to SlowDragon]

SlowDragon I am so sorry for the delay in my response. Thank you for taking the time to reply to my post.

Both tests were done fasted at 9am with water only and Levo 24 hours before.

I am taking vitamin D, selenium, magnesium, fish oil and get 3 monthly 12 shots.

I believe GP is going to retest me in another 3 months as "Thyroxine replacement may be excessive".

[SlowDragon Administrator in reply to Underactiveclare]

Refuse to reduce dose

Ft3 is only 56% through range

If Levo was reduced you would need T3 prescribed alongside

You might, eventually still need to reduce levothyroxine slightly and add T3

Retest in another 6-9 weeks and definitely include testing vitamin levels

[SlowDragon Administrator]

Last vitamin test results I could find from post 4 months ago showed low B12, folate, vitamin D and folate

If not retested since retest at next test in another 6-8 weeks

As you have Hashimoto’s are you on gluten free or dairy free diet

[Underactiveclare in reply to SlowDragon]

I am benefiting greatly from gluten and dairy free diet

[serenfach]

I go by how I feel, not the numbers. But you are not overdosed and cannot go "hyperthyroid". If you are feeling well, stick with it!

[Underactiveclare]

I do feel well serenfach thank you

[SlowDragon Administrator]

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. "

List of thyroid specialists and endocrinologists who will prescribe T3

healthunlocked.com/thyroidu...

[Underactiveclare in reply to SlowDragon]

Thank you again.

Are you saying that if they refuse, I can mention that the NICE guidelines advise professional discretion and knowledge over taking the guidelines word for word?

[SlowDragon Administrator in reply to Underactiveclare]

Yes

TSH is NOT a thyroid hormone

Many thyroid patients have low or suppressed TSH

The most important thing is ALWAYS FT3