Endocrinologist appointment

[Cassav]

Hi all,

So, I just had my appointment with the endocrinologist. So she said that I'm over replaced based on the results below as my TSH is suppressed and my T4 is at the top of the range. She said that the gold standard marker is TSH.

December result

TSH 0.012 (0.27-4.2)

T3 4.8 (3.1- 6.8)

T4 22.3 (12-22)

At this point I interupped her and said I wouldn't consider a dose reduction. She said it's my choice but she had to warn me that hight T4/suppressed tsh (can't remember which she said) can be a miscarriage risk in early pregnancy but that ultimately it's my choice. Please reassure me about this, surely there isn't a miscarriage risk unless my T3 is very high?!

I told her that the baby that I lost in Jan was very small and that I won't risk that happening again so I need both my T4 and T3 to be decent.

She ordered a celiac test as she said once you have one autoimmune condition you're at risk for others. I told her that my celiac test in 2014 was negative but she wanted to repeat it as well as test for B12 again.

She ordered a thyroid ultrasound for me.

She also said she would consider adding in some T3 based on my results (very suprised at this!) but because I'm hoping to conceive very soon there is no point starting and stopping it.

We discussed my symptoms and she asked about when they started etc and family history of thyroid issues. In response to my insomnia she said that can be caused by an overactive thyroid or being over medicated. I asked her as because my insomnia varies during the month could it be my hormones, which she didn't really answer.

[jimh111]

I don't know of any miscarriage risk unless levels are quite high or low. Nobody as far as I know hasn't compared TSH, fT3, fT4 with miscarriage risk. This isn't surprising as it would be unethical to leave someone with abnormal hormone levels during pregnancy. I haven't heard that it is fT3 that determines risk, the foetus is able to convert T4 to T3 at different rates during pregnancy.

I would try to reduce your levothyroxine and perhaps ask if she will prescribe a little LT3 to reflect what happens in a person without thyroid disease. This is just guesswork, there is no science in this area.

[Cassav in reply to jimh111]

Thanks jimh111 . The insomnia is a risk to my health and any future pregnancy as well as just being pretty miserable so if I were to reduce my T4 a little it would be in the hope that this would improve and as I've read on this forum it would perhaps improve my T4 to T3 conversion. Has anyone had this experience of their conversion improving after reducing their dose?

But on the other hand as I hope to conceive very soon it might be better to leave my dose as it is as body will require more T4. I told her that I'm trying to conceive so she won't prescribe T3 now. And going down the T3 route is more complicated during pregnancy and will take time. It's just so hard to decide as I've already had the worst happen.

[jimh111 in reply to Cassav]

Yes, you will need more when pregnant, so your current dose will help but you will need to be monitored to make sure it is enough. It's a shame nobody has researched this important issue, they could record thousands of TSH, fT3, fT4 before and during pregnancy to get some information on optimum levels. It would be expensive but well worth it, instead of guessing.

[Batty1]

Have you tried lowering your T4 just a little to see if this helps with insomnia … its possible your T4 level is too high for you.

[Cassav in reply to Batty1]

No, I haven't tried this yet but perhaps I should. What amount do you think I should reduce by? SlowDragon previously suggested a reduction of 25mcg per week to bring my over range t4 back into range but as it's now at the top of the range she said I should stay on my current dose.

[Batty1 in reply to Cassav]

That’s really hard to say all you can do is try to reduce it by 25 for a couple of weeks or longer and see how it works for you .

[Cassav in reply to Batty1]

Thanks

[HealthStarDust]

May I ask if this was a NHS endocrinologist?

The advised I received was simply not too low or too high thyroid hormone, and TSH in range but below 2.5 in first trimester.