Just wanted to get people's thoughts on my latest thyroid bloods. I'm currently on 100mcg of Levo and the private GP i see for this says that if we do anything, it may be useful to drop it down to 75mcg. I don't really want to do that, so i think staying at 100mcg could be sensible. What do you guys think?
Drs comments were:
"As you can see you do not need any more thyroxine than the amount that you are currently taking, if we do anything it might be prudent to reduce to 75mcg as although you still have elevated thyroid peroxidase antibodies your TSH is suppressed and T4 and free T3 are high in the range. Your bound T3 and T4 appear slightly over normal range as well, only marginally but this is clear indication that your thyroxine should not be taken any higher at present."
TSH: 0.055 mIU/l [0.55 - 4.78]
Free T4: 16.87 [10.4 - 19.4]
Free T3: 6.37 [2.6 - 7.1]
Thyroid Peroxidase antibodies: 1187.9 [<60]
Triiodothyronine(T3): 2.22 [0.6 - 1.81]
T4: 167.3 [59 - 154]
These were taken around 10:45 on an empty stomach with only water consumed beforehand and my last levo was taken over 24 hours before.
Thanks!
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I've been feeling fine. Past couple of weeks i've been pretty tired and wondered whether i was due an increase. Always something that can be improved, but if this is as far as I can go with levo then i guess i need to try to optimise my other things like vitamins, selenium, etc.
Well your FT4 and FT3 are both highish but not over range. You seem to have responded very favourably to Levo, your conversion from FT4 to FT3 seems very good.
You're lucky as being male often means you need a higher dose due to bodyweight. If you feel well then definitely dont meddle 😆. No harm in looking at vitamin and mineral levels.
Endo-waffle! Your FT4 is 71.89%. Maybe room for a very small increase, I agree you don't want it too high for several reasons. But, you haven't given us the FT3 result.
Also, your dose of levo has nothing to do with your antibodies, so I don't know why he was talking about them!
Your bound T3 and T4 appear slightly over normal range as well, only marginally but this is clear indication that your thyroxine should not be taken any higher at present.
I don't think it is. What's most important is your FT4.
OK, so he's right. You shouldn't need any more levo. Because you appear to be an excellent converter, and your FT3 is pretty high. Any more levo would probably send that sky-high - over-medicated - and cause hyper-like symptoms.
In fact, it could already be too high, and that's why you feel tired.
Even so, I think going down to 75 is a bit excessive. Maybe try reducing to 75 mcg once a week, but not every day. Just to see if it helps. With the proviso that you can always go up again if it doesn't help!
That said... Do you have Hashi's? Because it's a bit suspicious that your FT3 is higher in range than your FT4.
OK, so Hashi's is the common name patients use to talk about Autoimmune Thyroiditis. But there are two types: Hashimoto's and Ord's. The difference is that Hashi's has a goitre and Ord's doesn't. And, with Ord's the thyroid ends up very small, like a shrivelled pea.
With both of them, the immune system mistakes the thyroid for the enemy, and launches continuous attacks on it to destroy it. They may be little/short attacks, or they may be huge. But during any attack, the dying cells release their stock of hormone - T4 and/or T3 - into the blood, causing levels to rise for no apparent reason - well, not apparent to doctors who know nothing about it. These high/highish new levels are only temporary. They may last a short time or they may last for months. But, eventually, the excess hormone will be used up/excreted, and the levels will come down to hypo again.
Unfortunately, as I said, doctors know nothing about that, and want to slash your dose. But that's not the right thing to do. The right thing to do is reduce it temporarily - or stop it altogether until you feel hypo again.
So, I suspect that that is what has happened to your FT3. A few T3-containing cells have released their stock into your blood, causing your FT3 to rise higher than your FT4. There's not a lot you can do about it, except try reducing your levo a bit, temporarily and see how it goes.
greygoose sorry to tag you, but I’ve requested a prescription and the dr has asked me to try 75mcg. Should I give it a go? I’ve been really tired lately and also had the following, which may be unrelated:
Well, I wouldn't if I were you. If you feel good on this dose, why mess with it? They just love to mess around with our dose, it justifies their existance! I maintain what I said above, maybe a small reduction once or twice a week, but not 75 every day. That would be too much of a drop.
I echo greygoose You felt good and now you are tired. I get very tired if I'm under or over medicated. But the drop from 100 to 75 is large and way too much to adjust in your situation. I'd tell your doctor that you are willing to try a small reduction of 25mcg twice a week and see how it goes. That's a very fair answer to him and is a good compromise. Chances are by the next blood test you will need to go back up again if the Ord's has calmed down again.
Thank you (& greygoose ). We've settled at every other day. She said my case is "complex" (she's a GP after all, not a specialist) so wants me to see an endo. She said to not go to a local one as they may be a bit "traditional", so I've been looking at some a bit further afield in Manchester.
They often say 'your case is complex' - had it said to me. But it just means they don't know much about thyroid. And I don't really think she understands the significance of the antibodies - they rarely do. Time will tell if your high FT3 had anything to do with the Hashi's or if is was just over-medication. But I'm pretty sure it was to do with the Hashi's and at some point will drop to a point that you need to raise your dose again.
I think your reduction is going to prove to be too much. So, I do hope you added the previso that you could raise it again if necessary!
I've been told various health problems of mine over several decades are "complex". I discovered ages ago that this just means they think I'm mentally ill and/or depressed and/or anxious. This just means that I won't be getting any proper investigation or treatment of whatever I'm complaining about.
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