Hypo Dr lowered dose!

[Lowestoft]

Hi everyone,

My Dr. lowered my prescription from 150mcg to 125mcg on the basis of a TSH result of 0.01.

Test done as advised on here. No T4 or T3 was done. No discussion about symptoms . In fact it was done without any discussion.

I’ve had to wait a month to have an appointment with my Dr. Was not able to speak to anyone at the practice who was medically trained.

Still have many symptoms of hypo. My TSH has been 0.01 for years .T4 over range for first time but T3 in middle of range.

Any advice for my appointment next week would be greatly appreciated.

I’ve had tests done at Monitor My Health

Monitor My Health

Vitamin D 86 Replete

TSH 0.01 (0.27- 4.2)

Thyroxine T4 26.9 (12-22)

Tryodothyronine T3 5 (3.1-6.8)

Cholesterol 4.8 (0-14)

HDL1.56 (1.25-4.5)

NonHDL 3.31(0-4)

Triglycerides 1.53 (<4.5)

Glycated Haemoglobin 40 (<42)

Failed tests at MMH

Ferritin, folate, HB, B12 and TSAT

Waiting to repeat.

Also Drs blood results

Full blood count

Total white blood count 6.7 10*9/L [4.0 - 10.0]

Red blood cell count 4.58 10*12/L [3.8 - 4.8]

Haemoglobin concentration 134 g/L [120.0 - 150.0]

Haematocrit 0.418 [0.36 - 0.46]

Mean cell volume 91 fL [83.0 - 101.0]

Mean cell haemoglobin level 29.2 pg [27.0 - 32.0]

Platelet count - observation 232 10*9/L [150.0 - 410.0]

Neutrophil count 3.84 10*9/L [2.0 - 7.0]

Lymphocyte count 1.99 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.60 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.23 10*9/L [0.02 - 0.5]

Basophil count 0.05 10*9/L [0.0 - 0.1]

Clinician viewed 31 Jan 2024

Result type Pathology

Tests B12 & serum Folate

Filed by UNKNOWN - 31 Jan 2024 18:51

Result Abnormal

What you need to do Communicate Patient

Pathology Investigations

B12 & serum Folate

Serum vitamin B12 level 382 ng/L [187.0 - 883.0]

Serum folate level 5.2 ug/L [3.1 - 20.5]

B12 Comment Total B12 level > 300 ng/L: Vitamin B12

deficiency unlikely. HoloTC not performed.

All tests for vitamin B12 should be

interpreted in conjunction with

haematological and clinical findings.

Neurological features of Vitamin B12

deficiency can occur without anaemia.

Clinician viewed 31 Jan 2024

Tests Liver function tests

Result Abnormal

What you need to do Communicate Patient

Pathology Investigations

Liver function tests

Serum bilirubin level 11 umol/L [< 21.0]

Serum total protein level 69 g/L [60.0 - 80.0]

Serum albumin level 40 g/L [35.0 - 50.0]

Serum globulin level 29 g/L [21.0 - 35.0]

Serum alkaline phosphatase level 89 u/L [30.0 - 130.0]

Serum alanine aminotransferase level 21 u/L [0.0 - 55.0]

Clinician viewed 31 Jan 2024

Result type Pathology

Tests Liver function tests

Filed by UNKNOWN - 31 Jan 2024 18:51

Result Abnormal

What you need to do Communicate Patient

Pathology Investigations

Liver function tests

Serum bilirubin level 11 umol/L [< 21.0]

Serum total protein level 69 g/L [60.0 - 80.0]

Serum albumin level 40 g/L [35.0 - 50.0]

Serum globulin level 29 g/L [21.0 - 35.0]

Serum alkaline phosphatase level 89 u/L [30.0 - 130.0]

Serum alanine aminotransferase level 21 u/L [0.0 - 55.0]

Clinician viewed 31 Jan 2024

Result type Pathology

Tests Urea and electrolytes

Filed by UNKNOWN - 31 Jan 2024

Result Abnormal

What you need to do Communicate Patient

Urea and electrolytes

Serum sodium level 141 mmol/L [133.0 - 146.0]

Serum potassium level 5.1 mmol/L [3.5 - 5.3]

Serum urea level 4.1 mmol/L [2.5 - 7.8]

Serum creatinine level 79 umol/L [45.0 - 84.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 64 mL/min/1.73m^2

[SlowDragon Administrator]

31 Jan 2024 18:51

B12 & serum Folate

Serum vitamin B12 level 382 ng/L [187.0 - 883.0]

Serum folate level 5.2 ug/L [3.1 - 20.5]

These are too low

what vitamin supplements were you taking before test?

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Lowestoft in reply to SlowDragon]

The only supplement I take is cod liver oil. No b ones. Thank you for links to b supplements.

[SlowDragon Administrator in reply to Lowestoft]

You need to retest folate, B12 and ferritin at least once a year

Ideally test vitamin D twice a year

[SlowDragon Administrator]

TSH 0.01 (0.27- 4.2)

Thyroxine T4 26.9 (12-22)

Tryodothyronine T3 5 (3.1-6.8)

was test done early morning and last dose Levo 24 hours before test

Do you always get same brand Levo at each prescription

These results do suggest possibly on slightly too high a dose

Poor conversion rate might improve with lower Ft4 and improving B12 and folate

Request GP test full iron panel test including ferritin

Retest thyroid levels in 8-10 weeks

[Lowestoft in reply to SlowDragon]

Thanks SlowDragon, test was done at 9am ,no Levo for 24 hours. I get different levo -whatever the pharmacy have but NOT TEVA.

[serenfach]

I love the "What you need to do Communicate Patient" instruction! Did he communicate the test results to you? I bet he looked at that lot and thought I dont know what it all means, so I will ignore it, but look as though I know something by dropping the thyroid dose.

Communication used to mean a two way discussion but it seems not any more. Remember the GP/Endo is there to advise, not dictate.

[Lowestoft in reply to serenfach]

Hi Serenfach,

Thanks for replying. No communication from the doctor. I phoned surgery and was told by receptionist that Dr had changed my prescription.No two way discussion.I have an appointment tomorrow, after waiting for a month.

[serenfach]

You do not have to agree with the change of dose, especially without any discussion. I went through this, phoned the Practice Manager and demanded my dose was put back until I could discuss the ongoing symptoms with the GP face to face. They did, and the "discussion" with the GP gave me an increase in dose because I told him how wrong it was to go by TSH, and would he like the research to read. I think he gave in rather than read anything!

[Lowestoft in reply to serenfach]

I’m hoping for the same result tomorrow.The Dr. lowered my dose before I could stop it!! My T4 is slightly over range but T3 sits in middle of range.

[serenfach]

Tell him you will buy what you need if he does not up the dose, as you are fed up with feeling ill. That usually scares them as it shows you mean business. Good luck!