good morning!
I have an endocrine appointment on Thursday and want to go in armed with good advice.
Latest results from blood test taken on empty stomach, before 9am, 24 hours after levo dose.
TSH 1.54 (0.3-5.0)
T4 10.1 (7.9-16)
I take 75mcg of levothyroxine.
I’m thinking that my T4 could be better but i know he will say all fine nothing to change! Symptoms are not awful but I do feel tired.
Not sure of latest vitamin results as have not had them tested recently.
Your FT4 is only 33.71% through the range. Most hypos need it up around 75%. And your TSH is a bit high. So, yes, you do need an increase. Just being in-range is not good enough. It needs to be in the right place. 
Yes you need 25mcg dose increase in levothyroxine
Retest in 8-10 weeks after increasing
Which brand of levothyroxine are you currently taking
Ideally don’t change brand when increasing dose
Next test make sure you test Ft3 and vitamin levels
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You would definitely benefit from an ancrease to 75mcg!
Tick off ALL your symptoms on the following list and use as evidence that you are still undermedicated....in addition to low FT4 as greygoose has explained.
Symptoms are important and must be factored into diagnosis
thyroiduk.org/signs-and-sym...
She is currently on 75mcg ,….increase to 100mcg you mean
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Hello, I was concerned about my out of control BP and asked the question here about the relationship of hypertension to thyroid dysfunction and I’m thankful to the response I received, as until then I hadn’t realised I needed to take my other medications at least 2 hours after my Eltroxin (50mcg). Since then I have been fastidious about doing that and now a couple of weeks later, I feel more energetic and my BP is settling down.
thank you all for confirming what I thought.
Well my appointment went as predicted! An increase was not supported at all. We had a 45 minute heated discussion about this. I’m gonna break this down into points, strap in!
1. First he stated the amount of people in the country that have a thyroid problem and how it was no big thing. Also touched on people googling etc before I had even said a word to him.
2. I stated my case and he checked my results as to which he stated there was no scientific evidence that my symptoms were thyroid related. I disagreed and he proceeded to spout a lot of intellectual information about how the levo was working at a cellular level and my results show it is working well.
3. I discussed guidelines etc and treating the patient not the numbers he felt I was disrespecting him. He continued to inform me of his clinical experience and the many conferences he has been to and that he could not support an increase as it went against his orthodox practice. Which I have a right to disagree with apparently but I don’t have the right to decided on my health care.
4. I explained it is my body and my health and I am asking him to support an increase in medication as I do not feel well. He declined. He has offered me a blood test in 6 months and a follow up in a year. He didn’t even remember the reason I am under them is due to my thyroid nodules.
I just can get on with this man at all. His bedside manner is shocking. He said it was unusual for patients to make this request and challenge him. He insinuated my symptoms are likely something else.
Im disappointed and unsure what to do now. I want to just up my dose myself to be honest but how do I get the gp to change this?
So this was a consultant? Wow! I have come across one like this. You can’t work with someone like that because they know it all and they won’t budge.
Would there be an option to go private (but someone who does NHS as well)? If it is, you could have a one off appointment as private patient and then see him / her as a follow up on the NHS.
You can see any consultant on the NHS even if it’s outside your ‘catchment’. Perhaps you could identify someone from the files here and tell your GP you’d like a second opinion. You’re entitled to that.
Another option is to self medicate and just deal with your GP. I did that with T3 initially.
It’s incredibly hard when these so called experts are anything but.
I think that is sensible advice and I will definitely look into doing this. Me and this consultant do not vibe and I can’t be under his care. I just don’t trust it.
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