I was diagnosed with autoimmune hypothyroidism last August. Currently on 75mcg levothyroxine.
Symptoms are better but not gone as much as I’d hoped so requested an increase via letter as couldn’t get appt. They then phoned me for a telephone appt but said as numbers are in range they won’t agree to trial an increase.
Latest bloods:
FT3 4.0 (3.1-6.8) 24.3% through range
FT4 16.6 (12-22) 46% through range
TSH 0.99 (0.27-4.2)
What do you think? Should I push for an increase and if denied should I buy levo privately and increase regardless?
They’ve booked me into a rare face to face appointment next week to discuss further but I don’t think it’ll make any difference.
Opinions appreciated x
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RosieTheRoo2023
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Was test done as recommended……early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
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.
Comprehensive list of references for needing LOW TSH on levothyroxine
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
I’d push for increase as that FT3 in particular is low, but you could suggest 75/100 alternate days (rather than 100 every day) as a compromise as you don’t want to overshoot sweet spot, and gp might be more inclined to agree? He/she is watching TSH and that’s why they’re reluctant.
Use this to reassure GP that they can allow your TSH to be a little bit below range without increasing risks ~ it's complex but the jist of it is as long as TSH stays over 0.04 the risks are actually no greater than they are when it's 'in range' :
You can use this one to argue that TSH as low as 0.4/0.5 is perfectly acceptable and within guidelines .....since yours is 0.9 on 75mcg, a small dose increase may well keep your TSH in range anyway .. they won't know unless they try ... emphasise 'it's only a trial to see if it improves symptoms, and if symptoms of overmedication ensue you can simply reduce dose, no harm done' :
Personally before adding T3 which is kinda the last chance saloon I would say you have plenty of room for an increase in Levo. If your FT4 was higher then by rights your FT3 should improve as well. You need an increase.
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