Test results and lowered levo

[Mogget]

Hi,

Wondering if I can get some advice!

During a visit to an endocrinologist (unrelated to my thyroid problems) I was surprised with thyroid function tests mid-afternoon. The results (TSH 0.04 & T4 20.4) led to the endo recommending my levothyroxine be dropped from 100mcg (a dose I’ve been on for years) to 75mcg. By chance the following week I had routine TFTs booked at my GP surgery which returned the following results (fasting at 8.40am):

TSH: 0.3 (0.4-4.9)

T4: 14.7 (9-19)

T3: 4 (2.4-6)

My dose has still been lowered to 75mcg (on the basis of the TSH being slightly suppressed). Should I see how I get on and push for it to be returned to 100mcg if I feel worse?

I should say I’ve never felt well, but have other health problems too, and I’m never quite sure what’s causing what.

TIA!

[Forestgarden]

Your T4 and T3 show you are definitely not overmedicated... if anything, you're under medicated. I would refuse the reduction if you feel ok on it. Was the endo a diabetes specialist by any chance?

[Mogget in reply to Forestgarden]

Thank you. I’m going to push back on the dose reduction. I don’t feel well generally but I don’t think it’s due to my levo dose being too high. No idea of the endo’s specialty but probably..! I didn’t like their manner generally…

[SlowDragon Administrator]

were both tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

do you always get same brand levothyroxine at each prescription

Free T4 (fT4) 14.7 pmol/L (9 - 19) 57.0%

Free T3 (fT3) 4 pmol/L (2.4 - 6) 44.4%

Shows you likely need dose INCREASE in Levo

Poor conversion rate of levothyroxine (ft4) to active hormone (ft3)

Next step …..refuse to reduce dose

Request/ politely insist vitamin D, folate, ferritin and B12 levels are tested

For good conversion of Ft4 to Ft3 we need to maintain GOOD vitamin levels

What vitamin supplements are you taking

Is your hypothyroidism autoimmune

[SlowDragon Administrator]

See you have bad asthma

Inhalers (steroids) will quite likely lower TSH

[Mogget in reply to SlowDragon]

Interesting - I didn’t know that about steroids! I’m often on prednisone too. And hydrocortisone for adrenal insufficiency.

And thanks - the first test I mentioned was mid afternoon and non fasting etc as it came as a surprise. The second was a scheduled one at 8.40am. I always schedule as early as poss in the morning, fasting and no levo!

Thanks for the advice and the vitamin information - I’m going to ask for those tests and also refuse to decrease my levo dose. I supplement vitamin D (3000iu sublingual every other day). The others I don’t supplement so need to look into those for sure.

And yes it’s autoimmune hashimotos

[SlowDragon Administrator in reply to Mogget]

the first test I mentioned was mid afternoon and non fasting

And that explains lower TSH than second test

On steroids the medics should NOT be dosing by TSH, but by Ft4 and Ft3 results

[Noelnoel]

I should say I’ve never felt well, but have other health problems too

Quite often “other health problems” are caused by thyroid dysfunction and being undermedicated, which you could become on the lower dose. This may exacerbate existing health problems and very possibly create new ones

[Mogget in reply to Noelnoel]

Thanks for your reply. Do you think I should be on a dose higher than 100mcg?

[Noelnoel]

Above, SlowDragon sets out your results and how far through the reference range you are, saying you likely need dose INCREASE in levo

If those were my numbers I would most certainly be considering an increase and at the very least I would definitely politely decline a reduction. I would also take into consideration everything else she says. I would especially be pondering why my conversion to FT3 seems poor and checking core nutrients with a view to attempting to raise them (if they were low) to see if this improved conversion. If there was no improvement a further conversation would be needed

I should add that my husband is supposed to be taking levo but first wanted to address his dire core nutrients to test if raising them improves his thyroid function. To this end he’s been taking betaine and ACV to try to improve absorption; he believes he has low stomach acid because despite taking supplements for a couple of years his ferritin and folate remain stubbornly low. He has also changed some brands. We’ve been tracking his basal temp because it was very low 35s and is now 36.3. This is pleasing so he’s continuing and will test in a month or so to see what his nutrient levels are now and also his thyroid hormone status

However, none of this will necessarily change his thyroid function and he may well have to start levo

[Mogget in reply to Noelnoel]

Thank you - that’s very helpful. I’ll work on addressing my vitamins & minerals to see if that improves conversion. First hurdle will be convincing my GP to put me back on 100mcg (at least..!).

[Noelnoel in reply to Mogget]

I would certainly be doing that in a hurry. I wouldn’t want to suffer a drop in thyroid hormone levels