Serum Ferritin: 75ug/L (30-250) “normal - no action”
I did not have Vit D, B12 or folate tested. Apparently I have to have my doctor to authorise this, which I’m sure they will do on request ( I didn’t know this at the time)
I have a good relationship with my doctor. When I discuss these results with her, do you think I should ask for my dose to be reduced to maybe 112.5?
Many thanks for reading this.
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Rezzar
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If you feel well on current dose of 125mcg refuse to reduce it.Using TSH reading to dose is useless.You are not over medicated, T4 is 65% and T3 50%.Conversion is good @ 3.71(recommended 4 or under).If you are showing no symptoms I’d leave as is.Don’t be alarmed by “abnormal” regarding TSH reading.
Important to test vitamin D, folate, B12 and ferritin at least annually
Low B vitamins are more common as we get older, especially B12
Ferritin,
look at increasing iron rich foods in your diet to improve ferritin to around 100……this can help improve conversion of Ft4 to Ft3
Free T4 (fT4) 15.6 pmol/L (9 - 19.1) 65.3%
Free T3 (fT3) 4.2 pmol/L (2.4 - 6) 50.0%
obviously nether are anywhere near top of range so dose does not need reducing
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with themand their families and carers or guardian. "
Thank you SovietSong and SlowDragon for your swift response, it’s good to know I’m not over medicated and my conversion is good. That’s all very reassuring.
I feel good, but sometimes alarmed at the amount of hair that falls out every day!
I’m currently on mercurypharma but sometimes it’s teva.
I do not take any vitamin supplements, but I like to think that I eat a good varied diet.
Thank you for your advice to remain at the same dose of 125mg, and giving me a link to the nice guidelines.
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
I do not take any vitamin supplements, but I like to think that I eat a good varied diet.
When on Levo we frequently develop low stomach acid this results in poor nutrient absorption and low vitamin levels regardless of how good or poor your diet is
Majority of patients on Levo need to supplement vitamin D, vitamin B complex
Ideally you would want to keep TSH a tad higher than 0.04 if it's possible to do that and still feel well enough . So it may be worthwhile trying 112.5mcg.
But if you currently feel well , there is a risk that you will feel less well on a lower dose , .. i've been seriously inconvenienced for several months by changing doses when i felt very well, just to satisfy the doctor ... and we had to put the dose back up anyway as i developed symptoms of undermedication on the lower dose,
If you do have any symptoms that could potentially be caused by slight overmedication (which can frankly be 'all sorts' eg , i had pain that we all thought was kidney stones when i was overmedicated ), then trying a very slightly lower dose of 112.5mcg is obviously a worthwhile experiment .
It may help your decision if you understand that there is very good quality research that shows that TSH between 0.04 and 0.4 actually had no greater risks associated with it than TSH ' in range did ,..... but note it did find the risks increased sharply when TSH was below 0.04
if you do try a lower dose , give it a full 6 wks before making your mind up how it feels ... in my experience of reducing doses, the first 2/3/4 weeks can feel very undermedicated, but by wk/ 5/6 thing were settling down and improving as my body acclimatised itself to the new levels.
Thank you Tattybogle, if I did reduce my dose to 112.5 what are the symptoms of being under medicated? I am concerned that I might not recognise if I am more tired than usual as I tend to push myself with exercise and try to keep going however I feel. Maybe I will try the lower dose and see how I am after 6 weeks. I will give it some thought and discuss things with my doctor. thank you for your advice.
Be careful with the exercise. Too much can down-grade your conversion of T4 to T3 because it uses up your calories, and you need calories to convert. As it is, your conversion isn't that brilliant, your FT3 isn't that good, and if you reduce your levo it will go down even further.
My TSH has been totally suppressed for many years, zero. And I'm pretty sure I have not suffered any ill consequences from that. I am now 79. I'm very, very wary of any research that suggests TSH needs to be kept over any given level.
I do not take any vitamin supplements, but I like to think that I eat a good varied diet.
That's as maybe. But, you're not what you eat, you're what you absorb. And even people with the healthiest diet on the planet - whatever that may be! - can suffer from nutritional deficiencies if they're hypo. That's because hypos usually have low stomach acid, which makes digesting food and absorbing the nutrients difficult. And we need optimal nutrient levels for your bodies to be able to use the hormone we're giving it. So, really important to get them checked out.
Thank you Greygoose your reply has given me a lot to think about. I’m a bit concerned that my conversion isn’t that brilliant, and my FT3 isn’t that good. What figures do I need to see to turn that around?
Thank you for the advice to get my vitamins checked out, I will do this.
I’m currently on mercurypharma but sometimes it’s teva.
Ideally always get same brand
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots,
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Don’t let them bully you into reducing meds when you feel well and your numbers are fine. My TSH is always <0.01 and yes it will show as abnormal but it’s nothing to worry about. Free T4 is the only one that matters. The GPs always react to any change in thyroid blood tests but not to any other abnormal test results. My Endocrinologist told me GPs do not understand the endocrine system so now I won’t let my GP change my meds unless my Endo says it’s ok (after discussing it with me first)
Thankyou Irishacres. I have a doctors appointment booked in two weeks time. I shall now study all the information I’ve been given on this forum, before discussing my blood results with my doctor.
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
TSH implies over active, T4 under range, confused!!
Folic Acid prescribe by doctor as level under range.
Why have my hypo symptoms returned despite TSH dropping below range?
On NDT and my TSH in a range
Latest blood tests - is my TSH now at a “good” enough level to be satisfied? 
