Over-medicated (Levothyroxine)?

[Merrymoo]

Hello, I wondered if someone could help me? Apologies for posting lots of results below, but I thought it might help with context. I have just received my latest NHS results and I think I may be over-medicated still? Interestingly, I had a dose reduction 6 weeks ago and although my FT4 has reduced, so has my TSH. (All blood tests were taken between 8am-9am, before medication and with no biotin 5 days before). I should add that I have been taking various supplements in the last two months to potentially help with inflammation and possibly TSH levels under the advice of a functional doctor (although not a thyroid expert), which is the reason I have done several random blood tests. I also cut out gluten in November and Dairy in June. I have minimal symptoms compared to two months ago, but as I have osteopenia I am keen not to over-medicate and make this worse. I have an appointment with my GP on Weds and would really appreciate advice on how to guide the conversation! TIA:

26/08/2023 Medicheck / un-medicated

TSH 11.2 (0.27-4.2) (278.1)

FT4 13.1 (12-22 (11.1%)

06/09/2023 NHS / un-medicated

TSH 6.58 (0.27-4.2) (160.6%)

FT4 12.8 (12-22) (8%)

08/12/2023 NHS / un-medicated

TSH 2.4 (0.27-4.2) (54.2%)

FT4 14.6 (12-22) (21.7%)

18/12/2023 (Blue Horizon) / Un-medicated

TSH 10.6 (0.27-4.20) (262.8%)

FT4 12 (12-22) (0%)

FT3 3.1 (3.1-6.8) (0%)

Tg 263 (<115 )

TPO 166 (<34)

02/04/2024 (Blue Horizon) / Un-medicated

TSH 20.6 (0.27-4.20) (517%)

FT4 11.9 (12-22) (-1%)

FT3 4.1 (3.1-6.8) (27%)

Tg 235 (<115)

TPO 147 (<34)

18/04/2024 (NHS) / Un-medicated

TSH 11 (0.27-4.2) (273%)

FT4 14.5 (12-22) (25%)

28/05/2024 (Monitor My Health). Test after 4 weeks on Levo 50 and then 2 weeks on Levo 75 (advised to increase dose by GP as many symptoms)

TSH 0.1 (0.27-4.20) (-4.3%)

FT4 29.1 pmol/L (12-22) (171%)

Ft3 5.1 (3.1-6.8) (54.1%)

TPO 134 (<34)

NHS tested the same day with following results:

TSH 0.1 (0.27-4.2) (-4.3%)

FT4 26.7 (12-22 (147%)

*DOSE REDUCTION ADVISED TO LEVO 50*

02/07/2024 (Monitor My Health). Test after 4 weeks on Levo 50

TSH 0.06 (0.27-4.20) (-5.3%)

FT4 23.1 (12-22) (111%)

FT3 4.4 (3.1-6.8) (35.1%)

TPO 127 (<34)

16/07/2024 (NHS) Test after 6 weeks on Levo 50

TSH 0.08 (0.27-4.20) (-4.8)

FT4 20.00 (12-24) (66.7%)

[HealthStarDust]

Oh crikey. Something similar has just happened to me recently. I reduced dose once levels were too high, then very bizarrely the levels came back even higher 8 weeks later, then after 8 weeks of no levothyroxine my TSH is still suppressed and FT4 and FT3 still over range. Madness!

[Merrymoo in reply to HealthStarDust]

It's odd, isn't it? I should have added that I have had a recent thyroid scan which confirmed thyroiditis. I'm really not sure what to do now?

[HealthStarDust in reply to Merrymoo]

I’m wondering if that’s what I have right now and I am so very confused by it. I’m confused as to what thyroiditis actually is and if it’s what the group think here call the ‘hashi swing’.

You seem to be getting some care so that’s good. I’m having to fight for it with a GP not knowing what to do and local endocrinology not accepting referrals and being generally crap at giving GP advice. Seems like everyone is passing the buck. I should mention it’s all NHS.

Hapoy to compare notes via chat. We hear so often that people go from hypo to hyper, and hyper to hypo after surgery, yet what is happening to us makes so little concrete sense right?!

[tattybogle in reply to Merrymoo]

6 wks is really the earliest to look the effect of a stable dose on bloods , blood levels are likely to be swinging around a bit during the first few wks after adding thyroid hormone , or changing dose, as the HPT axis responds to the addition of T4 and rebalances TSH response.

since 50 mcg seems unlikely to be 'too much' given how low your T4 has been and how high you TSH has been before levo , personally , i think if you give 50mcg another few weeks to settle in.... you may find your TSH starts to rise again.

that would give you a better idea of how you feel on 50mcg .

how i feel on any dose will usually keep change over the first few wks ,i find week 8-12 is probably better for assessing how i feel.