Reducing to 25mcg Levo only

[Amber-sky]

Hi all. Just wondered if anyone has ended up on 25 mcg Levo only (no T3 or NDT) as an ongoing, not starter dose?

Just had my bloods back (below) and my TSH remains low and T3 high despite dropping from 75 to 50 Levo 3 months ago.

TSH .01 ( .3 - 4.2 )

T4 15 ( 9 - 19 )

T3 5.9 ( 3 - 5.4 )

GP suggests reducing to 25 and retest in 10 weeks. Or might I even end up not taking any thyroxine at all?

Before starting Levo in 2022 I had a high TSH, low T4 and T3 mid range. Have felt fatigued before and during taking Levo. My original starter dose was 50, then upped to 75 and now going back down again

Many thanks

Note. Tested at 9 am. Only drank water. Took meds 24hrs before test. Take Vit D and magnesium. Weigh 50kg.

[greygoose]

Your TSH is low because your FT3 is over-range. But your FT4 is only 60% through the range, so you're not taking too much levo.

I would imagine you have Hashi's and are having a minor Hashi's 'hyper' swing to have an FT3 that high:

FT3: 5.9 pmol/l (Range 3 - 5.4) 120.83%

That said, it's only slightly over-range, which is where some people need it. It's not life-threatening! lol BUT it's not usually to have and FT3 that much higher than the FT4 in-range. Makes it look like you're converting T4 you don't have. So, the obvious conclusion is: Hashi's.

I would not say you need to reduce your levo, if it's Hashi's the level will go down by itself, eventually. And when a doctor reduces a dose, he doesn't like putting it up again, even if you need it. So, personally, I would resist this reduction but reduce it myself if I felt over-medicated.

Why did you drop from 75 to 50 three months ago? Were the results the same?

[Amber-sky in reply to greygoose]

Thanks for the reply greygoose and yes I have Hashi’s. I was reduced from 75 to 50 as my results were very similar.

June 2024 TSH .01, T4 15.4, T3 6.2.

March 2024 TSH .02, T4 14.6, T3 5.7

So is it possible to have had this hashi swing for about the last 6 months?

My GPs text from today below:

“Your thyroid results are a fraction closer to normal (T3 target is 3-5.4, you are currently 5.9, in June it was 6.2). I wonder if you need any thyroxine at all! But I know last time you were worried about reducing the dose. Can I suggest you reduce to 25mcg daily (I have sent a script to Lloydsdirect for this) and recheck in 10 weeks?

I know you are worried about symptoms of underactive thyroid, but you are currently OVER treated, increasing the risk atrial fibrillation and osteoporosis, so it is important we normalise your blood levels.”

[greygoose in reply to Amber-sky]

Yes, it's perfectly possible. And your GP needs educating about Hashi's. It should have been the first thing he thought about, but I don't expect he even knows how it works. And he'd rather reduce your dose to a size that will make you ill when levels go back to hypo again.

In any case, as I said, your FT3 really isn't high enough to worry about. But he's probably talking about your TSH when he said you're increasing your risk of heart and bone problems because they're all convinced that bones and hearts need TSH. But they don't. TSH has nothing to do with AF or osteoporosis. So, as I said before, if it were me, I'd refuse a further reduction of levo and just reduce it myself if I felt the need.

[Jazzw in reply to greygoose]

A weight of 50kg might be the reason why 50mcg is more than “enough” at the moment. And I agree about Hashi flares potentially being the cause

[greygoose in reply to Jazzw]

Well, it might be if her FT4 was a lot higher. But to have an FT3 higher than the FT4 means something else is going on. And that something else is more than likely Hashi's. You cannot convert more T4 to T3 than you have T4, therefore unless taking T3, FT3 will always be at least slightly lower than the FT4.

[Amber-sky]

Thank you again that is very interesting and could explain the results - I’ve been really scratching my head trying to work it out.

Just not sure how to deal with my GP as they don’t like to be challenged. In the meantime I’ve ordered another thyroid blood test from medichecks to see if I can get a fuller picture.