So, following on from my last post I have recently had a blood test and I post below my results from July 2024 and the last lot from the other day - both done with the suggested timing protocols.
July: - this was on 75mcg T4 and 12.5mcg T3
* TSH 0.01 mIU/L (.35 - 4.94) -7.4%
* Free T4 (fT4) 14.3 pmol/L (9 - 19.1) 52.5%
* Free T3 (fT3) 5.4 pmol/L (2.4 - 6) 83.3%
* T4:T3 Ratio 2.648
September: - this was on 75mcg T4 and 6.25 T3
* TSH 0.03 mIU/L (.35 - 4.94) -7.0%
* Free T4 (fT4) 12.3 pmol/L (9 - 19.1) 32.7%
* Free T3 (fT3) 4.7 pmol/L (2.4 - 6) 63.9%
* T4:T3 Ratio 2.617
I've received the following message from my GP today. "I have reviewed your bloods. The TSH is still suppressed which is an indication of over replacement still. As you have stopped the liothyronine I would now reduce the levothyroxine from 75mcg to 50mcg and we can again repeat the thyroid levels in 3 months."
You'll notice she says I've stopped the liothyronine despite me actually putting it in writing to her that I'm taking 6.25mcg.
I'm surprised that my T4 has fallen and wonder why? The only thing I am doing differently, apart from the reduced dose of T3 is that I'm now taking a selenium supplement.
I'm really not sure what I should do now. I feel okay and can still exercise. Not too tired. Any suggestions will be very gratefully received. 😊
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diamondial
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I am only taking selenium as a supplement - nothing else. I sent for a private Vitamin D test in 2017 after my blood test at the doctors as they didn't do it. The result was 30.9 (insufficiency range 30.1-50). I'm going to attempt to upload the only 2 blood test results I can find other than thyroid TSH/T4/T3. I can see folate and B12 which were tested in 2017 but can't see them on the 2023 one. I don't really understand the blood tests other than the thyroid ones!
I was prescribed 100mcg many years ago. It's all lost in the mists of time, or mists of my mind as to when/why it was changed. It might have been a change of doctor. My doctor, who I've never seen, seems quite keen to drop my dosage. She's now not even suggesting 75 and 50 on alternate days but but going straight down to 50 daily. Sigh.
She should not be dosing by the TSH! It's bound to be low when taking T3, but it doesn't matter. It is low because the pituitary has decided that you don't need it anymore, and that is not a problem. And you can have a suppressed TSH and still be under-replaced.
The important number is the FT3, followed by the FT4. Once the TSH gets below 1 it is of little use. If I were you, I would put my foot down and refuse to reduce your dose any further and make yourself ill just because she doesn't have a clue what she's doing. If your TSH has been suppressed for a while it might never rise again, even if you stopped thyroid hormone replacement completely. How far a you prepared to go to placate this uneducated doctor?
Yes it's clear she's only interested in the TSH and won't be happy until it's within range. I don't know what to say to her to be honest, or more likely write to her. The doctors surgery has now started a new system whereby all requests to see a doctor are checked by one doctor and then distributed to the other doctors as they see appropriate - Total Triage apparently so I think writing to her is my only option. I feel rather defeated.
Recommended that all thyroid blood 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)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
When I had the usual thyroid tests done last week I asked about vitamin and mineral testing and the nurse said they only test Vitamins D and B and the doctor has to request them. I'm going to have a think as to whether to write to my doctor and request vitamin testing or just go straight to private testing. I feel rather unsure at the moment and will give myself a day or two to let it percolate in my mind to see if a plan emerges. Many thanks for all your help - much appreciated. 😊
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