Dose reduction after blood test results

[tutbury]

I take 125mg thyroxine everyday. Blood test result for July 2024 showed Tsh of 0.07 (0. 35- 4.5) and

T4 19.7 (11.00 - 24.00).

It stated Satisfactory on the blood report on line from Dr... No action required

I run out of 25mg tablets and request from Dr. Telephone call immediatly to say I should have reduced medication to 1,25 alternate days and told to get another blood test.

I hadn't had the message.

I reduced to 1.25 alternate days for 2 weeks but request Ed a T3 test also.

This week 29 Oct I have the blood test. Tsh now 0.10 (0.35-4.5)

T3 4.3 ( 3.9 - 6.8)

T4 now 15.9 (11.00-24.00) and it as tastes 'borderline' against the results on line. I receive a text from the Dr to say reduce to 100 every day.

What should I do?

I am 73, female and have a kidney disease, coleac disease and asthma.

[PurpleNails Administrator]

tutbury I have changed your post title so it clearer what your post is asking.

I think you may have used your full name, we recommended you keep this private.

[SovietSong]

Hi,your T4 was only 67% on 125mcg levo daily and it has dropped to 62% since your decrease.Your T3 is just 13%.Conversion is coming in under 4.How are you feeling?have you many hypo symptoms?

[SlowDragon Administrator]

Tsh of 0.07 (0. 35- 4.5)

T4 19.7 (11.00 - 24.00)

Was original test done early morning, ideally before 9am, only drinking water between waking and test and last dose 24 hours before test

Free T4 (fT4) 19.7 pmol/L (11 - 24)

Ft4 was only  66.9% through range

No Ft3 result or vitamin levels

What vitamin supplements are you taking

Dose levothyroxine should NEVER be adjusted based on just low TSH

As a coeliac you are highly likely to have low vitamin levels and poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone)

Low Ft3 strongly linked to reversible low kidney function

Suggest you refuse to reduce dose further

Bloods should only be tested 8-10 weeks after any dose reduction

Assuming tested as recommended ….your original result did not suggest you needed dose reduction at all with Ft4 only 66% through range

[SlowDragon Administrator]

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 them and their families and carers or guardian. "

Free T4 (fT4) 15.9 pmol/L (11 - 24) 

Ft4 is now only 37.7% through range

Most people, on ONLY levothyroxine will need Ft4 at least 60-70% through range

results show you need dose INCREASE…..not further inappropriate reduction

Next step get FULL thyroid and vitamin testing done …..and if GP won’t increase dose back to 125mcg (assuming that’s what you need) see endocrinologist

It takes LONG time for TSH to alter

Why TSH is sluggish - mechanism called 'Hysteresis'.

healthunlocked.com/thyroidu....

starts at the end of the first reply from Tattybogle : " To understand why TSH stays suppressed for a long time after an episode of hyperthyroidism/ overmedication, (or ANY T3 use) has finished... "

and is continued in detail much further down in another reply from me : " CONTINUED HYSTERESIS ~ Why TSH remains lower for quite along while following episodes of hyperthyroidism / overmedication .... (or any T3 use) , it is due (at least partly) to a mechanism called 'Hysteresis'.

Absolutely essential to maintain GOOD vitamin levels

Suggest these are tested now if not been tested recently

Research links on low vitamin levels and Hashimoto’s

healthunlocked.com/thyroidu...

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to NHS

thyroiduk.org/contact-us/ge...