TSH of 0.23 [0.27-42]isn't 'really' a problem , but the fact that it is slightly below range does mean GP is likely to be extremely unwilling to increase your dose at the moment .
however your dose is pretty small and your fT4 is rather low in range , so (assuming you left no more than 24 hrs from last dose levo for this test ?) you probably would benefit from an increase in levo dose.
since the fT4 is still so low , it is very likely that your TSH will start to rise again if you give it a bit more time ( how long ? dunno , how long is a piece of string ~ couple more months hopefully ?).... but unfortunately waiting longer for it to rise a bit may be the only way you'll get an NHS GP to agree to increase levo dose . (they are specifically told not to prescribe doses that suppress TSH,, and unfortunately many of them will interpret 'supress' as 'do not go below range ' even though it really means ' so low it's unmeasurable' )
these first 2 may come in handy if it doesn't rise much :
this one will come in handy when TSH is more than 0.4 healthunlocked.com/thyroidu.... list-of-references-recommending-gps-keep-tsh-lower-in-range
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p.s it is expected that fT3 will fall a little bit when you start levo because higher TSH causes a small 'boost'' in thyroidal T3 production , and also a small boost to conversion from T4 to T3 . (presumably to try and compensate for low fT4 ). When the TSH is then lowered by adding T4 from levo , this T3 'boost' disappears.
I skipped one dose of Levo (which I take before going to bed), and had the test in the morning. So 36hrs after my last dose.
Thank you! I've given up hope doctor will treat correctly, but I'll keep pestering them, so those links are helpful. For now, I'm able to increase my own dose. So it's good to have the forum's views into consideration!
Would you increase to 100mcg? Or would you take a smaller step?
i wouldn't recommend increasing without GP involvement at this point . it would be better to allow TSH time to raise and get GP to agree you do then need a bit more .
DIY at this point will likely just complicate the issue when trying to get official dose increase . (it will lower TSH further . meaning you'll end up struggling to get them to prescribe the amount you are taking.. leading to you having to continually self source some of it , and likely have constant TSH arguments whenever you need the GP for anything .
if you end up with below range TSH but they understand how you got there, and they were involved in the process , it makes it somewhat easier to hold your ground in the ensuing TSH. arguments.
also, since you left so long from last dose , your fT4 level is not really as low as that result appears. it would be better to re-test properly so you know what your 'usual fT4t levels really are. (and get in the habit of doing it that way so future test are properly comparable).
If you normally take levo at bedtime, there are a couple of ways of doing it:
simplest is : night before test , just bring dose forward by a few hrs to take it 12 hrs before test . (12 hrs is long enough to avoid the peak which happens during first 6 ish hours after taking tablet , fT4 level is near enough to it's lowest level after 12 hrs and doesn't fall much further between 12 -24hrs , so personally i prefer this method for simplicity even though it's going to be very marginally higher than it would be at 24 hrs ) ... (edit >> or as SD mentions below, take half dose am and half dose bedtime ~ and go back to just bedtime after test ~ i do this one as i already split my levo am / bedtime every day anyway )
a more complicated method is: to do what slow dragon usually suggests for delayed timing over previous 2 days to give 24hrs ( which effectively misses one whole dose out and puts it back straight after test, which i find a bit of a faff to remember , and is still not quite representative of 'usual' fT4 levels because you haven't included that delayed dose)
however if you are still intent on DIY increasing, smaller is better once you are getting somewhere near what could be a full dose , so i'd definitely go with 12.5mcg rather than 25mcg at this point . but honestly however tempting it is to increase now , with TSH as low as that , it will probably be much less hassle in the long run to just wait a bit longer for your TSH to rise .
I've always tested like this, but I will change it next time. Thanks for all the different options.
Yeah, you're right about have to weigh it up against how to strategically get the doctor on your side. .I am feeling quite well, probably not quite there, but I can definitely manage like this for a good while. So there's no rush in having to increase. I'll think it through.
Thanks SlowDragon . I do try and make it as easy to read all the info you might need. So I'm glad it's helping.
I skipped one dose of Levo (which I take before going to bed), and had the test in the morning. So 36hrs after my last dose. Test was before 9am on only water indeed.
Are you recommending that I wait to increase until TSH has gone a bit up again?
I take 50mcg from Hillcross and 25mcg from MercuryPharma. I can't always get the same brand, and this is the first time I've had Hillcross.
I could probably do better on eating red meat. I've added pate to my diet now. And apple butter (high in iron). Ferritin was 62.4 (30-169) last November.
I skipped one dose of Levo (which I take before going to bed), and had the test in the morning. So 36hrs after my last dose
So Ft4 is false low as 36 hours is too long
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
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