Blood Results

[gedpolar]

My results are TSH level 0.05 T4 level 22.5 serum free 5.7

have been on lenvo 200mcg for 18yrs Gp says am overtreated am 45yrs with TT Want will he put me on now Thanks x

[shaws Administrator]

The first question I will ask is - how do you feel. If the answer is 'well' you are on the right dose.

My TSH is 0.01 and am well. If you need a copy of the Pulse online article to show your GP, email [e-mail] (she doesn't work weekends).

This is what Dr Toft, ex of the British Thyroid Association says:-

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

****

These are a couple of excerpts

If you’re new to the use of thyroid hormone, and you’re up to a dose that should be working for you, but you’re not benefiting from it, be sure to let your doctor and your pharmacist know. The dosage range that’s safe and effective for most patients is between 2-to-4 grains (120-to-240 mg) of desiccated thyroid. The equivalent dosage range for T4 is 200-to-400 mcg (0.2-to-0.4 mg).

and cursor to January 25th 2002

If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours.

web.archive.org/web/2010122...

[FallenAngel in reply to shaws]

I too have TSH 0.01 and my endo says its too low ... have they ever said this to you and why it is low? Thanks

[gedpolar]

Thanks for ur reply at this moment I am tired dizzy just not myself not sleeping bit down thats why GP done me bloods coz of how long I,ve been on meds thort my body was rejecting meds goin to GP on Tues do u think he will lower my dose also forgot to say I was discharged from my consultant 10yrs ago so GP dealing with me shud I ask to be referred back to the hospital again thank you x

[shaws Administrator in reply to gedpolar]

Ask to be referred as you are suffering hypo symptoms. Maybe the Endo will add some T3 which may make you feel better. If he suggests lowering tell him that Dr Toft ex of the British Thyroid Association has said in an article in Pulse online says the, and if he would like a copy tell him you will provide one. You can have a suppressed TSH if you are still feeling rough or the addition of T3.:-

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

[gedpolar]

Thank You so much I will speak to my GP xx

[Jackie]

Hi From those results, high T4, it looks like you need a litlle less T4 ( levo) and some T3, first essential to have a Free T3 test. it helps all the symptoms especially weight. There was no T3 available when you started treatment.Often at any time, the body can stop converting enough T4 to FT3,hence the problem. It does slightly lower the TSH, so you may find you need to see an endo to have it, GP`s scared of it,,like most drugs! Start low dose, always split into 2, 12 hours apart, then bloods again 6 weeks ,increase if needed. It is always better to also start lower than prescribed for the first few days, as powerful and can cause side effects.

Best wishes,

Jackie

[gedpolar in reply to Jackie]

Thank You Jackie am seeing my GP Tue xx