Advice please on failure to respond to thyroxine.

My husband has masses of hypo symptoms and was diagnosed when his TSH was 6.

He's been increasing his dose of levo gradually, and is now on 150mcg, but his symptoms remain the same.

His serum TSH is now suppressed at 0.01 (0.3-4.2);

serum free T3 is 5.3pmol/L (3.1 - 6.8)

serum free T4 is 26.2 (12-22);

These figures seem to indicate overmedication, but he has no hyper symptoms.

Does anyone have any thoughts on this please?

[shaws]

Maybe if the GP added some T3 to his levo which may make him feel better. I was more ill on levo but as soon as I stopped it and took T3 alone I began to recover and eventually I added some NDT but had to go private.

My TSH is the same as your husbands and I feel well.

[shaws]

This is an excerpt from Dr Toft ex of the British Thyroid Association:-

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.

[Hidden in reply to shaws]

Thanks Shaws - that provides useful ammunition for a forthcoming endo appointment.

[Jackie]

Yes I agree with shaws, may be he needs a little less T4 and some T3, Most people need FT3 near the top of range and T4 top third, rough guide, the main criteria is how he feels. Do not hesitate to ask for a referral, to a good endo, of your choice, not the GP`s.

Best wishes to you both,

Jackie

[Hidden in reply to Jackie]

Thank you - there does seem to be a consensus emerging here, and I'll encourage him to push for the T3.

[Heloise]

You could go down this chart to a low TSH and high T4.

drrind.com/therapies/thyroi...

[Hidden]

Thanks Heloise. Not sure what to make of this. The chart would suggest he has early stage Hashimotos, but I'm sure he doesn't as he doesn't have elevated antibodies.