Just had preoperative nurse on phone telling me i need to speak to GP about my bloods. It has been that long that anyone has questioned them that it has thrown me a bit!
TSH 0.05 (bottom range 0.3)
Free t4 25.5 (top of range 22.6) roughly this time last year it was 20.
No t3 done. Last time in 2016! It was 5.1
My TSH has been suppressed for ages but free t4 all within the range but now it has tipped over. Does this mean I'm over medicated? I'm on 175mcg Levothyroxine. Also take folic acid, iron, b12 injections, vit d.
Thanks
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Eoperez
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How do you feel? Yes, free T4 is over-range and TSH is suppressed, but if you feel great I would be most reluctant to reduce levo - at least until you know where free T3 is ... so you really need free T3 testing.
If free T3 is over-range, yup you're over-medicated; but if free T3 is top third of range and you feel great, I'd say you should stay on your current dose.
If free T3 is low in range and you don't feel great - and key nutrients are all good *quite likely if you are supplementing) - that means you have a demonstrable "poor conversion" problem and are likely to benefit from a reduction in levo AND the addition of lio - so need a referral to an endo ...
That means getting the list of T3-friendly endos from Dionne at Thyroid UK - tukadmin@thyroiduk.org - as not all endos will prescribe lio even if you clearly don't convert well.
Thanks. If they try to reduce my dose, like they usually do, I'll ask them to test my t3 first. I never feel great but that's cos I've got other health issues going on Really appreciate the advice, thank you & merry Christmas x
The only way I can feel functional on levothyroxine is if my T4 levels are over the range but my actual thyroxine levels are only mid-range so system-wide I'm not over medicated. My T3 levels were also low again which proved that I wasn't over-medicated. It's all about how you feel.
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Never ever agree to dose reduction based just on TSH and Ft4
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
I do usually have them first thing and fasted, but this was late afternoon at a pre-op assessment appointment. I'm sure all will be ok when I speak to my usual GP as she is more understanding than most. But if I have any problems getting t3 tested I'll look at the private options. Thanks
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and B12 last tested
I wouldn't but know my GP based on numbers will say I'm over medicated! Will ask them what ferritin was at hospital and look at private vit d test. Thank you
Can't remember the last time I felt great like normal people! Feel like I'm not drowning in treacle as much as I was but on my better days I tend to over do it! But generally I feel like crap!
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Really appreciate the advice, thank you & merry Christmas x
Is tsh alone enough to diagnose?
Downward trend of T4 and upward trend of TSH, but doctor reluctant to prescribe thyroxine 
