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Should the amount of my thyroid med be lowered?

on 75 MCG/ML liquid Tirosint.  My doctor wants to lower it to 50MCG/ML What do you think based on my blood test results?  Anytime my medication is lowered I am concerned about experiencing depression and brain fog.                      TSH is 0.23, Reference Range .3-4.7, Optimal Reference Range 0.5-2                                                                  Free T4 is 1.5, Reference Range .8-1.7, Optimal Reference Range 15-23 pmol/L,                                                 Free T3 did not do Optimal reference range 5-7 pool/L,                                                                                          TG Ab 12.4 Reference Range < 4.0, Optimal Reference Range < 2 IU/mL,                                                         TPO Ab 32.5 Reference Range <=20, Optimal reference Range < 2IU/mL                                                             *All Optimal Reference Range's from Dr. Izabella Wentz, thyroidpharmacist.com
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Avatar universal
A couple of things before further discussion.   First, do you take your Tirosint in the morning before the blood draw for your thyroid tests?  Second, please give me the range on the lab report for FT4.  Why wasn't Free T3 done?  FT3 is very important and is likely too low due to reduced conversion of T4 to T3 when taking T4 med.   Have you been tested for Vitamin D B12 and ferritin?  
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I took my Tirosint at 6 a.m. and my blood was drawn at 3:30 pm that same day.  After this is it preferable that I not take my thyroid med the day my blood is drawn?  FT4 Reference Range .8-1.7   My eno doctor does not think FT3 important (conventional doctor) and I did not know that he was not testing it.  I asked and he agreed to test FT3 in my next test that I take in 6 weeks after being on a reduced dose of thyroid med.  When tested 2 months earlier on a different thyroid med my vitamin D was 49, reference range 30-100, B12 was 1169, reference range 200-1100, and ferritin not measured.  My iron was 66, reference range 45-160  thank you!
No you do not take thyroid meds 12 hrs bfor a test same with Iron you do not take iron supplements 2-3days prior to testing . Your vit D is low you need to take Vit D3  gel 10,000 with k2/100 mg .
Iron panel should be done : Iron : Ferritin: %serum: TIBC SERUM  ffs endos are killing you all slowly
Avatar universal
With regular T4 medication, 4 hours after a daily dose, FT4 levels are 13-36% higher than the 24 hour trough, and FT3 levels are about 8% above trough.  I am not sure what the remaining effect would be at the time of a blood draw 9 1/2 hours after taking the med: however, even the ATA/AACE suggest not taking thyroid med the morning of the blood draw for thyroid tests, in order to avoid false high results.  

Your FT4 result of  
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Avatar universal
Your FT4 result of  1.5 is well up in the range; however, you need a FT3 test as well.  They need to both be taken into account.  Even more important than lab tests is how you are feeling.   Were you having any symptoms when the doctor erroneously decided to reduce your med dosage based on your TSH level?   I say that is wrong because our bodies  get a continuous, very low flow of thyroid hormone in the untreated state. When you take a significant dose of thyroid med all at once it spikes FT4, and to a lesser degree FT3, which then suppresses your TSH level for most of the day.   So it is the dosing procedure, not the dose itself that causes TSH suppression.   I have some very useful info on all this.  I will sen a PM.  To access, just click on your name and then click on messages.  

Further Vitamin D should be at least 50, so yours is okay.  B12 is somewhat higher than needed.  Ferritin is  a storage form of iron that is readily available for use.   Ferritin is a precursor to serum iron levels and it needs to be tested also.  Ferritin is very important for a hypothyroid patient and should be at least 100.  

A good thyroid doctor will treat a hypothyroid patient by raising FT4 and fT3 as needed to relieve hypo symptoms, without going too far and creating hyperthyroid symptoms.  Typically this reuires FT4 at mid-range, and fT3 in the upper half of its range and adjusted from there as needed to relieve symptoms.  With the info I can give you perhaps you can convince your doctor to change his dosing procedure and get your levels adequate.   IF not then you will need to find a good thyroid doctor that will do so.  
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D levels shoukd be 70-100 for women where are you getting your info? Fre T3 needs to  be 3.8 to be optimal in t3 if on NDT , on t4 meds only its no going to be near optimal or in a good range
Avatar universal
Thats def not from Isabella wentz optimal  free T4 is def not over 3 and Free T3 optimal is 3.8 and if on NDT your TSH should be close to zero,not on any meds TSH should be no higher than 4  anitbodies should be 0 .
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Avatar universal
If you were asking me where I get my info, it is from my research, and my paper linked below.  The paper was written with two co-authors, one of which is a widely known and respected doctor from Germany, who has cp-authored over 100 scientific papers, mostly on thyroid issues.  

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

Due to the number of different steps in the total thyroid process, and their related confounding variables, TSH has a negligible correlation with a score of typical hypothyroid symptoms.  Serum FT4 and FT3 have only a fair correlation with those same symptoms,  due to some of those same variables, plus the inter-individuality among hypo patients.  As a result,  one size does not fit all.  Hypo symptoms must be all important, since that is the cause of patient concerns.
FT4 and FT3 levels are a general guide, but hypothyroid patients must be treated as needed to relieve hypo symptoms.
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