Higher dose of medicine?

[Grammy00]

I take 88 mcg of Levothyroxin daily. My blood work was recently done with the following results:
T4 Free: 0.78
TSH: 0.89
Does this indicate a higher does of medicine?
I am sluggish, no energy, and cold all the time.

[Grammy00]

Thank you for the information. I will be contacting my doctor!

[Barb135]

The range your lab is using is quite a bit different from those we, typically, see, but I was right; your FT4 is very low.  Rule of thumb for those of us on thyroid replacement hormones is to have FT4 at about mid range; yours is only at 19% of its range. To reach mid range, it should be about 1.1. so yes, this indicates that you need a higher dose.

The problem is, that TSH is not a thyroid hormone; it's a pituitary hormone and is merely an indicator of actual thyroid status, so it's a very unreliable tool for determining dosage. FT4 isn't used directly by the cells; it must first be converted to FT3, which IS used directly by the cells.  Some of us don't convert adequately, by not testing FT3, you aren't getting the full benefit from your lab work.  You should talk to your doctor about testing FT3 next time you have lab work done.

You should also talk to your doctor about testing thyroid antibodies to determine whether or not you have Hashimoto's Thyroiditis.  Hashimoto's is the most common cause of hypothyroidism in the developed world.  Your treatment won't change, but at least you'll know that if you have Hashimoto's, your dosage will have to be increased periodically, in order to keep up with the destruction of your thyroid.

The antibody tests to ask for are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).

If your doctor refused to test the Free T3 or the antibodies, or if he refuses to increase your thyroid med, you should probably start looking for a new one, as this one will keep you ill.

[Grammy00]

The range for T4 was 0.59-1.61.  I have taken the same amount of my medicine for several years.
No Free T3 test was done and no my doctor has never mentioned Hashimoto's.

[Barb135]

What is the reference range for the Free T4?  Ranges vary lab to lab and have to come from your own report.  From ranges we usually see, your level looks quite low, but we need to verify that, but it does appear that you could use an increase.  How long have you been on 88 mcg?

I guess it's safe to assume there was no Free T3 test done?

Do you know if you have Hashimoto's?