Hi Elaine, I am at a watershed moment and in need of your valued advice once more. I have been on Block and Replace about 8yrs.for Graves /TED. Started on 20mg. Carb/50mcg. Levo. TSH has been bottom of range or just under . To feel well, I have learned I need fT3 half way through range so have made slight adjustments over the years.
Jan 2023, on 5mg C/75mcg.L - TSH 1.18/ fT4 half way in range / fT3 37% . I had hypo symptoms so upped Levo to 100mcg.
March - TSH 0.06/ fT4 87% / fT3 58% .
July - TSH 0.05/ fT4 61% /fT3 37%. I feel hypo symptoms creeping back.
I test negative for TG and TPO. All vits. optimal. I presume I have TRAb Blocking antibodies dominating. Would you advise I stay where I am , increase my Levo again or as I am tempted to do reduce Carb to 2.5 and see if that raises my fT3 .
Thanks for your support

Hi Annie,
You could do either but I like the block and replace protocol where you eventually stop the carb and remain on levothyroxine alone. For that reason I'd probably lower carb to 3.75 and if that doesn't help, then to 2.5. TSH is very misleading because of the TSH receptor antibodies falsely lowering TSH. Even a level higher than 0.5 during treatment is unusual and suggests too high of an anti-thyroid drug dose.
Best to you, Elaine