Thyroid UK

Advice appreciated for appointment with GP today - thanks

I was diagnosed with UAT in March and have been taking 25mg of Levo since. My TSH has gone from 6.6 to 2.3 in May to 1.9 last week. Whilst I do feel better in some ways, I wouldn't say I'm 100%. The main things for me are a foggy head (though it is a bit better) dry and very itchy legs, and a sluggish/gurgling/bloated digestive system. I spoke to my GP on the phone after the last results, and he said that some people don't feel better until their TSH is below 1, so to make an apt to see him after the next set of results. However, as my TSH has decreased to 1.9 now, I'm thinking he might not agree to give me a higher dose at this stage as it still seems to be going down.

Am I being impatient, is 4 months too short a time for symptoms to have improved/gone? Also, on 3 or 4 days where my digestive system has really been playing up I've taken an extra tablet mid-afternoon and it has seemed to help ie I've not felt as terrible as normal after dinner - but is that actually possible?

The doc also thinks it's likely I have PCOS, though I have tested negative for insulin resistance, so I'm wondering if thyroid issues could be causing the sex hormone imbalance.

Sorry that's a bit of a ramble, but any advice on how to handle the appointment would be very much welcomed.



6 Replies


Your GP is very right. Many people don't feel better until their TSH is below 1 and some don't feel better until it is below range. An increase in thyroxine sounds like a good plan. It may make you feel very much better.

Low thyroid hormones can cause sex hormone imbalances and insulin resistance and many other things. You may find that you do start to feel better some months after getting your thyroid hormones sorted out. It can take a while though.

Please do ask for your serum iron, ferritin (stored iron), vitamin B12, folate and vitamin D to be checked. Because hypothyroidism can cause some issues with low stomach acid, you may not be absorbing as much as you would normally. Suboptimal levels of iron/ferritin in particular can mean that you don't use thyroid hormones very well. There is also recent evidence to suggest that non-anaemic women who have ferritin levels below 50 benefit from iron supplementation. This could be part of the missing link for you.

I hope all goes well with your GP :)

Carolyn x


Thanks for the information Carolyn. It's particularly reassuring to know that my thyroid could be causing the PCOS symptoms, I will ask the doctor about it.

Emma x


He may disagree with you, but the thyroid does affect every system in your body so he really ought to agree that it is a possibility. Once you are on the correct dose of thyroid medication and it doesn't sort itself out, it might be worth looking at PCOS. It is a possibility.

Do you have low progesterone levels? Is that why they are thinking PCOS? Oestrogen dominance/low progesterone are relatively common in hypothyroid patients for some reason.


I've just replied to Shaws' post below before seeing yours. He confirmed the diagnosis of PCOS today as I had an ultrasound a few weeks ago which showed multiple follicles, and my blood test results showed elevated testosterone and LH (I think it was). He has told me to read about Metformin and discuss it next time I go so I will have a look at that, but I'm crossing my fingers that in the meantime things will improve.


Emma x


I am not medically qualified but will say I think your dose of 25mcg is still too small, unless you are very frail. If you cursor to the question dated June 8, 2001 to read the answer. You may have to copy and paste the link as I don't think they work yet with this new system.

This is an extract from Pulse Online by Dr Toft ex of the BTA:-

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

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.

I cannot link to the following but for your information I have copied this re PCOS:-

Multiple Ovarian Cysts as

a Major Symptom of Hypothyroidism

The case I describe below is of importance to women with polycystic ovaries. If

they have evidence, such as a high TSH, that conventional clinicians accept as evidence

of hypothyroidism, they may fair well. But the TSH is not a valid gauge of a woman's

tissue thyroid status. Because of this, she may fair best by adopting self-directed

care. At any rate, for women with ovarian cysts, this case is one of extreme importance.

In 2008, doctors at the gynecology department in Gunma, Japan reported the case

of a 21-year-old women with primary hypothyroidism. Her doctor referred her to the

gynecology department because she had abdominal pain and her abdomen was distended

up to the level of her navel.

At the gynecology clinic she underwent an abdominal ultrasound and CT scan. These

imaging procedures showed multiple cysts on both her right and her left ovary.

The woman's cholesterol level and liver function were increased. She also had a

high level of the muscle enzyme (creatine phosphokinase) that's often high in hypothyroidism.

Blood testing also showed that the woman had primary hypothyroidism from autoimmune


It is noteworthy that the young woman's ovarian cysts completely disappeared soon

after she began thyroid hormone therapy. Other researchers have reported girls with

primary hypothyroidism whose main health problems were ovarian cysts or precocious

puberty. But this appears to be the first case in which a young adult female had

ovarian cysts that resulted from autoimmune-induced hypothyroidism.

The researchers cautioned clinicians: "To avoid inadvertent surgery to remove an

ovarian tumor, it is essential that a patient with multiple ovarian cysts and hypothyroidism

be properly managed, as the simple replacement of a thyroid hormone could resolve

the ovarian cysts."[1]


1. Kubota, K., Itho, M., Kishi, H., et al.: Primary hypothyroidism presenting as

multiple ovarian cysts in an adult woman: a case report. Gynecol. Endocrinol.,

24(10):586-589, 2008


Thank you, that's really helpful. My doc agreed to up my dosage to 50mg but did warn me that if the results show I am over medicated in a couple of months he will reduce it again, even if I'm feeling better. So we shall see! He said he didn't think there was a link between hypothyroidism and PCOS but I'm really hoping the increased dose will kick start my pesky ovaries into behaving!

Thanks again


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