Results not altered despite dose increase

[Impalpable]

Hi there

I was wondering if anyone could help me. I was on 75mcg of levothyroxine and advised my GP that I was still feeling tired (results TSH 1.92, FT4 16.6) so he agreed to increase the dose to 100mcg.

3 months later and my results are almost identical, TSH 1.98, FT4, 16.8.

I am trying for a baby and have had one confirmed miscarriage and two suspected very early miscarriages. My GP advised that it could do me more harm to increase levothyroxine as my results havent changed but I am worried as I still experience some symptoms (although I am better than I was) and I would like to conceive a baby.

Does anyone know more about this and whether I should seek a second opinion or does that sound right?

I have increased my activity level significantly in those 3 months because I've started to feel better.

Many thanks for any help.

[humanbean]

Your TSH is too high, and you need an increase in your levo.

Something that may be of interest :

eje-online.org/content/143/...

If you look at :

Table 3 TSH - median, 2.5 and 97.5 percentiles in persons without known thyroid disease or diabetes

You can see that in healthy women who are under 40 the median TSH is 1.40. (Median is the number for which 50% of people are lower and 50% of people are higher).

You could print out the paper and show it to your doctor if they would be amenable to reading it, and you could point out the relevant table.

One thing that isn't well known is that TSH does not follow a normal distribution pattern. It is highly skewed towards the lower end of the range. To explain what I mean...

You can see this in the paper I linked above. The reference range for females under 40 would be 0.37 - 5.09 with the people, test and equipment used in the research paper. Finding the middle of that range would give a figure of 2.73. But as I pointed out earlier, the median is 1.4 i.e. much lower than the middle of the range.

You could try another 25mcg of levo and I think it is extremely unlikely that you would drop below the TSH range or go over the FT4 range.

[Impalpable in reply to humanbean]

Thank you so much for your reply. I am paying privately to the gp at the moment so I might go back to the nhs and try and point out what you have just told me. I'm not convinced by my current gp. Such a battle isn't it! Thank you again.

[humanbean in reply to Impalpable]

Actually, I've just realised I was using the numbers where people with positive antibodies were included in the analysis.

If you look at the results where people with antibodies were excluded the results are :

For women under 40 the reference range is 0.37 - 3.3, the median is 1.3 and the middle of the range is 1.835.

[faith63]

Your doctor doesn't know what he is talking about. You should get a free t3 levels tested as well. T4 meds alone, don't work for many. I would go to a fertility clinic..maybe they have better thyroid treatment, but doubtful. Do you have Hashimotos? Important to know, because antibodies cause infertility in themselves not just the dose of thyroid.

[Impalpable in reply to faith63]

Thank you for your reply.

The radiologist said during the appointment that I had an autoimmune disease 'like hashimotos', I am positive for thryoglobulin antibodies but not the other type. I've had a bit of a rocky-ride with the whole thing and when I brought my results from the endocrinologist and his reccomendations to my GP he was verbally abusive and accused me of faking blood tests etc, so no one has ever really explained what hypothyroidism is, or what I ought to be doing or what type I have (I have googled).

My husband and I have discussed a fertility clinic, I think perhaps you are right, I want to give myself the best chance.

At first I felt much better on medication but my symptoms are slowly creeping back although I am able to do alot more than before treatment.

[faith63 in reply to Impalpable]

Please stay away from that GP and report him! Look at the website Hypothyroidmom..it has good info on pregnancy and Hashi's. Many on there, including the website owner has had multiple miscarriages and there are guidelines for treatment to prevent this on the website..check it out! Good luck!! Let us know what happens.

[Impalpable in reply to faith63]

I'm not sure I worded it all properly, the verbally abusive GP has left the health centre now and I haven't been back since. I have just filed a complaint to the NHS with about 40 pages of attachments (surgery brushed off my complaint). Very confusing but seeing another Dr now.

Thank you for the information about hypothyroidmom, thats really useful to know, I will look at that today.

[Impalpable]

I went to speak to the Dr at a new NHS health centre and he recommended we reduce the dose when I said I started to say I was trying to conceive and he wants to do another blood test in one month.

He wrote out a one month pescription for the 100mcg when I said I was feeling much better on that dose but theres no chance he will increase it.

I have a feeling theres some terrible comments about me on my nhs file by the crazy Dr making things really hard for me.

[Angel_of_the_North in reply to Impalpable]

You need a TSH of less than 2 in order to conceive and carry to term, and you are only just under that and not getting lower. I'd go for an increase if you still feel unwell and ask for an endo referral (and possibly fertility clinic also).

[ld31]

Thing is although I take 200 micro grams a day, I don't feel tired, I suffer from bad insomnia.