Some advice please!

I have just been diagnosed with hypothyroidism and have been taking 75mg of Levothyroxine for six days but to no effect. My test results were very low: T4 <3.9 and TSH level 146. I am having another blood test in four weeks but wonder if I should ask to go on a higher dose before as I am feeling so dreadful and finding it extremely difficult to function.

10 Replies

  • Welcome to the forum, Vcle1909.

    It takes 7-8 days for Levothyroxine to be absorbed before it starts working. Improvement will be slow because it takes up to 6 weeks to feel the full impact of a dose. TSH 146 is very high and FT4 3.9 very low. It will take a few months before you are on an optimal dose as increases are usually in 25mcg increments every 6-8 weeks. Most people are comfortable with TSH just above or below 1.0 and with FT4 around 18-22. Symptoms may lag behind good biochemistry by a couple of months.

    Leave 24 hours between last dose and blood draw. It's usually advised that people wanting a dose increase have an early morning fasting blood test (water only). I don't this will be necessary for you next blood test because TSH is likely to remain quite high although considerably below 146.

    For maximum absorption Levothyroxine should be taken with water on an empty stomach, 1 hour before, or two hours after food and drink, 2 hours away from other medication and supplements and, 4 hours away from iron, calcium, vitamin D and oestrogen. Post your results in a new question with the lab ref ranges (figures in brackets after results) and members will interpret and advise whether you need to supplement.

    Vitamin and mineral levels become trashed in thyroid patients. Ask your GP to test ferritin, vitamin D, B12 and folate when your next thyroid blood test is done. Low/deficient levels cause musculoskeletal pain, fatigue and low mood similar to hypothyroid symptoms.

  • As Clutter says :)

    Just one point. 18-22 is a good value for the more common reference ranges for t4 but they do vary. For example, the reference range for my T4 results is 7.8-14.4 so 22 would be too high. Most ranges are around 11-20 or 25 though. Basically most people do best with t4 near or even just above the top of the range.

    I hope you start to notice some improvement soon.

  • Thanks for your advice, I guess I will have to be patient. I was tested for B12/folate levels and they were okay. I do ache and am extremely tired so will ask to have other levels checked next time too. I have just been reading about foods to avoid so will follow that advice too.

  • Do you know what your B12 and folate levels were? The ranges are very wide for those particular vitamins and you can have symptoms if your B12 is below 400 or 500 (depending on the units of measurement) or your folate is below 10-12.

  • Vcle1909, get into the habit of asking for test results with the lab ref ranges. Normal, fine or okay usually means they are somewhere within range which isn't same as optimal.

    You are going to have to exercise patience, which is easier said than done, because thyroid treatment and recovery takes a long time. In the meantime try to get 8-10 hours sleep and if you can nap during the day to cope with fatigue you should do so.

    The only food which is a real no-no is soy (except fermented soy). Raw cruciferous veg may be goitrogenous but lightly cooking them can destroy the goitrogenous properties. If thyroid antibodies have been tested and are positive 100% gluten-free diet may be beneficial. Ask your GP whether antibodies have been tested, preferably thyroid peroxidase (TPOab) AND thyroglobulin (TgAb) antibodies as it's not uncommon for TPOab to be negative but TgAb positive for autoimmune thyroid disease (Hashimoto's).

  • Vitamin B12 was 414

    Folate was 3.6

    What do you think?

  • You need to put the range which will be in brackets for folk to give their opinions. Different labs have different ranges so knowing the range is the only way to know where your figure sits within the range.

  • You ought to get vitamin D and ferritin checked too. both those results look low to me, but it's hard to be sure without seeing the reference ranges.

  • Please see y other response to you

    Your TSH and the state your body is in will not resolve on levothyroxine

    You need t3 liothyronine but either way nothing can be a quick fix

    It takes time to repair the damage done by an underactive thyroid which must have taken years to develop unless you had RAI or surgury or a catasthrophic accident of some kind

  • Hang in there! It has probably taken a long time to get to the stage where you were diagnosed, sorry but it will probably take a long time to improve. Sometimes you feel worse after about a week on a new dose then improve only to have another low.

    It is not like taking painkillers or antibiotics which act promptly, your body has to have time to readjust. I would suggest that before you look after yourself, eat sensibly possibly adding some iron and B vit rich foods and see how you are in about 3 months.

    It is easy at the beginning to get overwhelmed by all the information and to dash from one potential fix to another when what you need is to support your body whilst it sorts itself out. Sadly it is a lifetime problem so there is plenty of time to find what suits you

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