Help with results, managing hypo please

Hi, could someone advise me on what they see looking at my results, I'm feeling worse and worse each month, gaining weight (eating/craving sugar sugar sugar which I'm sure is the culprit)

29 Feb

TSH 5.98 (0.35-5.5)

FT4 10.7 (11-23)

Vit D 64 (>50)

17 March

TSH 3.44

TPOab 1300 (0-60)

25 April

TSH 5.05

FT4 12.3

B12 454 (190-900)

Folate 10.3 (2-19)

Ferritin 65 (20-250)

Vit D 56

Started 25mcg levo after April appointment

31 May - Blue Horizon results

TSH 3.77 (0.27-4.2)

FT4 11.82 (12-22)

TT4 81 (64.5-142)

FT3 4.34 (3.1-6.8)

TPOab 291.5 (<34)

TGab 432 (<115)

Vit D 47 (insufficient 25-50)

B12 232 (insufficient 140-250)

Folate 12.3 (10.4-42.4)

Ferritin 70.5 (20-150)

Started iron, b12, b complex, Vit d after blue horizon

16 June

TSH 4.54

FT4 11

B12 1044

Folate 8.2

Ferritin 45

Dr advised I reduce b12 to 3 times a week after June result

Upped levo to 50mcg after June app

18 July

TSH 4.03

FT4 11.1

B12 502

Folate 7.8

Ferritin 51

4 Replies

  • misslissa First of all, ignore your doctor and get that B12 back up to 1000. Supplement 7 days a week for now and when back to optimal level try reducing to 5 days a week.

    Assuming folate is in the range 2-19 again, 7.8 is not good enough. It should be at least half way through the range so at least 10.5.

    Assuming ferritin is in the range 20-250 again, 51 is not good enough. Again it needs to be half way through range so aim for 135, although 70 is the minimum required for thyroid hormone to work, preferably more.

    Your FT4 is still too low for a treated hypo patient, it should be in the upper third of the range so 19+ in the range of 11-23. Although your TSH is no longer over range, it is still too high. The aim for a treated hypo patient is 1 or below or wherever it needs to be for your FT4 and FT3 to be in the upper part of their ranges.

    You need an increase in your dose of Levo which is what your GP should be doing as you have only been on it since April ie start Levo > test after 6-8 weeks > adjust dose > retest after 6-8 weeks > adjust dose of necessary > retest after 6-8 weeks > adjust dose if necessary etc., until you find the dose that gets your test results in the right place and symptoms improve.

    ETA: are you supplementing ferritin and folate? If taking B 12 you should also take a B Complex to balance the B vits and if you get something like Thorne Basic B or Jarrows B Right they both contain 400mcg folate which will help raise your folate level.

    Also, I see you have very high antibodies. Have you started a completely gluten free diet to help reduce the antibody attacks? Supplementing with selenium also helps reduce the attacks.

  • Hi, yes I'm on Jarrows b12, Solgar high potency b12, Vit d, selenium, magnesium and Solgar gentle iron. Been taking since end of April.

    Seeing GP tomorrow but I'm nervous about it with TSH not being out of range. You know how these GP's only care about that.

    My concern is that I've been feeling more tired, more achy, generally look crap with bad skin. Then the worst I think is my mood, I'm getting incredibly depressed and very very irritable. My moods aren't fair on my family.

    No I'm not gluten free.

  • misslissa I think you mean Solgar high potency B Complex :) . I've just had a look at that and I'd advise you to change it. Solgar B complex 50 contains folic acid and you really should be taking one with methylfolate, as the Thorne and Jarrows ones I mentioned above do. Folic acid is synthetic and folate is natural - see here why folate is better and scroll down to "Synthetic, huh? What are the Concerns?".

    Your high antibodies mean you have autoimmune thyroiditis aka Hashimoto's disease. With Hashi's, symptoms and results will fluctuate as and when antibodies attack. To reduce the attacks you need to be completely 100% gluten free. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. Supplementing with selenium is also supposed to help reduce the attacks, are you taking 200mcg?

    Here are some articles about Hashi's:

    If your GP doesn't want to increase your dose of Levo, there is an article by Dr Toft, past president of the British Thyroid Association and leading endocrinologist which says:

    "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.

    This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

    If you email she will let you have a copy of the article which you can print out and show your GP.

    Once you are on an optimal dose of thyroid hormone, your symptoms should improve, but you need to learn all you can so that you can have useful discussions with your GP and not let him keep you at a level where you still feel unwell.

    And going scrupulously gluten free (no cheating) should help enormously, many members have benefitted from doing so, some also need to be dairy free.

    Unfortunately we need to be proactive, learn as much as we can and help ourselves because there are a lot of doctors who don't know enough to help us.

  • Thank you, lots of info there. I am taking the Jarrows b12 as well as the Solgar b complex. So I should change to thorne or Jarrows for the complex you think?

    I am taking 200 selenium.

    I'll email Louise for that article, hoping I won't need it but I'd like to have it all the same.

    I'm reading and reading, slowly getting my head around it all but it's hard to absorb it all and make it sink in!

    I want levo to work but considering I've felt gradually worse since starting it I'm not feeling that positive. I'm thinking about NDT but don't want to give up on levo without a fair trial.

    Dr's in the morning, could I jump up to 100mcg now do you think or does it have to be in 25mcg increments?

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