Results and treatment

[lisan1]

I was just diagnosed.

My results are

Tsh 5.6 ( upper ref 5.5)

Free t4 12 (10-19)

Free t3 3.8 (3.5-5.3)

Ferritin was 39

I have started 25mcg levo. I've also started taking Ferrous Fumarate 3 times daily to increase my ferritin. Will this be enough for me to feel better so you think ? How soon will I see an improvement ?

[SeasideSusie Remembering]

lisan1 25mcg Levo is a starter dose. Hopefully you have been told to book a re-test for 6-8 weeks' time, the results of which should prompt an increase in dose of 25mcg, then another re-test after another 6-8 weeks resulting in another increase of 25mcg, and so on until you settle on a dose where your symptoms abate.

Your TSH will lower and your FT4 will increase. The aim for a treated hypo patient is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well. Don't let your GP dose by test results alone, a lot of doctors believe that once your results are in range, regardless of where in the range they are, then you must be well and if you still have symptoms it can't possibly be your thyroid!

When having your next test, ask for thyroid antibodies to be tested also, this will rule out (or in) autoimmune thyroid disease. The antibody tests are Thyroid Peroxidase and Thyroglobulin. Also ask for the following vitamin and mineral tests:

B12

Vit D

Folate

These all need to be optimal (not just in range) for thyroid hormone to work properly.

When making an appointment for future blood tests, always book the first appointment of the day, fast overnight (water only) and leave off Levo for 24 hours. This gives the highest possible TSH which is what you need for a dose increase. Take Levo and have breakfast after the blood draw.

As for taking your Levo, always take it on an empty stomach, one hour before or two hours after food, with water only. You can take it at what time of day suits you as long as it's on an empty stomach and away from other meds and any supplements by a couple of hours.

Your ferritin needs to be half way through it's reference range, with a minimum of 70 for Levo to work properly.

As you are taking iron supplements, you should take each tablet with 1000mg Vit C to aid absorption and help prevent constipation. It's important to leave 4 hours either side of taking your Levo when taking iron supplements as iron affects Levo's absorption. That can be difficult when taking iron 3 times a day so you might need to take your Levo in the early hours of the morning but I'm sure you'll work a time out that's convenient.

It takes about 6 weeks for Levo to be fully absorbed when starting, and as 25mcg is such a tiny dose you may not feel any benefit until your dose gets increased. It can take months to really start to feel better, hopefully not that long for you.

[lisan1 in reply to SeasideSusie]

Thank you so much for your reply.

I have had these tested as well:

B12 564 (211-911)

Folate 11.68 (>5.38)

Do you think that 25 mcg could be enough for me?

[SeasideSusie Remembering in reply to lisan1]

lisan1 No, I don't think 25mcg will be enough, it is a starter dose usually given to children and elderly people or those with heart problems. Usual starter dose is 50mcg, occasionally 100mcg. You will probably end up on 100mcg, maybe more, just whatever is needed for you to feel well. Follow the advice above regarding testing and finding your optimal dose. As I said, don't let your GP dose by numbers, if you don't feel well and still have symptoms you need to be assertive and push for an increase in dose.

Folate is fine.

B12 should be at the very top of the range so 900-1000. You coukd supplement with Solgar or Jarrows sublingual methylcobalamin lozenges 5000mcg daily for a month or so then reduce to 1000mcg daily as a maintenance dose. When taking B12 we also need a B Complex to balance the B vits, look for one that contains methylfolate whichbis natural rather than folic acid which is synthetic and requires the body to convert it to folate (which we're not all good at doing).

You really need Vit D testing, either ask your GP or do a home fingerprick blood spot test through City Assays for £28 vitamindtest.org.uk/vitamin... The recommended level is 100-150nmol/L.