When will it get better?

I started taking Levothyroxine ca 3 months ago. I increased the dosage (per doctor's orders) every couple of weeks starting from 50 mcg to 150 mcg.

First is before meds, second result after 3 months.

TSH:

2.12 mIU/L

0.013 mIU/L

Range 0.4 - 4

*

FT4:

9.84 pmol/L

28 pmol/L

Range 12 - 22

*

FT3:

4.42 pmol/L

8.2 pmol/L

Range 3.9 - 6.8

*

T4:

-

122 nmol/L

Range 6 - 140

*

T3:

-

2.41 nmol/L

Range 1.1 - 2.5

What I am wondering is if it's okay that my fT3 and fT4 a little above the range? Can it be dangerous in long term?

I am feeling awfully tired most of the time, as if I am not medicated at all. So far I've only noticed that my hands and feet are warm.

I will see my doc in January.

(Edited to arrange lab results better. Wish there was a little widget for that :) )

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12 Replies

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  • zerendipity Your GP was rather stupid to tell you to keep increasing your dose every two weeks like that. The normal way is to start on 50mcg (sometimes 25mcg), retest after 6-8 weeks and increase depending on results. Then 6-8 weeks after that increase, retest again and another increase. And so on. So you have actually got up to quite a high dose in a very short time compared to normal.

    Your results show you are overmedicated. You really should drop your dose down by 25mcg and then retest in 6-8 weeks to see what your levels are like. The one to watch is FT3, that is the one which should be kept in range. Long term, over range FT3 can cause health problems.

    By the way, your conversion appears to be good. Good conversion takes place when FT4:FT3 ratio is 4:1 or less, yours is 3.4 : 1 so it appears that Levo suits you.

    One reason you may be feeling tired is that your vitamins and minerals are not at optimal levels, low ferritin in particular can cause fatigue. Ask your GP to test

    Vit D - optimal is 100-150nmol/L

    B12 - optimal is very top of range, even 900-1000

    Folate - This should be at least half way through it's range

    Ferritin - This should be at least 70 for thyroid hormone to work properly, normally half way through range is suggested, and I've seen that for females it should be 100-130.

    PS - your GP wont really understand optimal. They're not taught nutrition, so anywhere in the range, even if it's only one point over the lower end, is fine for them. But we really do need optimal levels.

  • Thank you, SeasideSusie! I will lower the dosage to 125 mcg.

    When I started treatment my ferritin was 18 μg/L (10 - 150), that was on supplements. I then switched to heme iron which has better absorption and take 27 mg a day together with magnesium and vitamin C.

    Vitamin D level is over 100 and vitamin B12 over 1000. Iron level is my main concern. My doc said that these are essential nutrients for conversion so I take supplements every day.

    I suppose I have to go and beg for a ferritin test.

    It's good to know that my conversion is good, I was worried about it. Thanks again :)

  • Good levels of most things :)

    Ferritin can take a long while to increase to a good level. If you want to boost it, and if you're a meat eater, you can add some liver if you don't already eat it. I can't tolerate iron supplements but have managed to raise my ferritin to a very good level with eating liver once a week. If you don't like liver, you can add it (minced if you like) to cottage pie, casseroles, curry, bolognese sauce, etc, and you probably wont notice it's in there. Chicken liver pate also if you like that sort of thing.

    Do you take your levo on an empty stomach, one hour before or two hours after food, and keep supplements well away from it - two hours for most supplements, four hours for iron and Vit D?

    And as Shaws has mentioned in her reply, blood tests should be done after fasting overnight (water only to drink), leave off Levo for 24 hours, and book the very first appointment of the morning.

  • I take levo on empty stomach first thing in the morning and wait at least one hour before I eat, two hours before other meds and 5-6 hours before supplements. And testing was done ca 24 hours after medicating.

    I guess I have to eat more pate because I absolutely abhor all other liver products. Luckily here in Denmark they have at least 25 different kinds of liver pate.

    Oh, and I forgot to mention the good things that have happened since starting treatment: constant fluttering in ears is gone, awful heavy periods have normalised, flaky dry skin on legs and arms has gotten much better and my limbs are warm.

  • Are you saying that you take iron and magnesium at the same time? If you do that, you won't get any benefit from either of them. They need to be four hours apart. :)

  • Yes, I take them together. Several sources say that it's good to take iron and magnesium together and then some sources say it's not. I'm really confused now :/

  • Well, as your ferritin level isn't rising very much, I would take it that it's not.

    I've always read that iron should be taken entirely on its own, apart from vit C.

  • Thank you for pointing it out. I'll take it separately from now on.

  • Hello zerendipity :)

    You can't rush this, no matter how much money you throw at it ( done that ) how hard you try to adopt healthy living practices ( been there ) you just have to wait. You didn't become hypo overnight and there is often a drag between good bloods ( and yours appear to be heading that way ) and feeling better. Hang on in there !

  • I am assuming your doctor prescribed levothyroxine when your initial TSH was just 2.12 mIU/L . That is very unusual and I think many doctors wouldn't have prescribed until your TSH was over the range. The British Thyroid Association state the TSH should reach 10 initially before a doctor prescribes. Most of us on this forum think that's ridiculous but to prescribe at a TSH of 2.12 seems ridiculous to me as well.

    Also, as others have stated. Levothyroxine should be increased around every six weeks if you have hypothyroidism. I'm not sure if you have hypothyroidism.

    When you had your first blood test after taking levothyroxine, did you leave a gap between your last dose and the test of 24 hours?

  • My doc prescribed levo based on my fT4, fT3 and anamnesis. It was almost like an interrogation. He said that my problem is sluggish pituitary, not thyroid. And mentioned that for me to feel good my TSH should be 1.4 - 2

    I did not take levo for 24 hours before testing.

  • Thank you for your response. We recommend, if Hypothyroid, a TSH of 1 or lower but as you have a different condition yout doctor knows best :)

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