Blood test advice - Am I optimally medicated with Levothyroxine?

[Crazy_CatLady]

I was diagnosed with Hashimoto’s in June, as you can see my TSH was pretty high and I had Thyroid peroxidase antibodies. My symptoms were GI-related and tiredness. My iron was also low. So I’ve been taking iron supplements since June, and started taking levothyroxine. I started on 25mg, had blood tests every 6 weeks and have had the dose increased by GP gradually since – I did have to tell her I wanted it increasing from 50mg in October when the TSH was 2.53, she seemed to think that was OK. I have attached a summary I made of all my pertinent test results since June (I do like a spreadsheet!)

At my last test a month ago, TSH was 1.89. My GP says that is OK as I am well within range, even though previously she had said ideally she’d like to get my TSH down to 1-1.5, not sure what changed there. I can’t believe that no other thyroid parameters were measured, so I decided to get Free T4 and T3 measured myself privately with Blue Horizon. Everything is in range (TSH is actually lower now at 1.48), but I would like to know whether things are really optimal, or is there room for improvement? I am particularly anxious about this, as I am a runner and am training for the Boston Marathon, to be run end of April. I want to be a fit and well as I can  I have felt less tired and my GI issues have improved. The big test is to come when I start doing the longer runs (I’m at 11.5 km at the moment, and doing ok).

As an aside, I was referred to a gastroenterologist last month to see why my iron levels aren’t increasing as it looks like there could be an absorption issue. He didn’t seem to think there is a problem as serum iron is not important, but ferritin and haemoglobin are, and they are OK. I am aware that hypothyroidism affects absorption of iron, but he didn’t seem interested in that aspect – so it seems that even GI specialists are ignorant when it comes to thyroid issues.

Anyway, I digress. What I’m really hoping for is some advice on my TSH/FT4/FT3 and whether I should be happy with the levels.

[SeasideSusie Remembering]

Crazy_CatLady Based on your latest results, if you don't feel that you are optimally medicated then there is room for an increase. It's generally said that the aim of a treated hypo patient (on Levo) is for TSH to be 1 or below and FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel best. So there's plenty of wiggle room with your free Ts.

[Crazy_CatLady in reply to SeasideSusie]

Thanks for the reply SeasideSusie , I did kind of think that as my FT3 and FT4 are not at the upper end of the range. I'll see how I feel in the coming weeks, and if I don't feel right I might up my dose just a bit. If I didn't want to go up by another 25mg, can I increase by 12.5 by taking an extra 25mg every other day?

I don't want to have to go back to my GP and ask for an increase in dose, so I might have to see if I can somehow stash tablets by ordering prescriptions more frequently!

[SeasideSusie Remembering in reply to Crazy_CatLady]

Yes, an extra 25mcg alternate days would be fine, or get a pill cutter and half the 25mcg tablets , either way would do.