Thyroid UK
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Hi guys. Would like to get your thoughts on a strange problem. I was diagnosed with hypothyroidism last autumn. I also have Hashimoto. I've been taking levothyroxine for about 6 months (50mcg). To begin with, it really helped with my tiredness and TSH (it's now 0.6). Last time my endo told me to reduce thyroxine dosage to 37.5, which I did - for a short time. I started feeling tired quite a lot (I don't know if it was a coincidence or the result of dosage decrease) and switched back to 50mcg. But this seems to have made little difference. I feel tired all the time - even after 12 hour sleep I want to go straight back to bed. Really scary as only a few months ago I suffered from insomnia....I have no energy even for the smallest of daily tasks.

All my other blood tests (including iron, vitamin B, T3 & T4) seem to be in ranges, although I am vitamin D deficient and am taking a liquid vitamin D supplement regularly. I am also taking Wobenzym at the moment. Recent antibodies test also showed my antibodies are quite high and keep growing(( Can this be reason?

How did you manage the problem of fatigue? This morning I was researching ME(((((( I pray to God it's not that. Don't think I can cope with this as well.....

6 Replies

Yulia2010 Can you please post all your test results, with their reference ranges, for comment. It seems as though your endo is dosing by TSH but it's where the FT4 and FT3 lie within their ranges that are more important, particularly FT3.

Also, as you have high antibodies then that confirms autoimmune thyroid disease aka Hashimoto's, which is where antibodies attack the thyroid and gradually destroy it.

Adopting a strict gluten free diet and supplementing with selenium L-selenomethionine 200mcg daily can help reduce antibodies.

Make sure you include all tests. You mention vitamins and minerals, these need to be optimal for thyroid hormone to work, not just in range, so we can help with suggestions for doses of supplements if your levels aren't optimal.

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Many thanks for the reply. Here are some ranges: FT4 is 12.34 pmol/l (ranges: 10.80-22.00). Free T3 is 3.92 pmol/l (ranges: 3.10-6.80). TPO is 573 IU/ml (ranges: 0.00-34.00), thyroglobulin antibodies are 1508 IU/ml (0.00-115.00), total T4 is 96.78 nmol/l (66.00-181.00).


Yulia -

FT4 12.34 (10.80-22.00)

FT3 3.92 (3.10-6.80)

Your free Ts are too low, most Hypos feel best when they're in the upper part of their range, eg FT4 in the upper third so around 18+, and FT3 in upper quarter so around 5.9+


TPO Abs 573 (0.00-34.00)

TG Abs 1508 (0.00-115.00)

These confirm that you are positive for autoimmune thyroid disease aka Hashimoto's, which is where antibodies attack the thyroid and gradually destroy it. You can help reduce the antibodies by adopting a strict gluten free diet and supplementing with selenium L-selenomethionine 200mcg daily, also keeping TSH suppressed helps reduce antibodies.


Total T4 96.78 (66.00-181.00)

This tells you the amount of bound T4 you have, not a particularly useful test (the free Ts are more useful) but it does show that you have quite a low amount of T4 and explains your low FT4.


Do you have TSH result/range.

What about vitamins and minerals, you've mentioned iron, vits B and D?


Many thanks, SeasideSusie. I'd stuck to gluten free diet for almost 3 months but antibodies kept creeping up every time(( I gather it's something else I have intolerance of (eggs? milk?), not necessarily gluten. Probably a good idea to try AIP diet but I don't yet feel ready as can't imagine life without dairy products. My TSH is 0.624 (ranges: 0.270-4200). Ionised calcium 1.23mmol/L (1.16 - 1.32). Vitamin D - 24.99 ng/ml (ranges: 30.00 -70.00). Cortisol - 431.2 nmol/L (171-536). Iron (serum) - 24.54mcM/L (6.60 -26.00), potassium (serum) - 4.17mmol/L (3.50 -5.10). Sodium (serum) - 141.21mmol/L (136.00-145.00). Chlorine (serum) - 101.41mmol/L (98-107).


Yulia - I'm not Hashi's so I'm not gluten free, but from what I read here some people find a difference quite quickly, others it can take months. Some people find they need to be dairy free, some say they've given up sugar and, of course, soy products in any form are a no-no for us hypos unless it's fermented soy.


TSH 0.624 (0.270-4.200)

TSH is really good, the aim for a treated hypo patient generally is for TSH to be 1 or below, unfortunately if your GP doses by TSH only then it will be hard to get an increase in your Levo.

This article in Pulse Online Magazine by Dr Toft, leading endocrinologist and past president of the British Thyroid Association might help, where he 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)."

You can obtain a copy of the article by emailing


Vitamin D - 24.99 ng/ml (ranges: 30.00 -70.00)

The recommended level, according to the Vit D Council is 40-60ng/ml. See their article on what dose of D3 you need to achieve this

Scroll down to

"My level is between 20-30 ng/ml"

and the table tells you what daily dose you need to achieve certain levels ie

To achieve 40 ng/ml - take 2000 IU

To achieve 50 ng/ml - take 3700 IU

To achieve 60 ng/ml - take 5800 IU

When taking D3 there are important cofactors needed which you can read about here

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check here to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds


Cortisol - 431.2 nmol/L (171-536)

I don't know enough about cortisol to comment.


Iron (serum) - 24.54 (6.60 -26.00)

Was ferritin tested? Was a full iron panel done?

Ferritin needs to be half way through it's range.


The others appear to be in range.


What about B12 and folate?


Some information about Hashi's that might help


I don't know anything about the supplement Wobenzym or whether that will affect the absorption of Levo. Hopefully you take this at least two hours away from your Levo.


Many thanks for providing such detailed information and articles. They look really interesting and I can't wait to read them.

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