Appointment with GP

[Amirav]

Hi GP I spoke to at appointment today has advised me to start back on Levothyroxine but on a dose that is comfortable for me, either 25mcg or 50mcg. I take Levothyroxine in the morning so I have until tomorrow morning to decide. I am due a repeat thyroid test in 6-8 weeks. I find that I get sweats and tremor on whatever dose I take and I am nervous about starting back on Levothyroxine even though I have been on higher doses in the past which have stopped the sweats and tremor anyway. I am so confused!

He has started me on a loading dose of vitamin D because I am severely deficient and has said I really should be on ferrous fumarate 3 times a day and a retest for ferritin/complete blood count in 6 weeks because complete blood count shows iron deficiency anaemia and also loading doses of B12 but not before intrinsic factor antibodies blood test which he has ordered because of where B12 is in the range, also 5mg folic acid to take once a day oh and to not bother seeing the other GP again and instead report him. So I am guessing positive? Thank you

TSH 6.20 (0.2 - 4.2)

Free T4 10.6 (12 - 22)

Free T3 3.4 (3.1 - 6.8)

TPO antibody 703.5 (<34)

TG antibody 267.3 (<115)

Ferritin 23 (30 - 400)

Haemoglobin 116 (115 - 150)

MCV 77.9 (80 - 98)

MCHC 378 (310 - 350)

Iron 6.2 (6.0 - 26.0)

Transferrin saturation % 13 (10 - 30)

Folate 2.1 (2.5 - 19.5)

Vitamin B12 194 (180 - 900)

Total OH vitamin D 22.7 (<25 severe vitamin D deficiency)

[shaws]

I am not medically qualified but taking too low a dose can also cause problems but 50mcg i usually a starting dose with 25mcg added every six weeks until you feel well with a TSH of 1 or lower. Not to have a TSH somewhere in the range as many doctors believe.

Your last three minerals/vitamins are so severely low they will give you symptoms too.

I will give you a link by SeasideSusie who is very knowledgeable about bloods. This is from a previous post and you can read about Folate, B12 and Vit D.

healthunlocked.com/thyroidu...

[Amirav in reply to shaws]

Sorry is GP wrong to start me back on 50mcg and should be aiming for what I was on before? I was on a much higher dose which was 200mcg and GP has prescribed me things for the deficiencies

[Nanaedake in reply to Amirav]

As you have Hashomotos thyroiditis otherwise known as autoimmune thyroid disease then your TSH levels may vary according to the activity of antibodies therefore your GP seems very wise to raise your dose cautiously and retest in 6 weeks to find out what is happening. It's best to raise your dose slowly or it can make you feel quite unwell. Other's with Hashimotos may have better advice than me as I don't have autoimmune condition.

[Amirav in reply to Nanaedake]

Forgot to add that 25mcg is going to be added to dose 6 weeks after whatever dose I decide to take, I have only just read the prescription script

[shaws in reply to Amirav]

50mcg is usually a starting dose for six weeks, then 25mcg every six until your TSH is 1 or lower and you feel much better.

You have an Autoimmune Thyroid Disease called Hashimoto's, the commonest form of hypothyroidism. It is so called because you have antibodies and these attack the thyroid gland until you are hypothyroid. You can reduce the attacks by going gluten free.

[Nanaedake]

Great, you're getting somewhere. I think you'll find once you've addressed your vitamin deficiencies you will find a much smoother transition with the Levothyroxine although it can take a couple of weeks to adjust to a new dose. I know I often feel quite unwell untill things have settled down which can take a few weeks. It's better since my vitamin levels are higher in range so I hope you'll find that too. Good to find a new GP as it all sounds very positive.

[humanbean]

In my personal (and untrained) opinion you should start on 50mcg per day if you can.

The reason you felt so awful on Levo may well have been because you were so severely deficient in nutrients. Hopefully now that you have been prescribed things to raise your levels you will eventually find the Levo easier to tolerate.

You've been prescribed vitamin D, ferrous fumarate and folic acid? Is that right?

I really think you should delay taking the folic acid until after you start vitamin B12 supplements. It is always a good idea to take B12 on its own first then start the folic acid about 3 days later.

For more info on B12 and folic acid, join and post on the pernicious anaemia forum which you'll find here :

healthunlocked.com/pasoc