Thyroid UK
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Taking 50mcg Levothyroxine. Symptoms are

joint pain

dry skin

hair loss

cramps in legs


dizziness when standing

hard stools


weight going up and down


feeling cold with sweats

low body temperature

flaky nails


dark patches of skin in creases

do above symptoms suggest undermedication


TSH 5.60 (0.2 - 4.2)

Free T4 13.1 (12 - 22)

Free T3 3.5 (3.1 - 6.8)

12 Replies

Vika84 If you post your current thyroid test results, with reference ranges, members can comment on whether they think you are undermedicated.

However, some of your symptoms are indicative of low nutrient levels. Have you had the following tested, if so please post them with their reference ranges for comment, if not then ask for them to be done

Vit D





Thyroid results added thankyou



TSH 5.60 (0.2 - 4.2)

Free T4 13.1 (12 - 22)

Free T3 3.5 (3.1 - 6.8)

You are grossly undermedicated on 50mcg Levo. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

Ask your GP for an immediate increase and to support this :

From > Treatment Options

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, leading endocrinologist and past president of the British Thyroid Association. It is published by the British Medical Association for patients. Available from pharmacies and Amazon for about £4.95. It might be worth buying, highlighting the relevant section to show your GP in support of an increase in Levo.

Also -

Dr Toft states in Pulse Magazine, "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)."

Email for a copy, print it and highlight question 6 to show your GP and endo in support of an increase in Levo.

You should have an immediate increase of 25mcg followed by a retest in 6 weeks' time, another increase of 25mcg then another test 6 weeks later, and so on until your symptoms abate and you feel well.


Have you had thyroid antibodies tested? Do you have Hashimoto's? Have you been on a higher dose before and had it reduced? If so, what was the reason for reducing your dose?

1 like

Thankyou I have results of antibodies and they are TPO antibodies 884.5 (<34) and TG antibodies >1000 (<115) and I have been on higher doses but when I am on higher doses I feel more hypo and when I am on lower doses I feel more hyper


Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

When the antibodies attack, the dying cells dump a load of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds should then be adjusted again, increased until you are stable again.

Unfortunately, many doctors don't understand Hashi's or attach no importance to it. You need to read and learn as much as you can to help yourself.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection:


With your current results, you are in a hypo phase so you need that increase in your Levo.


Hashi's can cause gut/absorption problems which is very likely why your nutrient levels are so dire. When SlowDragon is around hopefully she will post some information and links to help with that.



Ferritin 10 (15 - 150)

Folate 4.2 (4.6 - 18.7)

Vitamin B12 187 (190 - 900)

Vitamin D 23.5 (<25 severe vitamin D deficiency. Patient may require pharmacological preparations)

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What has your GP done about these results?


They were done privately except for thyroid because gp was not taking notice of symptoms


Vika84 You need to take these results to your GP and ask him to treat you appropriately. He may wish to do his own tests and if he does I expect the results will come back very similar.

Ferritin 10 (15 - 150)

You need to ask for an iron panel and full blood count to see if you have iron deficiency anaemia. If you are diagnosed with this then the treatment will be ferrous fumarate 3 times daily.

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. You need an iron supplement, ideally you need an iron infusion so ask for one, but you may only be prescribed tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.

Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet


Folate 4.2 (4.6 - 18.7) Vitamin B12 187 (190 - 900)

You are folate and B12 deficient. Do you have any signs of B12 deficiency

You should post these results on the Pernicious Anaemia Society forum for further advice . Also include your ferritin result and any signs of B12 deficiency. You may need testing for Pernicious Anaemia, you may need B12 injections. See what they say then discuss with your GP.


Vitamin D 23.5 (<25 severe vitamin D deficiency. Patient may require pharmacological preparations)

You have severe Vit D deficiency. Check the following and discuss with your GP

NICE treatment summary for Vit D deficiency:

Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Do not accept 800iu D3 daily, you need the loading doses. Once these have been completed you will need a reduced amount (not 800iu daily) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays

There are important cofactors needed when taking D3

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 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

Check out the other cofactors too.

1 like

Thankyou there is a better doctor I can see and I have taken private results to him before which he has acted on


Also MCV 74.5 (80 - 98)

MCHC 369 (310 - 340)

Iron 5.7 (6.0 - 26.0)

Transferrin saturation 14 (10 - 40)

1 like

OK, that suggests iron deficiency anaemia so ask for 3 x FF daily

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines)

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.


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