Endo wants to increase.

Just received a letter today to tell my gp that they need to increase my dose.

Tsh 0.8 sorry no reference range

Only just started on levo 4 weeks ago and started at 75mcg.

Now endo says up levo to 125mcg.

Does this sound right?

Thanks

[SeasideSusie Remembering]

No, increases should be in increments of 25mcg. And as it can take up to 6 weeks for the full effect of a Levo dose, it may be slightly premature to increase your dose.

But without FT4 and FT3 results and the reference ranges for all your results then no-one can comment on whether an increase is needed.

Your TSH is definitely low in range, although the aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo. So maybe your FT4/FT3 aren't high enough in their range and your endo is happy to have your TSH suppressed.

Do you happen to know if your endo is a diabetes specialist rather than a thyroid specialist? Most endos are diabetes specialists and do seem to make a hash of treating thyroid patients, most don't know how to.

[SlowDragon Administrator]

Ask GP to test vitamin D, folate, B12 and ferritin before you will consider raising dose. Make sure to get actual results and ranges on these and come back with new post for advice

Plus need testing for high thyroid antibodies to confirm if cause is autoimmune thyroid disease (Hashimoto's) About 90% of hypothyroidism is due to autoimmune so it's likely

If vitamins are too low they need supplementing first so that thyroid hormones can be used

But sounds like Endo hasn't considered this

[Hidden in reply to SlowDragon]

Hi, I am on iron tablets. Not started my folic acid yet as I am convinced that I have b12 deficiency. Vit d is around 53. I also have hashimotos.

[SlowDragon Administrator in reply to Hidden]

Insist on full B12 testing including Pernicious Anaemia and intrinsic factor BEFORE starting folic acid

anhinternational.org/2013/0...

SeasideSusie can advise on iron and ferritin- has this been retested since started supplementing?

You will need to improve vitamin D too

Eg

healthunlocked.com/thyroidu...

As you have Hashimoto's then hidden food intolerances may be causing issues, most common by far is gluten. Changing to a strictly gluten free diet may help reduce symptoms. Very, very many of us here find it really helps and can slowly lower antibodies.

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/why-changi...

scdlifestyle.com/2014/08/th...

[Hidden in reply to SlowDragon]

No not yet, only been 1 month since on iron tablets. Will be rechecked soon I believe.

[SeasideSusie Remembering in reply to Hidden]

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range.

If your ferritin level was below range, it would be best to ask for an iron infusion which will raise your level within 24-48 hours.

Then you'd only need to maintain the level.

If yor ferritin level was below range then you should hav an iron panel and full blood count to see if you have iron deficiency anaemia.

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 apjcn.nhri.org.tw/server/in...

**

Vit D is recommned to be 100-150nmol/L according to the Vit D Council. As yours is only 53 are you supplementing? You need to be on 5000iu D3 daily for about 6-8 weeks, then reduce to 5000iu alternate days, then retest 3 months after starting this dose. Once you've reached the recommended level 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 vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

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

naturalnews.com/046401_magn...

Check out the other cofactors too.

[jimh111]

It depends on how your symptoms are doing. Based on a TSH of 0.8 I'd be tempted to leave it as it is for now, but the TSH is a poor marker of appropriate treatment. If you still feel substantially hypo then take the increase, otherwise say that you want to stay where you are for a little while. Bear in mind that it will take many months before you fully recover.

An increase from 75 to 125 mcg is perfectly acceptable if indicated by symptoms and supported by blood test results but seems a bit premature in your case.