Hi as per first post, I was diagnosed with hypothyroidism 6 years ago and I have been getting pressure in the middle of my chest. Other symptoms I have just lived with my whole life. My current dosage is 75mcg levo.
I recently had it reduced from 125mcg. GP did whole battery of tests (TPO antibodies, ferritin, folate, B12 and vit D) not sure what to do next. Advice welcome.
(75mcg levo)
TSH 5.01 (0.2 - 4.2)
Free T4 12.7 (12 - 22)
Free T3 3.4 (3.1 - 6.8)
Thyroid peroxidase antibodies 376.5 (<34)
Ferritin 7 (15 - 150)
Folate 4.2 (4.6 - 18.7)
Vitamin B12 193 (180 - 900)
Vitamin D total (25 OH) 22.9 (<25 severe)
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Ava134
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You will need to improve these, in conjunction with slow increase back up in dose of Levo. 25mcgs at a time - retesting after 6-8 weeks
The aim is to have TSH at or just below one.
All thyroid tests should be done as early as possible in morning and fasting and if taking Levo don't take it in the 24 hours prior to test, delay and take straight after.
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime
Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription
But you high TPO antibodies show you have Hashimoto's
With Hashimoto's then hidden food intolerances highly likely to 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.
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 louise.roberts@thyroiduk.org for a copy, print it and highlight question 6 to show your GP in support of an increase in Levo.
Also, according to the BMA's booklet, "Understanding Thyroid Disorders", (written by Dr Toft) 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. 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.
Ava134 Well, your GP is certainly making a pig's ear out of your health care. He has ignored some very serious deficiencies here. Make an urgent appointment to discuss the following, preferably with a different GP, sort out treatment, then consider complaining about this one's negligence.
Ferritin 7 (15 - 150)
You really should have had an iron panel and full blood count done to see if you have iron deficiency anaemia considering your ferritin is below range. This result is absolutely dire.
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 apjcn.nhri.org.tw/server/in...
If an iron panel and full blood count haven't been done, make sure they are.
You are folate deficient with very low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... You need to post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc You probably need testing for Pernicious Anaemia, you may need B12 injections, you certainly need a folic acid supplement. However, do not start taking folic acid until further investigations have taken place about your B12/Pernicious Anaemia.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Folate should be at least half way through it's range.
**
Vitamin D total (25 OH) 22.9 (<25 severe)
As you can see, you have severe Vit D deficiency and you need loading doses prescribed. See 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 if that is what he offers, it's the loading doses you need with your level. Once these have been completed you will need a reduced amount (not 800iu) 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 (not 800iu), 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
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
SlowDragon has covered the Hashimoto's, all I would add is that besides adopting a gluten free diet, supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
These suggest iron deficiency anaemia, something else to ask why your GP has ignored the results.
NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines) cks.nice.org.uk/anaemia-iro...
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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