Hi guys
Can anyone tell me whether there is such thing as therapeutic dosing on Thyioid hormone medication - (t4/NDT ) or once you start taking it does Everyone have to increase dose in order to suppress TSH?
If your thyroid is sluggish will it be shut down or work hand in hand with the pills?
E.g. Would someone with a borderline TSH require the same amount of hormone replacement pill after say a year of taking as someone who had overt hypothyroidism?
Thanks again
The aim of thyroid hormone replacement is to feel well and be symptom free. The amount of thyroid hormone needed to achieve this can vary among people with thyroid conditions.
Most people with thyroid conditions want to stay on an even keel and feel well rather than being on a roller coaster of high thyroid activity and then low activity so people try to find a dose that keeps their thyroid inactive which generally means being well replaced.
To feel well we also need our vitamins levels to be optimal so that our levothyroxine works well.
Ok thanks for your reply. Would make sense why you might feel hyper when first starting a low dose of meds
Have you been tested for thyroid antibodies and have you got Hashimotos? If you post your latest blood test results here people will help you make sense of them.
*TSH 5.29
Free thyroxine 15.1 (12-22)
Total thyroxine 67 (59-154)
Free T3 4.5 (3.1-6.8)
*Tgab 1229 (0-115)
TPA 30.2 (O-36)
I'm guessing the antibodies were there before when I used to hyper as a teen.
Am hearing I should look at free T3/t4's which are in range as opposed to TSH when it comes to medicating
I like the idea of using t4 or NDT as an additive rather than full suppression
Have you got the lab ranges? They are the numbers in brackets after the blood test result. We need them to interpret the results as lab ranges vary.
Without the lab range I can't be sure but I expect your antibodies are over range which means you have Hashimotos otherwise known as autoimmune thyroid disease.
The antibodies activity of Hashimotos means that your blood test results can vary according to the activity of the antibodies. When antibodies attack the thyroid, some of the cells die releasing a lot of thyroid hormone and this can make you feel as though you are overmedicated or overactive. When the attack calms down you will become hypothyroid again and possibly a little more hypthyroid than before so your need for thyroid hormone may increase over time.
The reason people with Hashimotos advocate taking a good replacement dose of thyroid hormone is partly because it helps to prevent antibodies attacks. At least that's the theory and as I said before, generally people want to stay on an even keel.
Thanks . Have added reference ranges. Does medicating help lower antibodies ? I guess Im worried about high doses because i felt a bit jacked up on only 25mcg when I tried it for a week. I also felt like I was losing weight and am already quite slim at 80kg and 6,4 tall
TgAb antibodies are over-range, have you had treatment for a thyroid condition in the past or is this a new diagnosis?
It's more usual with Hashimotos to have high TPA or both high TPA and TgAb.
Did your doctor rule out other co-existing conditions that have high TgAb antibodies?
Have you had your vitamin levels tested? You need vitamin D, folate, ferritin and B12 results.
Had treayment in past carbimazole and rai
Had to persuade my GP to do vits but He said he will add in next time i get a blood test which is next month.
This current GP has only looked at TSH and T4
So did you have a diagnosis of Graves disease previously? Have you had the antibodies tested for Graves disease?
My endo did suspect graves
Did he do the antibodies tests for Graves?
I think they Did some antibodies test. Would that be thyroglobulin which is still positive now
Yes, thyroglobulin but the other test would be TSI
endocrineweb.com/conditions...
Can you get a copy of blood test results going back in time and see what you've been tested for? You could ask your GP or get a print out from the receptionist at the surgery.
If not, and you can afford it, you can have thyroid and vitamin tests done through an online lab. See Thyroid UK's website for reliable labs to use.
Have you got symptoms or why did your doctor start you on levothyroxine?
After being advised to get Rai in 2010 I was found to be Euthyroid without any pills
got a blood draw done in 015 they said it was all fine Although since get printout of past 3 tests I now no TSH was 4 then Then i thought I'd get a test in June and august this yr and TSH was 7 and 6 respectively
A couple of hypo symptoms have been lerking and since pre RAI days and I noticed some hair loss as vain as it sounds that was when I started looking into it more but overall I have felt good though that was normal with everyone
You can have Graves and Hashimotos at the same time but finding out your antibodies status might help to work it out.
Your antibodies might be fluctuating and so symptoms might fluctuate too.
In any case as you are slightly hypothyroid the treatment is likely the same to alleviate hypothyroid symptoms.
This is all a bit confusing, Hypo88. Was your gland completely destroyed by the RAI? I'm guessing not, or the Hashimoto's antibodies would be completely gone. However, whether you have a gland or not, the Grave's antibodies will remain. So, I would say your next step should be to find out if Grave's antibodies were ever tested for.
At the moment, with a TSH of you are overtly hypo - whether doctors like that or not! You are hypo as soon as your TSH hits 3. So, any ideas of 'working in tandem with your thyroid' are pretty much impossible because you don't have a working thyroid.
How long ago did you try taking 25 mcg levo? Could be you didn't need it then, because you still had plenty of levo in your system, but you are getting progressively worse. But, with a TSH of over 5, that's too low a dose. You really need 50 mcg.
But, I think that, before going any further, you need to find out more about your past history, to know exactly what is going on. 
I will get that checked
Would your advice be different on confirmation of greaves antibodies ?
Regards
I haven't given any advice, because there's not enough information to base it on.
It's very likely that you never had Grave's, you had Hashi's 'hyper' swings - so many doctors don't know the difference. But, only a TSI antibody test that would confirm that. You could still have high Tg anitbodies if you had Grave's, although they usually indicate Hashi's.
The point is this :;
If you really had Grave's, it looks like the RAi killed off your whole thyroid and you are now hypo, but possibly won't get much worse.
But, if you had/have Hashi's, there is still some gland left, which the antibodies are going to kill off eventually, so it will get worse.
Personally, given the evidence you've presented, I would plump for Hashi's with partial destruction of the gland. But, I'm not medically trained.
In either case, you need to start taking the levo, now - preferably at 50 mcg - and get retested in six weeks. But, if it is Hashi's, you might also profit from a 100% gluten-free diet, and taking selenium. If it was Grave's, those things probably wouldn't help you.
If the rai killed off my thyroid completely then how would I be able to produce t3and t4 naturally ?
As TPO antibodies are negative would that rule out hashi?
Thank you
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