No dose increase

[Vkb6]

New here why won't endo increase. I have abnormal results and he says my symptoms (constipation/fatigue/pins and needles/breathlessness/feeling cold/sweats/muscle spasms/muscle weakness) are not thyroid related. Diagnosed 2014 taking 100mcg levothyroxine thanks for reading

OCT 17

*TSH 5.2 (0.2 - 4.2)

FREE T4 13.8 (12 - 22)

FREE T3 3.3 (3.1 - 6.8)

*THYROGLOBULIN ANTIBODIES 471.5 (<115)

*THYROID PEROXIDASE ANTIBODIES 256.3 (<34)

[shaws]

He is another who puts his head in the sand and knows absolutely nothing about the reason for us having a thyroid gland - its purpose - and the best way to control disabling clinical symptoms.

You are another patient who will have to Do It Yourself if you want to recover your health.

First of all the aim is a TSH of 1 or below with Free T4 and Free T3 in the upper part of the range.

Your TSH is too high and your Frees too low.

Email [e-mail] and ask for a copy of the Pulse Online article by Dr Toft who was President of the British Thyroid Association. Please highlight the range the TSH is recommended to be and seeing he is retired he probably was aware of clinical symptoms (hopefully) when training. At least he states TSH should be:

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

"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.

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).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

He goes on to spoil it by stating :

"If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed"

We have to realise no medical person seems to knows everything about clinical symptoms/best treatment when the rely completely upon blood test results.

[diogenes Remembering]

Lets look at your results in a different way. Forget- in or out of the normal range. Try instead - given the distribution of values that define normality what is the likelihood that your results are satisfactory for health. That is - how many truly healthy subjects at random will display your values and be well. TSH 0%. FT4 5%, FT3 2%. Doesn't add up well does it. This should be the way to diagnose - not in or out of a range but what is the likelihood of your results being in the range and giving you a healthy outcome.

[SlowDragon Administrator]

You have Hashimotos (high antibodies) also known as autoimmune thyroid

You need TSH much lower, certainly less than one and FT4 at top of range - around 18-20

Therefore need a 25mcg dose increase and retest in 6-8 weeks. Possibly further increase(s) too

All thyroid tests should be as early as possible, fasting and no Levo in 24 hours prior to test, delay and take straight after

Highly likely you have very low vitamin D, folate, ferritin and B12.

Have these been tested, If not ask GP to do so. Always get actual results and ranges

Post results when you have them

High percentage of us (over 80% apparently) find strictly gluten free diet essential - just don't expect endo to know (or care)

thyroidpharmacist.com/artic...

chriskresser.com/the-gluten...

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

drknews.com/autoimmune-gut-...

[Vkb6 in reply to SlowDragon]

Thanks for reply I will post these now because I am deficient and taking supplements for some of these

[SlowDragon Administrator in reply to Vkb6]

Not surprised, all vitamins are dire. You are under medicated for thyroid, so are hypo, therefore gut function badly affected.

Levo dose should be high enough for a TSH to be around one (or slightly less) and FT4 right at top of range

Your vitamin levels are so low they are preventing thyroid hormones from working.

Need to improve as per SeasideSusie advice.

But also highly likely that strictly gluten free diet is essential

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

You need a new endo.

Email Louise at a Thyroid UK for list of recommended thyroid specialists [e-mail]

You may need addition of small dose of T3, once Levo correct, vitamins good and gluten free

So try to pick endo that is T3 friendly