Higher Dosage ?: I've been on 125mcg Thyroxine... - Thyroid UK

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Higher Dosage ?

whatevs profile image
whatevs

I've been on 125mcg Thyroxine for the past 6 weeks as my previous does of 100mcg was not working any more and I had a TSH of 3.4 and T4 at 19.

I just got my results back today and they are as follows:

TSH 2.7

T4 20.2

So the TSH has come down a smidge and the T4 has gone up a smidge but wasn't what I was hoping for as I want my TSH to be at around 1 as per the advice here.

Do you think I should ask for an increase to 150 mcg per day to see if I can improve things ? I still have hypo symptoms every now and again such as tiredness, brain fog, shallow breath etc so i think there's scope for improvement.

13 Replies

Not necessarily. You haven't put the ranges - which is very naughty of you! - but it looks as if your FT4 could be top of the range. But, your TSH is still too high, so you're probably not converting very well. What you need, before doing anything, is get your FT3 tested.

Have you had vit D, vit B12, folate, ferritin and antibodies tested?

whatevs profile image
whatevs in reply to greygoose

Sorry Grey,

Ranges are:

TSH 0.20-5.00

FT4 9.00 - 24.00

I'm going to get my FT3 tested next week via the endo at the hospital.

Yes had all vits/mins tested in the past - not a problem with any of them and I supplement daily.

greygoose profile image
greygoose in reply to whatevs

OK, so that's a pretty decent FT4. But, do you want to just check you're taking the right supplements? If so, post your nutrient results, and what you're taking. :)

whatevs profile image
whatevs in reply to greygoose

Vitamin D3 111.0 nmol/L

Serum Ferritin 306.5 (30.00-400)

Serum B12 724.0 (197 -771.0)

Serum Folate 4.8 (3.9 - 20.00)

I take Vitamin D3, a B complex, Vitamin C and Magnesium Citrate every day.

Looking at some of my older labs when I felt better my thyroid results were as follows:

TSH 1.8 (0.2-5)

FT4 21.1 (9.0 -24.0)

FT3 5.5 (3.6 - 6.4)

So again, don't you think there's scope for a levo increase ? I don't think I have a conversion problem.

greygoose profile image
greygoose in reply to whatevs

Are those nutrient results before you started supplementing? They look pretty good.

However, if you're taking vit D3, you should really be taking vit K2 - MK7 as well. Taking D3 increases absorption of calcium from food, and K2 makes sure it goes into the teeth and bones, and not the soft tissues.

Those thyroid results are good. How what was your dose at that point? They don't indicate a conversion problem, but things change...

And, as jim says, the TSH could still come down a bit. It doesn't react very quickly. But, have you had your antibodies tested?

whatevs profile image
whatevs in reply to greygoose

My dose then was 100mcg and it was great for a while but then I started feeling tired again - retested TSH/T4 and things had worsened - hence stepping up to 125mcg per day.

I do feel better on 125mcg but not 100 % - so again I was wondering if there was scope for improvement via a higher dose given my TSH is above 1 and FT4 is within the range still. I thought the accepted wisdom was that some people need an almost undetectable TSH or FT4 slightly beyond the upper limit of the range ?

Edit: Here's the quote 'Dr A Toft writes in the BMA book “Understanding Thyroid Disorders”, “The consensus is that enough should be given to ensure that levels of T4 in the blood are at the upper limit of normal or slightly elevated and those of TSH at the lower limit of normal, or in some patients undetectable.” '

Haven't had antibodies tested again since my hashimotos disease diagnosis. GP/Endo don't see the point.

greygoose profile image
greygoose in reply to whatevs

Ahh, well, that's the usual thing that happens - raise dose, feel well, then symptoms come back again. It just means that you need an increase in dose. So, 100 mcg was clearly not enough for you.

However, as your dose gets higher, you need to slow down a bit, leave a longer time between tests, even increase by smaller amounts, because with an FT4 that high, you're getting near your sweet spot. We must not go too fast!

You must understand that the TSH doesn't make you feel anything, whether it's high or low. It's the FT4/FT3 that are the important levels. What should have said is that enough thyroid hormone replacement should be given to bring the FT3 up to near the top of the range - or whether makes you feel well. That will, undoubtedly, bring the TSH down, with time. But, his understanding of thyroid is just as limited as any other doctor.

OK, so you have got a diagnosis of Hashi's. So, not much point in testing the antibodies again. Once you've got it, you've got it for life. And, when you've got Hashi's, results can sometimes look a little strange, so how you feel is more important. :)

whatevs profile image
whatevs in reply to greygoose

Thanks for the detailed response Grey.

Yes I definitely appreciate that I need to be careful with upping my dose at this stage - if you look at my post history I actually had to move up really slowly from 100 to 125 as I was getting hyper symptoms initially.

The reason I'm fixating on the TSH/FT4 is that it is all that my GP will look at when determining my dose.

I will await the outcome of the FT3 result but as you say, it's how we feel that matters and at this point I still feel there's room for improvement.

Thanks for all your help.

greygoose profile image
greygoose in reply to whatevs

Yes, I realise you still don't feel well, but in your shoes, I would give it a bit more time before increasing. :)

whatevs profile image
whatevs in reply to greygoose

I'll take your great advice Grey - will give it 8 weeks and see if my symptoms improve before requesting an increase.

Thanks again for help.

greygoose profile image
greygoose in reply to whatevs

You're welcome. :)

I would give it more time, your fT4 is close to the upper limit (assuming typical reference interval) and going above it can be counter-productive. You may find your TSH comes down further in time, in any event it doesn't need to always get down to 1.0, signs and symptoms are more important. If you don't get well with these numbers you will probably need liothyronine instead of an increase in levothyroxine and its a struggle to get it. Give it another couple of months and see how you are then.

... and as greygoose has just written having your fT3 would be helpful. It can take six months or so for patients to fuly recover, even on the correct medication.

SlowDragon profile image
SlowDragonAdministrator

You say you have Hashimoto's

Are you on, or have you tried strictly gluten free diet?

It may help reduce symptoms, help gut heal and slowly lower TPO antibodies. Very many of us find it essential

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