Increase in TSH.

[Achilles_Pain]

Hi all.

After increasing my levo from 75mcg to 100mcg in mid/late 2016 it caused me problems and my results were a bit out (31st Jan 2017)

TSH 0.05 (0.3 - 5.0)

FT3 6.1 (2.5 - 5.5)

FT4 16.5 (9 - 25)

This is after I'd been to the GP because my knees had started popping and causing pain, which they'd never done before, plus all the other usual symptoms had returned. GP decided I was on too high a dose and reduced me to 75mcg, ordering tests which produced the above results after a few days back down on 75mcg, and then after a few weeks my tests were better (3rd April)

TSH 0.93 (0.3 - 5.0)

Most of the symptoms went away, though it took until late August for the knees to recover (it's been the patella tendon causing the pain, just below the knee, not the knee itself)

75mcg wasn't enough as some symptoms returned so, with my GP's approval, I tried taking 100mcg twice a week, on Mondays and Thursdays. This seemed to work for a while until the symptoms started to slowly return so I dropped back to 100mcg just on Mondays, which seems to be almost right as the returning symptoms went away, before returning again, but very slowly.

My most recent test (25th October) showed a TSH of 1.8 (0.3 - 5.0)

The GP I had been seeing at the practise has now left (moved to Manchester) and I saw a new (to me) GP. She has suggested rather than taking 100 on Monday I split it and take 87.5 Mon and Thu. Funnily, when I said I'd been taking 100 on Mondays only, because taking that amount twice a week felt too much she quipped that a lot of expert endos will say it's a waste of time as such a small change will make no difference, but I know my body better than they do!

My query is - if my TSH has increased to 1.8 that would suggest I'm not taking sufficient levo if the aim is to reduce it to approx 1.0, but taking more made me ill and reducing made me better (all relative terms, of course). Could my activities make a difference? I ran an 8 mile trail race yesterday (lots of sticky mud, 1000+ feet of hills to climb, a river to ford) and I have a half marathon next Sunday - how will this affect my blood results? Could it be I need to take more a day or two before a long or hard run, or would the GP's suggestion of splitting the levo make a difference? I should have asked her while I was there but didn't think to do so. Maybe I should take 87.5 three times a week (100 once a week doesn't feel quite enough, twice a week made me ill, so obviously a very fine balancing act going on here). I asked about 12.5mcg tablets but she said they are disproportionately expensive and the NHS doen't like prescribing them when you can get a 25mcg at a fraction of the cost and just split it in half, which seems logical to me.

When I was in the surgery for the blood draw I asked about vitamins but the nurse said that as the GP hadn't requested them she couldn't add them on. I did say I was taking D3 supplements following last year's low count (39) and had no idea if I was taking the right amount, but she said excess Vits just flush out of the body! Nothing has been tested since March '16 other than what I've given above, so no ferritin figures etc to report.

Thanks in advance.

[Clutter]

Achilles_Pain,

Advice to target TSH around 1.0 is a generalisation. If you feel better with TSH 1.8 and overmedicated with TSH 1.0 then you should stick with what suits you. You will have to experiment to see whether 87.5mcg twice or three times a week suits you best. I can't see any advantage in taking extra Levothyroxine before a run because it takes up to 7 days for the dose to be absorbed.

Your nurse is wrong. Vitamin D is not water soluble so excess won't flush out and it can build up and cause stones. VitD should be checked annually at least.

[Achilles_Pain in reply to Clutter]

Thanks, useful to know.

What type of stones? Gall? Bladder? Kidney? I had my first ever trip in an ambulance back in June with what turned out to be kidney stones, the first in my family to have them. They did loads of blood tests which don't appear on my medical record, presumably because they weren't ordered by my GP but taken in A&E. I take 2000 iu a day (when I don't forget), so not a massive amount. I tried Google but found two articles saying too much D3 causes kidney stones and two saying not enough causes kidney stones!

[Clutter in reply to Achilles_Pain]

Achilles_Pain,

Toxic levels of D3 can cause kidney, gall or bladder stones which is why annual testing should be done. Obviously stones can develop without high vitD.

[Rosetwine]

Yes TSH of 1.8 really is okay. If you really want to decrease TSH, however, I'd think taking a bit of T3 (like under 5mcg per day for sure) instead of being put on more thyroxine would do the job of lowering TSH better. Just a thought. However TSH of 1.8 is fine in my opinion.

[Rosetwine]

Also, ref Vit D, my Vit D last December 2016 was 70 and by March 2017 had dropped to 27 as I wasn't in sun much over winter!!!! (I don't take supplements at all). Vit D is a hormone which only lasts in the body for 6 weeks to two months so I wouldn't worry about overdosing that much... it dwindles off so fast!!