Hello, I was diagnosed hypothyroid 2011 and since then my thyroid results fluctuate quite a lot when on levo and this happened even before diagnosis. Will I likely go overmedicated if I increase? I take 50mcg levo. Thanks
TSH 5.3 (0.2 - 4.2)
Free T4 13.7 (12 - 22)
Free T3 3.6 (3.1 - 6.8)
Ferritin is 61 (15 - 150)
Vitamin D total 24.8
Folate 1.9 (2.5 - 19.5)
Vitamin B12 216 (190 - 900)
As a cold read, unless there's something that's not been mentioned, your results are nowhere near close to being those of someone who would be overmedicated with an increase in levo.
As per the usual forum advice, were your blood tests taken first thing in the morning, after an overnight fast, and 24hrs after your previous levo. dose?
TSH 5.3 (0.2 - 4.2) This is currently above the top of the range - most hypothyroid patients feel at their best when <1.
Free T4 13.7 (12 - 22) This is currently in the bottom 20% of the range - most hypothyroid patients feel at their best when near the top of the range.
Free T3 3.6 (3.1 - 6.8) This is currently in the bottom 20% of the range - most hypothyroid patients feel at their best when near the top of the range.
Assuming that you still feel symptomatic for hypothyroidism, it looks like you have plenty of room for a dosage increase in your levothyroxine. NB, as ever, it would be helpful to know if you're positive for Hashimoto's with raised antibodies.
Ferritin is 61 (15 - 150) SeasideSusie typically mentions that members' experience is that around 70 is the optimum range. SS has excellent dietary advice for managing iron levels and for how to take any supplements that might be needed. Do you have any information about the rest of your iron panel?
Vitamin D total 24.8 If this is the typical range, then you're still in the severe deficiency category with these results and need loading dosages to rectify this.
Folate 1.9 (2.5 - 19.5) This is below the reference range.
Vitamin B12 216 (190 - 900) This is round in the bottom 5% of the reference range.
I'm about to nip to bed - but when I can, I'll look for one of Seaside Susie's responses in which she makes suggestions for levels like yours.
ETA: scroll down to see Seaside Susie's advice about loading doses for vitamin D where she quotes clinical guidelines and also her suggestions for folate and B12: healthunlocked.com/thyroidu...
I have high antibodies yes
TPO antibodies 89.5 (<34)
TG antibodies >1500 (<115)
Symptoms are
Tiredness, constipation, depression, memory loss, poor stamina, bone pain, pale skin, cold intolerance, hair loss, dry skin, flaky nails, puffy eyes, dizziness and tinnitus
Remember every cell in your body needs the Thyroid to be working well or symptoms creep in so people can vary a lot in how they are affected. But as you will realise from the above replies it's not just down to the thyroid. Other things have to be in place to get the overall system working well. Have a look at the Thyroid Uk web site as loads of useful info that you may not be aware off but could help to make you more stable. Start with the how to take your medication and move onto things to do and things not to do. Sadly it doesn't take much to upset your thyroid but things like other medication need to be correctly managed or else they could be undoing all your good work. Its a huge learning curve but well worth the effort!
Thanks I take my medication as advised by endocrinologist and GP
I wonder why being over medicated is a concern for you when you should be worrying about being undermedicated!
You need to increase your medication as your results show you are nowhere near optimised yet, 50mcg is a starter dose.
I found going gluten free helped. I did better on NDT than levothyroxine my vitamins etc deficiencies resolved once on it but I only swapped after being optimised on Levo for two years and still not feeling good. You should persist with increase in dose usually 25mcg and get bloods done in 6 weeks as it takes that long for the Levo to be fully assimilated and keep increasing till TSH is under 1. If your GP is not supportive try and see another one or ask to be referred to an endocrinologist, although be warned they are not always very good. Mine at Guys was very good so I was lucky. Lorraine at admin has an article by Anthony Toft who was head of college of endocrinologists saying the TSH should be below 1 and free T4 and T3 in the top 1/3 of range fur most people to feel well, you can get this from her to show your GP and demonstrate your results are nowhere near and hopefully they will aim to get you to those optimised levels Instead of leaving you suffering like this and maybe scare mongering about over medication.
You must be feeling awful, so take heart that there is a lot of room for manoeuvre with your medication to improve matters along with following the advice to address your vitamin and mineral defficiencies.
I hope you start to feel much better very soon ☘️🍀☘️
I am under an endocrinologist
Tashia I hope the endocrinologist is addressing your issues. Follow Seaside Susie’s advice.
I forgot to say I did have occasional bouts of hyperthyroidism but I was not diagnosed or treated until the antibodies completely destroyed my thyroid so I was hypothyroid only, after the point of getting medication, making it simpler to get treated in my case.
Tashia Well, you have a lot going on that explains your symptoms.
TPO antibodies 89.5 (<34)
TG antibodies >1500 (<115)
First of all, your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.
So there is your explanation as to why your results fluctuate such a lot.
What happens is, when the antibodies attack the dying cells dump a load of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. These are called 'Hashi's flares' or 'swings'. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. These Hashi's flares are temporary and eventually things go back to normal. Some adjustment of dose of Levo might be necessary at these times, with readjustment when things are normal again.
Most doctors attach little or no importance to antibodies, or even know how Hashi's can affect the patient, so read, learn and educate yourself so you can help yourself here.
You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Gluten/thyroid connection: chriskresser.com/the-gluten...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
hypothyroidmom.com/hashimot...
thyroiduk.org.uk/tuk/about_...
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Hashi's and gut/absorption problems tend to go hand in hand and often low nutrients are the result, as can be seen from your levels.
To address absorption problems, please see the information and links that SlowDragon has given in reply to this post healthunlocked.com/thyroidu....
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Ferritin is 61 (15 - 150) Iron 5.9 (6.0 - 26.0) Transferrin saturation 11 (12 - 45)
Your Ferritin isn't too bad, although it needs to be 70 for thyroid hormone to work (that is our own or replacement). 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...
However, your low iron and transferrin saturation are cause for concern and need to be discussed with your GP. Did you have a full blood count done as well? Were Haemoglobin and MCV low, and MCHC high?
**
Vitamin D total 24.8
<25 is severe Vit D deficiency. You need loading doses so ask your GP for them, don't accept a prescription for 800iu which is a maintenance dose for someone with a decent level already. See NICE treatment summary for Vit D deficiency:
cks.nice.org.uk/vitamin-d-d...
"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 maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU 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 regims 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. Once these have been completed you will need a reduced amount (more than 800iu so post your new result as the time for members to suggest a dose) 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, 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
vitamindcouncil.org/about-v...
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 helps D3 to work and 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
naturalnews.com/046401_magn...
Check out the other cofactors too.
As you have Hashi's, for better absorption you should buy an oral spray such as BetterYou when you start buying your own D3 as a maintenance dose.
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Folate 1.9 (2.5 - 19.5) Vitamin B12 216 (190 - 900)
You are folate deficient with low B12. Do you have any signs of B12 deficiency - check here b12deficiency.info/signs-an... Then you should go over to the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc
You may need intrinsic factor antibodies testing, you may have Pernicious Anaemia, you may need B12 injections. You will need the folate deficiency addressed with a folic acid supplement, but don't start taking that until further investigation has taken place and B12 started.
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."
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TSH 5.3 (0.2 - 4.2)
Free T4 13.7 (12 - 22)
Free T3 3.6 (3.1 - 6.8)
Currently you are undermedicated on 50mcg Levo and no, you wont go overmedicated if you increase. Increases should be in 25mcg increments with retesting every 6 weeks to check levels and another increase if necessary. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo
Bear in mind that you have Hashimoto's and, as explained above, you levels can fluctuate due to antibody activity although a change in symptoms will probably make you aware of this.
Thanks I had complete blood count which showed low MCV and high MCHC
Tashia
I had complete blood count which showed low MCV and high MCHC
Iron 5.9 (6.0 - 26.0) Transferrin saturation 11 (12 - 45)
All this suggests iron deficiency anaemia. You need to speak to your GP and sort out the appropriate treatment - see 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.
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.
I applaud your faith in your endocrinologist but it can be misplaced. Many know very little about the thyroid as they are mostly diabetic experts and finding a GP thoroughly versed can be a rarity as well. It is six years since your diagnosis and you are still on a starting dose which would be unusual so I hope you are getting regular testing. The aim of medication is to get both the FT4 and the FT3 in the top third or even the top quarter of their respective results and you can see you are falling short of that. I know you told me you are taking your dosage from an endocrinologist but Thyroid UK who run this forum are recommended by NHS Choices for dysfunction of the thyroid so that's a pretty sound recommendation.
You are one of the 90% who have antibodies so not unusual but more difficult to get your head around, I'm one of the 10% so I appreciate how confusing that is with the swings so I hope that makes more sense to you now. All we can do is listen and learn and I think listening to others with the same problems can help us so much as they understand how we can feel. I spent a lot of time reading what people suggested and wondered at first whether to take note or not but I also read how these things worked out so finally gave it a go. Many of us supplement but tests have shown us we should and yes I feel great for doing so. It can be hard work keeping well but the end results can be very satisfying. My condition has changed as I've aged so I know we need to keep up the testing as we go long and we need to listen to what our body is trying to tell us which isn't always easy. Many medics think we we are in range then we are fine or normal but we often need to be optimal to feel good. What is more worrying and I'm sure others will agree with me but recently many have posted results for the important 4 things that really help the Thyroid, Vit D, B12, folate and ferritin and more results than ever are woefully under range and yet this is not being addressed at all. What is the point of testing if these things aren't looked into? SeasideSusie has nailed this so listen to what she advises from doing her own research.
Hope you are soon feeling better but remember everything in the Thyroid world takes time to change so patience is also needed.
I have just seen your other post. Have you copies of your results you can share when you were on 150 mcg? Did you think you were overmedicated then or did your GP say you were? Now knowing you have antibodies it's more than likely feeling you were over medicated than actually being. I presume the Endo and your GP know you are now onlyvtaking 50 mcg? If so I'm surprised they haven't queried why as surely they must see how bad you must be feeling now.
But let's think about the future and getyingvyou well. Increases should be done in 25 mcg so that would take you up to half what you were taking before which I don't think will be enough but that's the safest way to do it.
So fasting, early appointment, no Levo for 24 hours but you can and should drink water and that will give you the readings to act on. You can take your meds straight after.
Then go back to what I presume when you are first diagnosed of taking a 25 mcg increase for 6 weeks so you new dose has time to work up to its maximum then retest and continue this cycle until you are at the correct level for you. Post your results and ranges and we can advise on how you are doing. Again if you look at the Thyroid Uk site there is a list of possible symptoms. I suspect you will have more than you think as there are over 300. You may also be medicated for some of them and it's not being successful because your doctor could be treating the symptoms and not the cause which is down to your thyroid.
Despite the lab results, I don't feel overmedicated
Latest blood results - am I overmedicated?! 
Am I overmedicated
Am I overmedicated?
Latest bloods- GP thinks I may be overmedicated
