Thyroid UK
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Is 25mcg of Levo enough to lower a TSH of 3.11 at a quicker pace? Or would it be better to take a higher dose?

Guys my endo was very reluctant to prescribe me any thyroid medication because apparently i'm subclinical hypo - despite the fact I have hashimoto's which was evident from the antibodies test.. however, she decided that she wanted to help me because she could see how depressed I was about my hair loss ..

She prescribed me 25mcg medication to be taken once a day.. I feel as though this isn't enough as my TSH is at 3.34 and I need it to be as low as possible... I feel as though taking only 25mcg a day is going to make this a very slow and tedious process...

The more I take daily the quicker my TSH level will reduce, right?

If this is the case, I am considering buying some online but if I'm going to invest I feel as though I may aswell get a combined T3 and T4 as it's generally better and most people have better results.

Can you guys offer some advice on what you think I should do and if you know a website where I can get this medication imported from Thailand or elsewhere with a relatively fast delivery time, then just drop me a message - Much appreciation guys

Thanks xxx

Here are my blood test results:

TSH - 3.34 m/IU/L 0.27 - 4.20

Total T3 - 1.5 nmol/L 1.3 - 3.1

Free T3 - 4.5 pmol/L 3.1 - 6.8

Free Thyroxine - 16.1 pmol/L 12.0 - 22.0

(Thyroid Antibodies)

Thyroglobulin Antibodies - *452 IU/ML 0 - 115

Thyroid Peroxidase Abs - *254 IU/ML 0 - 33

11 Replies
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odd-bacon

You can't know if you need T3 unless your TSH is down to around 1, and your vitamins and minerals are all at optimal levels. Did you get them all tested as suggested by SlowDragon in your previous thread?

Your endo apparently said she may increase your Levo to 50mcg in 2-3 months' time. 6-8 weeks after starting is the correct time to retest and increase so it would seem sensible to wait and get retested.

If this is all about your hairloss, then I gave you a link in your previous thread to vitamins and minerals that are important for hair health.

Also, you have Hashi's and your results are going to fluctuate anyway, so are you addressing the Hashi's as per the suggestions previously made.

Don't assume that T3 is some magic potion, it's not. It's useful where needed, it can cause all sorts of problems when it's not.

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Thanks for your response Susie - it's just, most places I've looked I've read that 25mcg is an incremental dose and will barely affect you (especially on here), so I thought perhaps starting at 25mcg then going up to 50mcg after maybe 2 weeks and maintaining that for another 6 weeks may be better?

Out of curiosity, have you heard of people starting at a higher dose than 25/50mcg?

I also heard that hashi people have problems with conversion of T4 to T3 hence the query about buying a combined T3+T4 from abroad.

I have tried to go gluten freee over the past week, although I am struggling and have had a naughty cheat day... however I've learnt that you cannot have gluten cheat days with hashi's :/

Also:

Iron - 8.5 umol/L 6.6 - 26.0

Ferritin - 98 mmol/L 13 - 150

Do you know what it means if my Ferritin is high and iron is low? (Ive been supplementing with ferrous sulphate for months now hence why it's high - before it was 11)?

Reply

Odd-bacon,

TSH 3.34 is within range so most endos wouldn't diagnose subclinical hypothyroidism until TSH is over range even in the presence of positive antibodies.

25mcg should be sufficient. In any case, Levothyroxine needs to be introduced gradually or there is a risk of causing an adrenal crisis. You don't chuck high doses of replacement at hypothyroidism in the hope of hurrying things along. Read the 'dry sponge' analogy in thyrophoenix.com/adjusting_...

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.27 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

Thyroid peroxidase and thyroglobulin antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...

3 likes
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Hi Clutter, thanks for your response.

Liked the dry sponge analogy, was easy to grasp... and makes sense.

You say that t4 levels should be in the upper range - is mine high enough? and what should total and free t3 levels be preferably?

Iron - 8.4 umol/L 6.6 - 26.0 - is this low?

Ferritin - 98 mmol/L 13 - 150

Calcium - 2.48 mmol/L 2.20 - 2.60

Corrected Calcium - 2.48 mmol/L 2.20-2.60

Inorganic Phosphate - 1.18 mmol/L 0.87 - 1.45

Magnesium - 0.82 mmol/L 0.70 - 1.05

Oestradiol - 78 pmol/L (which seems a little low for the 3rd day of my cycle as follicular range is 98-571)

Progesterone - 0.2 nmol/L (also seems a little low for the 3rd day of my cycle as follicular range is 0.2-2.8 - so borderline).

Reply

Jump1,

Your FT4 is less than halfway through range so the 25mcg should help raise it. You can't optimise the TSH, FT4 and FT3 levels individually, you have to take them in the round. Currently TSH is a little high because the pituitary is indicating that there should be more FT4/FT3. Total T3 and Total T4 aren't used much in the UK, Free T4 and T3 is a better measurement. Don't become fixated on levels. Levels are optimal when symptoms are relieved.

Iron is low in range but I wouldn't know whether there is an optimal level for iron. There is certainly scope to continue supplementing iron to raise iron level.

Ferritin >70 is good for hair regrowth. 75-100 is optimal.

Calcium , phosphate and magnesium are within range.

I don't know anything about oestradiol and progesterone.

1 like
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As susie and Clutter have said just throwing higher dose of levo too quickly can easily cause more harm than good, it really unfortunately is a case of going fairly slowly till dose is the best one for you. 6/8 weeks after starting the 25mic would be a great time to recheck your levels, that and how you feeling generally is the best way to proceed frustrating though that is.

Reply

Strictly gluten free diet for Hashimoto's is likely to help heal gut

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

Low ferritin is linked to hair loss

Also zinc

Have you had vitamins tested?

Hashimoto's affects the gut and leads to low vitamin levels

Low vitamin levels stop Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

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Stay off thyroid meds if you can - try controlling it first with exercise, diet, meditation (anti-stress). The weight gain from thyroxine can be horrible - I know from personal experience. If i didn't swim regularly, I'd probably have gained a lot more. I've tried to cut my dosage (112mcg) and can't seem to (perhaps having T3 would change that but getting it here....)

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You don't want to think of it as lowering your TSH (it's not a thyroid hormone); you want to raise your free T3 (by raising free T4), so 25mcg levo won't do much as it is a starter dose for an elderly, frail person or someone with heart disease. A usual starter dose is 50mcg. Going gluten-free may help to reduce antibodies. Make sure that your ferritin, B12 and folate are optimal.

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Doesn't exogenous T4 inhibit the endogenous one? With such a small dosage surely she'd get even lower T4 levels or would it be too weak to cause the inhibition?

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Probably, yes, Which is why 25mcg is not a "normal" starter dose as it is too low to improve things and high enough to encourage the thyroid to take a rest.

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