Thyroid UK
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GP appointment

I had an on the day appointment today and was given 50mcg levothyroxine to take for a TSH of 78.5 (0.2 - 4.2) also given 3x ferrous fumarate to take. Given loading dose of vitamin B12 after being tested for pernicious anaemia and coeliac and given prescription for folic acid and loading dose of 300,000 iu for vit D does this all sound ok thank you TPO antibodies 694.5 (<34)

TG antibodies 378.3 (<115)

Ferritin 21 (30 - 400)

Folate 2.0 (2.5 - 19.5)

Vitamin B12 202 (190 - 900)

Vitamin D 10.3

12 Replies



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.

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. Levothyroxine can be taken at bedtime if you prefer.

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 as you will almost certainly require a dose increase. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

Take each iron tablet with 1,000mg vitamin C to aid absorption and minimise constipation and take iron 4 hours away from Levothyroxine.

Vitamin D should be taken with the fattiest meal of the day to aid absorption.


50mcg is the usual starting dose for hypothyroidism and you certainly are with a TSH of 78.5.

You need a blood test every six to eight weeks with an increase of 25mcg levothyroxine until your symptoms improve and disappear.

Blood tests have always to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levothyroxine and the test and take afterwards. This helps keep our TSH at its highest and may prevent unnecessary reductions by the doctor.

I will add in SeasideSusie re your vits/mineral results as she is very knowledgeable.

I am not medically qualified but had undiagnosed hypothyroidism.

I hope you begin to improve reasonably quickly.

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I thought that testing for Pernicious Anaemia should be carried out before starting B12, you should check that out on the Pernicious Anaemia Society forum

As well as adopting a gluten free diet, supplementing with selenium L-selenomethionine 200mcg daily can help reduce antibodies.

Hashi's information:

When taking D3 there are important cofactors needed

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

Check out the other cofactors too.

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Thank you yes I was tested for intrinsic factor antibodies is that pernicious anaemia?


That is the test for Pernicious Anaemia and apparently it gives quite a lot of false negatives but you said you were give B12 injections before testing and I don't think that is correct. The PA forum are the experts so you should post on there about your B12.


No given them after testing

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Your original post said before testing, it looks like you have edited it now so that's cleared it up.

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I'm also concerned Claudie6 has had a loading dose of B12 before the antibody test, because it can sometimes reduce the level of IFABs, if they're present. But, yes, the test leaves a lot to be desired anyway.

Antibodies to Gastric Parietal Cells should also be tested. This isn't considered as definitive a test for PA as IFAB, but in reality there are few other circumstances in which GPC abs appear. Once they appear, intrinsic factor production will be reduced anyway, which means you will really struggle to absorb B12 from food. Have a look at the pinned posts on the main page of the PAS forum; they contain a lot if useful info.


Thankyou B12 loading dose given after test for intrinsic factor sorry

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Thankyou B12 loading dose given after test for intrinsic factor sorry


Great, now you can start to recover

Levothyroxine is not an instant fix. It's a hormone and takes a while to get in the body. Ten days probably before you notice much and full 6 weeks to reach full affect. Which is why bloods are not redone until then

You will need further dose increases in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Be kind to yourself, especially in first few weeks/months. Strenuous exercise uses up T3, so best to do something gentle, walking yoga etc

Perhaps after Christmas seriously consider changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

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I have read that we need to be tested for the MTHFR gene mutation, as if prescribed Folic Acid, it can have a detrimental effect on us if we have the gene mutation. I have to take activated Methylfolate as I am Heterozygys for 1298 and 677.


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