Hi thanks for letting me join. I am a 28 year old female and I was diagnosed with hypothyroid in 2014. Is it possible I need a dose increase at all? I still feel very poorly and I take 125mcg Levothyroxine.
Thanks
TSH 4.01 (0.2 - 4.2)
Free T4 13.1 (12 - 22)
Free T3 3.2 (3.1 - 6.8)
Welcome to the forum, Nattie1.
Yes, you are undermedicated to have TSH 4.01 and both FT4 and FT3 are low. Ask your GP to increase dose.
The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP. The Thyroid UK office will reopen 3rd January.
TSH 4.01 (0.2 - 4.2) Most treated hypothyroid patients don't feel well until their TSH is around 1 or slightly lower. I would say you need a dose increase. I would increase by 25mcg and retest in 6 weeks time and increase again and so on.
Free T4 13.1 (12 - 22) Your Free T4 is very low in range indicating you need a dose increase. T4 has to be converted to T3 so you need enough for this to happen.
Free T3 3.2 (3.1 - 6.8) Your FT3 is really low in range showing that you don't have enough Free T3 for your cells to utilise. Again this shows you need a dose increase.
Ensure you take levothyrxoine fasting, for example, first thing in the morning with a glass of water and then leave an hour before eating or drinking anything. Leave 4 hours before taking any other medicines or supplements except for vitamin C which can help absorption of thyroid meds.
Ensure you don't take anything with milk in within an hour of taking levothyrxoine as it prevents absorption.
Has your TSH recently increased?
Your dose should be increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range
Have you had recent change in brand of Levothyroxine?
Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime
verywell.com/should-i-take-...
Do you also have high thyroid antibodies? This is Hashimoto's also called autoimmune thyroid disease. If so then levels can vary quite a lot
Low vitamin levels are extremely common. Have you had vitamin D, folate, ferritin and B12 tested recently? Post results and ranges if you have or ask GP to test if not been done
Yes TSH recently increased and have not changed Levo brands.
TPO antibodies 578 (<34)
TG antibodies 259.3 (<115)
Also supplementing iron, folic acid, D and B12
Can you post your vitamin results and tell us what supplements you are taking. Have you thought about going gluten free to reduce your antibodies and help levo to work better and reduce TSH below 1.
Hi I have found it hard to go gluten free and there have been times where I barely eat anything because of loss of appetite and my antibodies still increased
Ferritin 53 (30 - 400)
Folate 4.1 (4.6 - 18.7)
Vitamin D 41.2
(<25 severe
25 - 50 deficiency
50 - 75 suboptimal
>75 adequate)
Vitamin B12 228 (190 - 900)
Ferrous fumarate
Vitamin D
Folic acid
Hydroxocobalamin injections
These are all far too low. And when vitamins are too low we can't use thyroid hormones
You also need 25mcg Levo dose increase. TSH should be around one and FT4 towards top of range and FT3 at least half way in range
B12 - you need more frequent injections. Or was this test some time after last one.
You may need to supplement sublingual B12 daily in between injections
Plus a good vitamin B complex will improve low folate
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Vitamin D. How much are you taking. It's not enough. Aim for level around 100nmol. May need to increase dose in winter. Test twice yearly- via vitamindtest.org.uk
Ferritin is borderline. How much are you taking? Eating liver once a week will help improve levels
See SeasideSusie detailed vitamin advice
B12 done before injection, 800iu D3, 1 210mg tablet for iron thanks
Hi I take 125mcg levothyroxine
Ferritin, folate and B12 are all too low. Check out seaside Susie posts for what levels of supplements to take.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.
Prof Toft - article just published now saying T3 is likely essential for many
rcpe.ac.uk/sites/default/fi...
Getting TSH low with increased dose, plus improve vitamins and strictly gluten free diet should really help
Other important supplements- vitamin C, selenium
If after all this FT3 remains low then may need to consider addition of small dose of T3
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