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Thyroid UK
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Hello

I was diagnosed with underactive thyroid 7 years ago, my eyes are puffy, have lost my appetite, constipted, feeling the cold, puffy ankles, legs getting fatter, dry skin, low heart rate. Am I possibly undermedicated? I take 150mcg Levo.

Thank you in advance.

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Lauren_T,

You could be. When was your thyroid function last tested?

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October 2017

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Hello Laurent_T, welcome to the forum.

Difficult to tell if you are under-medicated, or if it's some other sort of problem, without seeing your lab results. Do you have a copy? If so, post the results and ranges on here, and let's have a look. If not, you really should ask for a print-out.

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TSH 5.6 (0.2 - 4.2)

FT4 12.7 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO ANTIBODY 355 (<34)

TG ANTIBODY >3000 (<115)

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You most definitely are under-medicated! Your TSH is very high for someone on thyroid hormone replacement - should be 1 or under. Your Frees are right at the bottom of their ranges, when most people need them up the top of the range to feel well. Plus you have Hashi's, so things are probably going to get worse, not better.

Do you take your levo on an empty stomach, one hour before eating or drinking anything other than levo? And at least two hours before taking other supplements or medication?

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Hi I take my Levo on an empty stomach a few hours before eating and drinking and I leave 6 hours before taking other medication and supplements thanks

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That's OK, then. :)

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Lauren_T,

You are undermedicated to have TSH 5.6 and FT4 and FT3 low in range. 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.

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_...

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Thanks I have bloods due on Friday so will increase after this has been done

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so you have antibodies and therefore Hashimoto's. It's strongly recommended to go gluten free in your situation. I did and it certainly helped. Also your vitamin levels are likely to be dire. You need to check B12, Vit D, ferritin, folate and iron. and Seaside Susie will give you good advice once you have results. If GP won't test then do a medichecks or Blue horizon finger prick test. Assuming you need to supplement it will take a few months to get back on track but then hopefully your TSh will reduce as your vits improve. TSH is far too high for someone taking levo. Hope you begin to feel some improvement.

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Thanks I have results of vitamins and minerals and I supplement can I post?

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yes post the vitamin results

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You're under medicated to have TSH so high

Ask for 25mcgs dose increase. TSH should be around one and FT4 towards top of range and FT3 at least half way in range

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

Low vitamin levels stop Thyroid hormone working

I saw your other post. These are all too low. Follow SeasideSusie vitamin supplements advice

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...

Once you get TSH down with increased dose, vitamins correct and strictly gluten free diet you should see great improvement

If FT3 remains low then you will ready to consider option of adding small dose of T3

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...

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