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Thyroid UK
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Trying to work out what ideal dose should be

Hi I am newly registered and here on behalf of my daughter. She is 16 years old and has Hashimoto's which was found in 2011. Her endo has been trying to work out what her ideal dose should be since her levels have been going up and down like a yoyo so he has asked her to start again with dosing. Her current dose is 50mcg levo which she has been on since October 2017, please see below.

TSH - 8.2 (0.2 - 4.2)

FREE T4 - 13.1 (12 - 22)

FREE T3 - 3.5 (3.1 - 6.8)

TGAB - 277.3 (<115)

TPOAB - 303.5 (<34)

Her endo is reluctant to increase due to symptoms of weight loss, sweating, insomnia, tremor. Is it safe for her to increase?


6 Replies


Your daughter has Hashi's and her endo doesn't understand it. Like most endos, he is probably a diabetes specialist and knows very little, if anything, about treating hypothyroidism. With Hashi's, when antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results and you can experience both hypo and hyper-type symptoms hence the weight loss, sweating, tremor, etc.

Your daughter is grossly undermedicated to have a TSH of 8.2 and such very low free Ts. She needs an immediate increase in her Levo of 25mcg, retesting in 6 weeks, another increase followed by retesting 6 weeks later, and repeat until her TSH is around 1 and free Ts nearer the upper end of their ranges.


Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. We need to read, learn, understand and help ourselves where Hashi's is concerned.

Your daughter 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...





Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. Thyroid hormone can't work unless nutrient levels are optimal. She needs the following tested

Vit D




and if Ferritin is low then

Full Blood Count

Iron Panel

1 like

Thank you, she has had vitamins and minerals tested, do I post them please?


Yes, include the ranges and say if she is supplementing and the dose.


Thank you, I will post these now


Welcome to the forum, Poka.

Your daughter is undermedicated to have TSH 8.2 with low FT4 and FT3. Ask for a dose increase. Symptoms of weightloss, sweating, tremor and insomnia can be due to under medication as well as over medication.

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 daughter's endo. The Thyroid UK office opens on 3rd January.

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.

It takes 7-10 days for a Levothyroxine dose increase 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.

Your daughter 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.



Thank you, I will arrange this with GP for her.


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