Thyroid UK
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Result advice please

Hey everyone, would be grateful for any advice. Started levothyroxine 50mcg in Dec 2017 when diagnosed. Still feel pretty rough. I also take vit D, iron, folate and B12. Thank you!

DEC 2017

TSH 104.4 (0.2 - 4.2)

FREE T4 11.3 (12 - 22)

FREE T3 2.5 (3.1 - 6.8)

TPO ANTIBODY 171 (<34)

TG ANTIBODY 277.5 (<115)

FERRITIN 4 (15 - 150)

FOLATE 2.2 (4.6 - 18.7)

VITAMIN D TOTAL 6.6

VITAMIN B12 191 (180 - 900)

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When exactly did you start taking Levothyroxine

You need bloods retested after 6-8 weeks. Dose increased in 25mcg steps (retesting after 6-8 weeks each time) until TSH is around one and FT4 towards top of range and FT3 at least half way in range

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

What have you been prescribed for your serious vitamin deficiencies

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

Low vitamin levels affect 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

Ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

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Hi!

I started Levothyroxine in Dec 2017 when diagnosed. I was prescribed vit D loading doses, ferrous fumarate 3 times a day, folic acid once a day and loading injections of B12.

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How nice to read of a GP who is doing the right thing

Get tested after 6-8 weeks after starting

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-...

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.

Watch out for brand changes with different dose. Eg when you next increase to 75mcg - you may get different brand as 25mcg pill

Be gentle with yourself. It's going to take few weeks/months and more dose increases until TSH comes down and symptoms improve

Strictly gluten free diet helps a high percentage of us. Worth trying

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As a long time Hashimotos I would say you have got too many variables in the mix at the moment. Accepted - you have low Vit D, B12 etc, but I think the main goal should be to normalise your thyroid levels in the first instance, otherwise you are not going to know what it is that is affecting your body - the Thyroxine or the vitamins?

I know it's tempting for you - even your GP - to see low thyroid and vitamin level results and throw everything at it, but Hashimotos is a fickle disease that responds not only to what you put in your mouth. Since reducing stress levels I have been able to drop down my Thyroxine to 25mcgs.

Even though I had low Vit D and B12 I cannot tolerate either of these supplements. B12 makes me feel drowsy and spaced out, Vit D upsets my tummy and makes me feel unwell. I found the only way I could boost my Vit D was by having short tanning booth sessions every week over the winter and my body seemed to tolerate this. Short sessions will not harm your skin and it means you get total body exposure. This is better than trying to put an unnatural supplement through a possibly malabsorbing gut. If you really must, try this. B12 patches worked better for me (you can get them on line) again, the route is better than through your gut.

I would remove the supplements right now and concentrate on getting to know how your body is responding to just the Thyroxine alone. It takes several weeks to get levels up, and yes, you may need more, but at least you will know it's that and that alone. After that you can then concentrate on your supplements. That's not to say don't follow a clean eating regime in the meantime. Check out Dr Rangan Chatterjee's book The 4 Pillar Plan for help on cleaning up your whole approach to diet, stress and exercise.

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Just because you can't tolerate supplements doesn't mean others should not take them

It's not helpful to say to a newly diagnosed person not to take vitamin supplements that GP has prescribed. The vast majority of us with Hashimoto's find vitamin supplements absolutely essential.

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It can take a while before we start to feel better.

Are you taking your Levothyroxine on it's own with water and 30 - 60 minutes before breakfast? And your supplements with lunch?

You should increase to 75mcg Levothyroxine after your follw up bloods in a couple of weeks. And be retested again after a further 6 weeks.

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ps

Did you have any tests to check your Adrenal Function?

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50mcg of thyroxine is just a starting point, so hopefully you will have the dose adjusted upwards after your next blood test.

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