Thyroid UK
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No increase in dose

If I take my Levo with just water and I leave 1-2 hours before having food and 4 hours before supplementing then why are my levels not improving?

Diagnosed hypothyroid 7 years ago, I am tired, can't wake up in the morning, periods very heavy, losing hair, eyes puffy, feeling cold. Taking 50mcg

Thankyou

Dec 2017

TSH *5.6 (0.2 - 4.2)

FT4 14.8 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO antibody *647.5 (<34)

TG antibody *374.1 (<115)

10 Replies
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You are under medicated and need an increase in levothyroxine. Your TSH should be 1 or less!!! You also are positive for anitbodies and should follow a gluten free diet. You also need to get your vitamins etc checked as the likelihood is that all your results will be low. Ask for Vit B12, VIt D, iron , ferritin and folate.

If you can pay for a finger prick test from Blue Horizon or medichecks you will get answers sooner! Once you have them post them on here for comments. In the meantime check out Seaside Susie on here, our expert regarding vitamins etc and supplements.

How long have you been on 50 mcg? Too long probably, your GP needs to go back to medical school.

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Been on 50 since October 2017 GP did not like where levels were on 175 I have results of iron etc thankyou

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Hi Katj :)

Clearly you need an increase in Levo dosage... 50 mcg is a tiny dose for someone who's been diagnosed hypo for 7 years. Your TSH is over range and far too high - it should be down around 1. Also your FT4 and FT3 are very low. All those symptoms indicate that you need a dose increase of Levo. You need to ask your GP for an increase, then do a re-test in 6-8 weeks.

Also, what are your B12, ferritin, folate and Vit D levels like? They need to be tested too, thyroid hormone can't work properly if the levels are too low.

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Been on 50 since October 2017 when GP did not like results on 175 I have results of iron etc do I post thankyou

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Because 50mcg is only a starter dose. Bloods should be retested 6-8 weeks after each dose increase

dose increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

You are extremely under medicated

Ask for 25mcg dose increase in Levothyroxine. Also request testing for low vitamin D, folate, ferritin and B12

Typical post showing Low vitamins due to under medication with detailed supplements advice from SeasideSusie

healthunlocked.com/thyroidu...

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

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...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

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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 print it and highlight question 6 to show your doctor

please email Dionne:
tukadmin@thyroiduk.org

Prof Toft - article just published now saying T3 is likely essential for many

rcpe.ac.uk/sites/default/fi...

But with Hashimoto's we must get vitamins optimal first and increase Levo dose enough to lower TSH to around one and FT4 towards top of range

Very likely gluten free diet will help or be essential

If after all these FT3 remains low then, like many with Hashimoto's you may need addition of small dose of T3

Email Thyroid UK for list of recommended thyroid specialists

please email Dionne:
tukadmin@thyroiduk.org

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GP reduced dose in October 2017 from 175 because she didn't like where levels were no idea what to do about iron etc

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What were results on 175mcg?

If it needed reducing (unlikely) a maximum reduction of 25mcg only to 150mcg

You need to increase dose back up in 25mcg steps. You are extremely under medicated

Your GP is clueless

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TSH 0.03 (0.2 - 4.2)

FT4 21.0 (12 - 22)

FT3 4.1 (3.1 - 6.8)

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So you were not over medicated. FT4 was in range (just) but FT3 was too low

You either had low vitamins, very likely with Hashimoto's, or if they weren't bad, you are (like many of us) a poor converter and need T3 as well

Typical post below with Low vitamins causing low TSH high FT4

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

So you need to increase your Levo dose back up, in 25mcg or possibly 50mcgs steps,

Ask for coeliac blood test and get vitamins tested urgently. Very likely terrible as you are now so under medicated

Strictly gluten free diet helps many/most of us

When you get back to roughly 250mcg or 175mcg, with good vitamin levels and strictly gluten free, if FT3 remains low then, like many of us with Hashimoto's you may need addition of small dose of T3

You will need T3 friendly endo

Email Thyroid Uk for list of recommended thyroid specialists

DIO2 gene test may help get T3 prescribed

thyroiduk.org.uk/tuk/testin...

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You have an inefficient doctor who probably believes that once the patient is prescribed levothyroxine and if the TSH is somewhere in the range (even up to 10) the patient should have no problems.

Once you realise they do not know anything about how the thyroid gland works or its purpose, that's when you have to take your own health into your own hands to get the best possible results on your blood tests.

For you to improve you need 25mcg increases every six weeks until your TSH is 1 or lower. Unfortunately many doctors are so uneducated about clinical symptoms and only look at the TSH and they are happy to keep patients on a dose which doesn't relieve all symptoms and I think that's what type of doctor you have.

Tick off your symptoms in link below. Give a copy to your GP and say you've been given advice by the NHS Choices for help/info on hypothyroidism and that the aim is a TSH of 1 or lower once diagnosed and given levothyroxine.

thyroiduk.org.uk/tuk/about_...

The aim is a FT4 and FT3 in the upper part of the range - not like yours being in the bottom part. Again doctor is happy yours is at the bottom of the range and this will not improve your health. We need both FT4 and FT3 in the upper part of the range.

T4 (levothyroxine) is an inactive hormone and it has to convert to T3, the only active thyroid hormone which is required in the millions of T3 receptor cells we have in our body, the brain/heart contains the most. So we must have sufficient in order to feel well and relieve symptoms.

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