Hi

[KelRob]

Hi everyone! Is it possible to still feel unwell on 150mcg Levo? I get the feeling if I take all the supplements in the world my symptoms will just not go away!

Iron stopped in Sep 2017, taking 9000iu vit D with K2 MK7 (oral spray Better You 3000iu sprayed 3x since October 2017), folic acid and had my first B12 injection last week.

Diagnosed 2010 with hypothyroid, nails are brittle, skin is dry, unsettled stomach, brittle hair, puffy eyes, tiredness, brain fog.

Dec 2017

TSH 4.8 (0.2 - 4.2)

FT4 14.7 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO antibodies 1900 (<34)

TG antibodies 577.3 (<115)

Ferritin 23 (15 - 150)

Folate 2.4 (2.5 - 19.5)

Vitamin B12 266 (190 - 900)

Vitamin D 60.1 (50 - 75 suboptimal)

Thanks

[Clutter]

KelRob,

Of course it is. You could be under or over medicated and that will make you feel unwell. If you post your recent thyroid results and ranges we'll let you know whether you are optimally dosed or not.

If you post your results and ranges for ferritin, vitamin D, B12 and folate I can advise whether you need to supplement.

[KelRob in reply to Clutter]

Dec 2017

TSH 4.8 (0.2 - 4.2)

FT4 14.7 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO antibodies 1900 (<34)

TG antibodies 577.3 (<115)

Ferritin 23 (15 - 150)

Folate 2.4 (2.5 - 19.5)

Vitamin B12 266 (190 - 900)

Vitamin D 60.1 (50 - 75 suboptimal)

[SlowDragon Administrator in reply to KelRob]

All too low

Definitely Hashimoto's with those antibodies

Ask GP for 25mcg dose increase and retesting in 6-8 weeks

Typical Low vitamins due to under medication and detailed supplements advice from SeasideSusie

healthunlocked.com/thyroidu...

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...

thyroidpharmacist.com/artic...

[Clutter in reply to KelRob]

Kelrob,

You are under medicated to have TSH 4.8 with FT4 and FT3 low in range. Ask your GP or endo to increase dose.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 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 [e-mail] 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_...

Ferritin is low in range. Ferritin is optimal halfway through range. I would supplement 2 x 210mg Ferrous Fumarate daily and take each tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Take iron 4 hours away from Levothyroxine.

Folate is deficient. Your GP should prescribe 5mg folic acid for 2-3 months to correct deficiency. Eating more leafy green veg will also raise folate.

B12 266 is low. If you have symptoms in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice as they are the experts re B12. If not, supplement 1,000mcg methylcobalamin to raise B12.

VitD is insufficient. Replete is >75 and optimal is 100-150. I would supplement 5,000iu D3 daily x 6 weeks and then reduce to 5,000iu alternate days and retest in April. Take vitD 4 hours away from Levothyroxine. Taking vitD with the fattiest meal of the day aids absorption.

[SlowDragon Administrator]

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

Essential to knowvif you have high thyroid antibodies, if so this is Hashimoto's also called autoimmune thyroid disease

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

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

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

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

Link about antibodies

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

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

List of hypothyroid symptoms

thyroiduk.org/tuk/about_the...

[KelRob in reply to SlowDragon]

Please see posted results

[SlowDragon Administrator in reply to KelRob]

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:
[e-mail]

Prof Toft - article just published now saying T3 is likely essential for many otherwise many need high FT4 and suppressed TSH inorder to get high enough FT3

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

Vitamins must be optimal first and gluten free likely essential too