Need some advice. Increase to 100mcg?High cholesterol and folate.

[Pinkkittty]

Hello everybody. I'm a newbie to the community. I was diagnosed with Grave's disease in 12/2016 and took Thiamazole since then. In early 2017, thiamazole didn't work well with me anymore and my hyperthyroidism was out of control. I then had radioactive iodine therapy in 9/2017 and started to take L-thyroxine in Oct. I've been on 75mcg L-thyroxine and supplementing 2000 IU Vit D3 and 30mg Zinc monomethionine since Nov. Here are my blood test results on 15/1:

TSH 1.25 <0.27-4.2>

ft3 4.04 <3.1-6.8>

ft4 18.8 <12-22>

cholesterol 234+ <0-200>; on 21/9 after the therapy cholesterol level was 255+

LDL 134 <0-160>

HDL 106+ <40-0>, on 01/2017 HDL level was 86

iron 11.2 <5.8-34.5>

magnesium 0.89 <0.66-1.07>

Vit D (25-OH) 42 ng/ml

Ferritin 94.1ng/ml

B12 376 <156-672>

Folate 26.6 <4-20>

It seems that my blood test results aren't bad, but I still have symptoms like severe hair loss, weight gain, constipation, sensitive eyes and sometimes breathlessness. I don't usually feel fatigued but I also don't have much energy throughout the day. I wonder if I should increase my dosage to 100mcg? Do you think I might have any deficiencies or should I take any supplements? My GP always says I'm normal since my results are within the range.

And as you can see I have pretty high folate level. I wonder if it's good or bad? Actually I'm planning to have a baby in the next few months (still have to wait because of my radioactive therapy) but I'm not taking any folate supplement yet.

I had high cholesterol level due to my 2 year thiamazole intake. I expected my cholesterol level would be back to normal since I have stopped taking it for 4 months. But my cholesterol hasn't improved much and HDL seems to be high, too. I know that high HDL comparing to LDL is good. But could it be a threat to my health if both cholesterol and HDL are too high? Is there any link between hypothyroidism and high cholesterol/HDL?

Thanks for reading and any of your advice would be appreciated.

[SlowDragon Administrator]

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

Is this how you did the test?

Your FT3 is on the low side.

And TSH perhaps a bit high for someone with no thyroid

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, or they need high FT4 and suppressed TSH in order to have high enough FT3. Note especially his comments about post RAI treatment currently being inadequate

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

However they are very reluctant to allow taking T3 in pregnancy, so you may just need higher dose of T4

[Pinkkittty in reply to SlowDragon]

Hello SlowDragon, thank you for your reply.

My blood was drawn at 10am, 24h gap before my last L-thyroxine, and more than 12h of fasting.

I've tried 100mcg for 1 week. My hair and eyelash loss as well as constipation have improved. But I have tight chest, a symptom that I usually had when I had hyperthyroidism. It really confuses me. I don't really know if I should ask my GP to increase my dose.

Do you think my b12 and ferritin are low? should I supplement them?

[SlowDragon Administrator in reply to Pinkkittty]

There's no range on the ferritin, so impossible to tell.

B12. You might try a good vitamin B complex

Yes your FT4 was already high. Just increasing dose can make us feel worse

You may need small dose of T3

Suggest you find a T3 friendly endo