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Looking for medical evidence to take to docs about keeping TSH low

I’m seeing my doctor on Wednesday and need to ask for a dosage increase. I have symptoms such as numb tingling hands and my thyroid feels swollen. However my TSH is around 3 so I need back up to my request as they will tell me everything is normal. Could someone point me in the right direction? Thanks Rhiannon

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Dr Toft's article

thyroiduk.org.uk/tuk/about_... > Treatment Options

"Dr Toft 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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist.

You can obtain a copy of the article by emailing Dionne at tukadmin@thyroiduk.org and highlight question 6 to show your GP.


Thanks Susie! That is exactly what I was looking for!


Also request that GP tests vitamin D, folate, ferritin and B12

Numb tingling hands can be low B12 or due to carpel tunnel. Both common when under medicated

List of hypothyroid symptoms


See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed


Do you know if you have high thyroid antibodies? If never had them tested ask that they are

High antibodies means you have Hashimoto's also called autoimmune thyroid disease

Low vitamins are especially common


Hi Slow Dragon, my antibodies were 1000 when I was first diagnosed in 2012. They were 200 when last check a year or so ago. I have Hashimotos : ( my vit D and B12 were fine but my ferritin was rubbish so have been taking iron and am going to request a re-test on weds.

Thanks : )

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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

Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance









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