help with dosage

[deelcee]

i have been struggling with hashimotos for years and all the meds can say is your in the normal range. This morning i received a letter from my endo via gp stating i cannot have t3 i'm probably taking the t4 incorrectly!! Well thats the last straw i have decided to medicate myself.

i have recently had a full private test with blue horizon and would like advice as to the next step.

currenly i am taking 175mcgs levothroxine

i have just purchased thyroyd from greater pharma 60 mg which contain 38mcgs t4

and 9 mcgs t3.

my results as follows

Ferritin 161.0 30-400 ug/L new range

magnesium H 1.01 0.66-0.99 mmol/L

New Range

TSH 3.57 0.27-4.2 mlu/l

T4 total 92.1 66-181 nmol/l new range

Free T4 15.0 12-22 pmo/l

Free T3 4.48 3.1-6.8 pmo/l

Reverse T3* 21.0 10-24 ng/dl

Reverse T3 ratio L13.89 normal >15 Ratio

borderline 12-15

low <12

anti-thyroidperoxidase abs H 287.0 <34 kl/ul

anti-thyroglobulin abs H 285 <115 kl/ul

vitamin d (25oh) 83 deficient <25 nmol/l

insufficient 25-5

vitamin b12 241 deficient <145 pmol/l new range

insufficient145-250

serum folate L 7.92 8.83-60.8 nmol/l

since receiving these results i have been taking vit.b12 complex and i'm due to start folic acid tomorrow. i am also upping my vit d

please advise what t4 and t3 i should start with?

[SlowDragon Ambassador]

You really need to get your vitamins optimal FIRST

You probably have malabsorption going on

Vitamin D mouth spray may work best as avoids poor gut function - Better You do various strengths

Recommended to also supplement vitamin K2 Mk7 and magnesium when taking high dose vitamin D

A good vitamin B complex to improve all B vitamins including folate plus a sublingual B12

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Are you on strictly gluten free diet?

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

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

Low vitamin levels affect Thyroid hormone working

Obviously your vitamins are struggling

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

gluten.org/resources/health...

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...

Not sure why your reverse T3 is flagged as it's not out of range

It is high, so does suggest just increasing Levo is not a good plan

[Clutter]

Deelcee,

It might be better to see your GP about the pre-diabetes HbA1c result and high CRP before you start self medicating.

You will need to titrate Levothyroxine dose as you introduce Thiroyd. Initially reduce Levothyroxine by 75mcg and introduce 1 grain (60mg) of Thiroyd. 2 weeks later you can reduce Levothyroxine by 50mcg and increase Thiroyd by 1 grain and repeat 2 weeks later. Hold at 3 grains for 6-8 weeks and have a thyroid test including FT3 before increasing further.

I commented on your results in healthunlocked.com/thyroidu...

[shaws]

If you are self-medicating with NDT i.e. "thyroyd from greater pharma 60 mg" this is equal to around 100mcg of levothyroxine so I'd start on 1/2 tablet for two weeks and then 1/4 tablet every two weeks thereafter till you are symptom free. Take pulse/temp before beginning and if either goes too high drop back to previous dose.

[Kell-E in reply to shaws]

shaws I know the charts say 1 grain is equal to 100mcg of levo. Most of us find that it is more like 75mcg or less. It has 38mcg T4 and 9mcg T3, so 38 + 9*4 = 74

If you assume that T3 is only 3x stronger than T4, then it would equal 65mcg.

Those charts are super conservative, for what it is worth

[shaws in reply to Kell-E]

Everyone is entitled to their own opinion because whatever dose we take it isn't down to the 'numbers' but how the person reacts to a particular dose.

It is a rough guide, and we don't necessarily know what dose will make us well. That is the 'proof of the pudding' when our clinical symptoms are relieved by whatever dose we finally take.

I don't think we can actually calculate because everyone's body is different and that is the aim - relief of all symptoms.

One doctor only took a blood test for the inititial diagnosis and how good that would be in this 'modern' age when doctors only adjust dose according to the TSH and not our symptoms.

[Kell-E in reply to shaws]

Oh, I definitely agree. I just think the official chart is so conservative that it can hardly be accurate even for the majority. My concern is that someone starts NDT and doses by the 100mcg equivalent, goes hypo at least initially and thinks NDT is not for them. I think it is more of a factor for someone with no thyroid or someone switching over from levo. Someone who is trying NDT as their first thyroid med won't notice.

My comment wasn't meant as a treatise on dosing by numbers. I've just looked at the math and there is no way that 1 grain is equal to 100mcg levo.

[shaws in reply to Kell-E]

I am not going to disagree with what is stated on the following link:

getrealthyroid.com/conversi...

[Kell-E in reply to shaws]

Well, I am going to disagree with their chart. The math is simply not there.