Advice please, is my dose low?

[Zara_227]

Have been told my results are normal (euthyroid) despite symptoms on 50mcg. Have been on it since diagnosis in 2011. I have gained more weight and feeling colder. Eyes feeling puffy and neck feels tight.

Help please, thank you

[Treepie]

You need to post your test results for TSH,FT4,FT3 ,Ferritin,folate,B12 and D3 in ordr to get helpful comment.50mcg is a small starter dose and it is probable that you are undermedicated."Normal" means in range but it is not necessarily optimal for you.

[Zara_227 in reply to Treepie]

TSH 4.8 (0.2 - 4.2)

FT4 14.6 (12 - 22)

FT3 3.3 (3.1 - 6.8)

[Clutter in reply to Zara_227]

Zara_277,

Results are NOT euthyroid because TSH is over range. You should ask for a dose increase to 75mcg.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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.

[Mary-intussuception]

Are you able to get a copy of your results? Do you know what your TSH is?

Do you know if you have Hashimoto's Autoimmune Thyroiditis ?

Have you had any tests to check the levels of the following nutrients - if not ask GP for these blood tests asap :

Vitamin D , Calcium

B12 and Folate

Ferritin.

Do you have any other medical conditions? On any other medication?

Have a look at the Levothyroxine patient information leaflet.

Ask your GP to investigate your symptoms.

[Zara_227 in reply to Mary-intussuception]

TSH 4.8 (0.2 - 4.2)

FT4 14.6 (12 - 22)

FT3 3.3 (3.1 - 6.8)

I don't know if I have Hashimotos

TPO antibody 504.3 (<34)

TG antibody 339.5 (<115)

I take omeprazole and fluoxetine

[Clutter in reply to Zara_227]

Zara_277,

Thyroid peroxidase (TPO) and thyroglobulin (TG) 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_...

[Mary-intussuception in reply to Zara_227]

You have Hashimoto's and you need an increase in dose and retests in 6 to 8 weeks time. Make sure to ask for nutrients blood tests also.

Do you take your Levothyroxine on it's own with water only.

You need to take your Omezprazole at a different time.

[Zara_227 in reply to Mary-intussuception]

I take levo with water only in the morning yes and omeprazole taken at night thanks

[Treepie]

You are undermedicated.TSH should be 1 or below and FT4. & FT3 should be in the upper part of the range.Your high antibodies mean you have Hashimotos or as the docs prefer auto- immune thyroiditis. Going gluten free may help.Also unless your vits. are optimal you will not make best use of the levo.

I do not think oneprazole will help see Dr.Nalcolm Kendricks recent blogs on heart disease.

[crimple]

you have Hashi's and you are under medicated. Your TSH should be 1 or less. Your T3 is too low and T4 not much better. You need a dose increase and as you have Hashi's you should go on a gluten free diet to help reduce antibodies. Also you need to get Vit B1, Vit D, iron, ferritin and folate levels checked. They are likely to be trashed as you probably have gut absorption issues.

Your doc is a sadist to have kept you on that pathetic dose for 7 years.

You likely have low stomach acid, not too much acid and so you probably shouldn't have omeprazole. Can't comment on fluoxetine.

[Maxxxx]

Hi - I just wanted to comment on the Omeprezole. When you have thyroid problems you get problems with LOW stomach acid which means that you don't absorb vitamins and minerals and hence you get deficiencies. It is essential to test Vitamins B12, folate and D as well as ferritin levels - then post the results on this forum for advice. Don't just accept that they are 'in range' as the need to be optimal.

Symptoms of LOW stomach acid mimics those of HIGH stomach acid, hence some doctors will prescribe Omeprezole or similar. These drugs lower the stomach acid further which acerbates the problems. Try and get off the Omeprezole - you might have to do it slowly - and start taking BETAINE & PEPSIN tablets to help you digest you food (they are digestive enzymes). You can buy them in one tablet.

Also apple cider vinegar (with its mother) will help you digest your food.

My original gastroenterologist got me on omeprezole and even tested my acid levels by putting a camera down my oesophagus. He was perplexed and said, "Your acid levels aren't that high". But he never made the connection with hypothyroidism. That took another year and several doctors later to figure that out!

[Mary-intussuception in reply to Maxxxx]

Some people need their PPI.

Everyone has individual needs.

[Zara_227 in reply to Maxxxx]

Ferritin 50 (30 - 400)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 177 (180 - 900)

Vitamin D 25.5 (25 - 50 deficiency)

[Treepie in reply to Zara_227]

You need to supplement all the above.Look up Seaside Susies posts for detailed advice.

[SlowDragon Administrator]

You are very under medicated. Dose should be increased by 25mcgs steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

See a different GP and request 25mcgs dose increase and retest in 6 weeks

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

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: at [e-mail]

Your vitamins are terrible on other post because you are under medicated

They must be improved at same time

Typical Low vitamins due to under medication and detailed supplements advice

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

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

Low vitamin levels affect Thyroid hormone working

Yours are obviously terrible at moment

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...

When we are hypothyroid then as others have said

LOW stomach acid is common. Symptoms are the same as HIGH stomach acid, but treatment is VERY different

However you can not just stop Omeprazole. Improving thyroid and vitamins first

Then with lots of further advice - suggest you put up new post in a few weeks asking about this

Omeprazole also lowers vitamin levels, B12 and magnesium especially

gov.uk/drug-safety-update/p...

pulsetoday.co.uk/clinical/m...

Low stomach links

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

healthunlocked.com/thyroidu...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

[silverfox7]

After hearing about PPI's n hear I Googles it and the report was frightening! The. Implement opposite to what we need but if, like me, you decide to stop then you must ween yourself off slowly as they are addictive and onlybintended for short term use-i dont expect your doctor mentioned that!

[humanbean in reply to silverfox7]

Saying they are addictive is slightly misleading. There are no cravings or psychological effects when coming off PPIs like there would be if coming off, say, cigarettes, the effects are purely physical.

People who go on PPIs and then stop them find that they get far more stomach acid after stopping than they ever had before starting the PPIs. So, very often they feel forced to start taking the drugs again.

This article may be of some help when coming off PPIs :

howtotreatheartburn.com/how...