levothyroixine dosage

[HYPOUSER]

Hi,

I cant get to know the right dosage or get my thyroid to normal levels.Every month I am checking and below are the levels.I am TTC since 5 months after miscarriage and on letrozole with no luck yet.So frustrated.When TSH appeared to be in range of .5 in Nov, my T4 was elevated to 6.3(but actually expecting to be below 1.7) and in Dec the reverse happened.So not sure why this mismatch and fluctuations happen. And in Jan to Feb no major changes in tsh numbers ,also T3 seems to b still low normal.How can i seem to bring my thyroid to normal.I have excess hair shedding, thinning, breakage etc and lost 3/4th volume of my hairs for more than a year and been diagnosed as hypothyroid since 10 years but not given medications as most of the doctors say it was in range when i had tsh 4.5 and didnt try to lower to normal and I was struggling much with all symptoms without knowing this was the cause.I am afraid if i have to do a scan but my endo doesnt suspect anything as when i swallow or my neck looks normal when touched.Please any inputs or advice will be of great help.

Feb 2018-Levo 50mcg

TSH-3.39 ( 0.450-4.5) uIU/mL

Free T4-1.2(0.82-1.77)ng/dL

FreeT3 2.6 (2.0-4.2) pg/mL

------------------------------------

Jan 2018 -Levo 50mcg

TSH 3.24 ( 0.450-4.5) uIU/mL

FreeT4 1.16 (0.82-1.77)ng/dL

FreeT3 2.73 (2.0-4.2) pg/mL

-------------------------------------

Dec 2017-Levo 25mcg

TSH 5.5 ( 0.450-4.5) uIU/mL

FreeT4 0.98(0.82-1.77)ng/dL

------------------------------------

Nov 2017-Levo 25mcg

TSH 0.519 ( 0.450-4.5) uIU/mL

FreeT4 6.3(0.82-1.77)ng/dL

FreeT3 2.3(2.0-4.2) pg/mL9

TotalT3 69 (97.0-169.0 ng/dL)

[SlowDragon Administrator]

You need further 25mcg dose increase.

TSH should be below 2.5 when TTC or pregnant

Has GP tested vitamin D, folate, ferritin and B12

These are often too low and may need supplementing

Very good levels needed of B12 and folate for baby's development

[HYPOUSER in reply to SlowDragon]

Yes, my vit d is 46, b12 is 612,ferritin is 75,folate didnt check yet but I am beta thalasemmia minor and just taking the folicacid 800mcg in prenatals

[SlowDragon Administrator in reply to HYPOUSER]

Are you in UK?

If so vitamin D is too low at 46

If non Uk it's different units and 46 is ok

[HYPOUSER in reply to SlowDragon]

Was in UK,moved to US recently.Yes its measured as ng

[HYPOUSER in reply to SlowDragon]

When you say additional 25 mcg, it means you want me to try 75 mcg? I was afraid to add extra thinking it might bring my tsh too low similar to what happened in Oct (<.006).I am also curious as to why the medication was working well when i switched to 50 mcg from 25 mcg in Jan start, and it brought down my tsh from 5.5 to 3.12 in 2 weeks but didn't show any improvement much after 2 weeks while testing in feb. If taking 75 brings my tsh and t4,t3 to normal will be more than happy.Any thoughts?

[SlowDragon Administrator in reply to HYPOUSER]

When we increase dose it often improves to begin with

If on only Levothyroxine (T4) it's often case that in order to get high enough FT3 we need to take "too much" Levo and TSH becomes suppressed

Did you feel over medicated on 75mcg?

You could try alternate days 75mcg/50mcg

Looking to get TSH around, or below 2

FT4 towards top of range and FT3 at least half way in range

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

[HYPOUSER in reply to SlowDragon]

I was never on 75 mcg so far, only switched between 25 and 50 as adviced by family physician.I was so pissed off that my doc doesnot respnd well and started seeing a good endo and she too thinks going on higher dose might help to bring down my tsh.I have to try adding and see if it gets better and oh yeah I was not aware that we should not take Levo before the test, every time I take it morning 7.30 and doctors didnt tell me either.I will surely take it after the tests hereafter.Thanks much, you are making me feel better now

[Clutter]

Hypouser,

I'm sorry for your loss.

You are undermedicated to have TSH 3.39 on 50mcg and should request a dose increase. Having TSH >3.0 can make it difficult to conceive and increases the risk of miscarriage.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed dose is usually increased by 30-50% or 25-50mcg to ensure good foetal development. NICE also recommends that hypothyroid women planning pregnancy should be referred to endocrinology. I haven't included the link as it is not accessible outside of the UK.

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

13. The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

thyroid.org/patient-thyroid...

[HYPOUSER in reply to Clutter]

Yeah, thats why I am trying hard to bring my levels to normal and just dying to see values close to 2 atleast.Thanks for detailing the references and range.Sure,planning to increase the dose for good.