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[Kimo90]

Hi do I need an increase to 200mcg levo my FT4 14.6 (12 - 22) and TSH 4.65 (0.2 - 4.2) my hair is thinner have hard stool and sleeping more each day thank you

[shaws Administrator]

Due to your high TSH, yes you do need an increase. The aim is to bring the TSH to 1 or below but doctors believe, wrongly, that once it reaches somewhere in the range, their job is done and patients is optimally medicated.

When you post results you also have to put the ranges. Labs differ and it makes it easier to respond.

Do you have your blood tests at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levothyroxine and the test? If not follow this procedure next time as it is beneficial for the patient.

Also, in the Profile page there is only your name and it would be helpful if you could put a short history of your journey to hypothyroidism.

[Kimo90 in reply to shaws]

Sorry

I have provided a profile

[Kimo90 in reply to shaws]

Yes bloods done early morning and fasting and leaving off thyroid medication for 24 hours

[Kimo90 in reply to shaws]

Once again I am very sorry

[shaws Administrator in reply to Kimo90]

There's no need to apologise, all of us on this forum had to learn slowly due to the doctors not really knowing how best to treat us. It is a big learning curve to know how the forum works

[Kimo90 in reply to shaws]

Ok thank you I didn't realise I had to provide ranges but I have now

[Clutter]

Welcome to the forum, Kimo90.

You do need a dose increase if TSH is 4.65 on 175mcg.

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.

[Kimo90 in reply to Clutter]

Thank you Clutter

[Kimo90]

Can results go up and down a lot with continuing hypothyroid symptoms?

[shaws Administrator in reply to Kimo90]

Sometimes yes - they can go up/down and warrant a blood test to be taken, to make sure everything is optimum. However the aim is sufficient thyroid hormones to relieve all symptoms but sometimes doctors keep our TSH 'in range' when the aim is 1 or lower. Few doctors seem to be aware of this and are happy if our TSH is somewhere in the range (which is up to about 4). If symptoms return you should request a blood test.

It should consist of TSH, T4,T3, Free T4, Free T3 and thyroid antibodies (if you've been diagnosed as having Hashimoto's.

Tick off the symptoms you have and cross off when relieved.

thyroiduk.org.uk/tuk/about_...

[Kimo90 in reply to shaws]

Ok thank you. I am positive for TPO and TG antibodies. Also have FT3 result 3.7 (3.1 - 6.8)

[shaws Administrator in reply to Kimo90]

O.K. you have an Autoimmune Thyroid Disease - commonly known as an Hashimoto's. Going gluten-free can help reduce the antibodies which attack the thyroid gland and they wax and wane so sometimes you may feel 'hyper' due to the antibodies being 'dumped' . Your FT3 is too low and should be nearer 6. Your FT4 is also too low so an increase is needed . Both should be towards the upper part of the ranges.

[SlowDragon Administrator]

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

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

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 gut and gluten connection is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

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...

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]

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...