Hello all, I have a problem with my GP. I am hypothyroid on 100mg Levo [other drugs I take are Hydrochloroquinine [RA] Dulluxotine [Depression] Mebeverine [Bloating, Irritable bowl] Naproxine [Joint pain] omeprazole [told I have to take this becasue risk of bleeding regarding duluxotine and naproxen taken together?] vit d [2000 per day]
I am in groundhog day in that I go to my GP tell him I am feeling terrible, I have no energy and my brain feels like i have dementia, every six months or so he grants me a blood test, two days ago the results came back
Serum TSH level 4.19 Mu/l [0.27-4.2]
Free T4 14.6 pmol/L [11.0-22.0]
Now I love this website and all the information here says that TSH should be around 1 to feel well, now I tell this to my GP and he looks at me as if I am talking rubbish, he tells me blood test results are "within range" and is now talking of referring me to a chronic fatigue clinic, Any advice welcome. Thanks Tom
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tom210
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If possible see another GP, you are undermedicated but it's also likely some of your other meds are making you feel unwell. If you can improve your thyroid levels you may find you don't need so many pills and potions 🙂
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
tukadmin@thyroiduk.org
Ask for list of recommended thyroid specialists too
You are extremely under medicated and very likely vitamin deficiencies as result
Presumably you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?
Bloating and gut symptoms are most likely to be gluten intolerance with Hashimoto's
Joint pain likely low vitamin D
Omeprazole is a PPI that is for treating high stomach acid it causes low vitamin levels as result
Probiotics and fermented foods like kefir and sauerkraut too
If 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 is very poorly understood
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
All thyroid tests should ideally be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
You are undermedicated. See another GP and ask for a dose increase.
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 dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.
Title - Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications
Doctors pay very little attention to the risk of nutrient deficiencies in practically everyone, not just those on PPIs.
You could ask your doctor to test the things I've listed. They might or might not agree to do the testing. If they do agree ask for a copy of the results and the reference ranges once they are available.
Nutrient deficiencies of all sorts make people feel terrible. By supplementing where appropriate you could make yourself feel a lot better.
On top of that, of course, your levothyroxine dose is far too low, as bantam12 and SlowDragon (and others) have pointed out, and you will feel awful because of that too.
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No Action On High Cortisol Levels
Further to My Fist Question
Results need further attention, speak to your GP
Further bloods and advice on supplements 
Advice needed for further testing
