Thyroid UK
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Symptoms from Hashimotos ?

Hi I have been diagnosed with Hashimotos for about 6/7 years and I would like some help regarding dose. My current symptoms are constipation, tiredness, difficulty getting out of bed, feeling cold, puffy eyes, losing hair, queasiness, bloating, joint pain, period pain, irregular periods, depression, anxiety, paleness to skin, poor immune system function, memory loss, ears ringing, pins and needles. I take 25mcg levothyroxine and looking to add T3 since I have never felt well on any dose of levothyroxine.

Thank you


TSH 4.76 (0.2 - 4.2)

FT4 14.5 (12 - 22)

FT3 3.2 (3.1 - 6.8)

TPO antibody >1200 (<34)

TG antibody 278.5 (<115)

3 Replies

Just a quick reply, 25mcg of Levo is an extremely small dose and looking at your results it would seem to me that you need an increase. The other thing is that I would get your B12, folate and iron levels checked as pins and needles can indicate a deficiency. Hopefully someone will be along soon and expand on your results.


Don't consider T3 at the moment, there are other things that need sorting.

First of all, you are way undermedicated on 25mcg Levo and with a TSH of 4.76 and such low free Ts. The aim of a hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their reference ranges if that is where you feel well. So the first step is to get an increase in your Levo, 25mcg now, retest in 6 weeks, another 25mcg increase, retest after 6 weeks, etc, until your levels are where they need to be. Only then can you know if you need T3 and it will be your FT4 and FT3 levels which will tell you that. If your FT4 is high in range and FT3 low in range that will show poor conversion of T4 to T3 and the need for the addition of T3.

You also need to address the Hashi's by adopting a strict gluten free diet and supplementing with 200mcg selenium l-selenomethionine daily to help reduce the antibodies.

As Hashi's can cause gut/absorption problems which can lead to poor nutrient levels or deficiencies then it is essential to test vitamins and minerals and supplement where needed. Some of your symptoms are indicative of low levels. Optimal levels are essential for thyroid hormone to work. You need them to be:

Vit D - 100-150nmol/L

B12 - top of range

Folate - at least half way through range

Ferritin - minimum of 70, preferably half way through range

If Ferritin is low you need a full blood count and iron panel to check for anaemia.


You are extremely under medicated and very likely have terrible vitamin levels.

Your antibodies are very high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary 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 can 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 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 plus testing vitamins

First steps are to increase Levo dose up in 25mcg steps until TSH is around one and FT4 towards top of range. Retesting 6-8 weeks after each dose dose increase

Supplementing to improve low vitamins at same time

Strictly gluten free diet helps very very many


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