Update. Looking for more advice.

[Sheffield6]

.

Joint and muscle improved considerable. Probably the D3.

Just as Fatigued on Levothyroxine 112.5 mg

Any ideas what else I could do?

Thyroid stimulating hormone 0.48 miu/l 0.27 - 4.2

Free thyroxine 17.9 pmol/l 12.00 - 22.00

Total thyroxine(t4) 94 nmol/l 59.00 - 154.00

Free t3 4.8 pmol/l 3.10 - 6.80

Thyroglobulin antibody <10.0 iu/ml 0-115

Thyroid peroxidase antibodies <9.0 iu/ml 0 – 34

Vitamin B12 442 Pg/Ml 197 - 771

Folate (Serum) 6.8 Ug/L > 2.9

Ferritin * 417 Ug/L 30 - 400

C Reactive Protein 0.8 Mg/L <5.0

Vitamin D Level 16.6 Nmol/L(VITAMIN D3 5000IU FROM 19 JAN 2018.)

Egfr Using Creatinine (CKD-EPI) Per 1.73 Square Metres > 90 Ml/Min

Creatinine Level 69 Umol/L [62 - 106]

Inorganic Phosphate Level 0.82 Mmol/L [0.8 - 1.5]

Alkaline Phosphatase Level 77 Iu/L [30 - 130]

Adjusted Calcium Concentration 2.26 Mmol/L [2.2 - 2.6]

Albumin Level 46 G/L [35 - 50]

Calcium Level 2.31 Mmol/L [2.2 - 2.6]

[SeasideSusie Remembering]

Vitamin D Level 16.6 Nmol/L(VITAMIN D3 5000IU FROM 19 JAN 2018.)

Did your GP put you on loading doses of D3 according to NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar.

How much D3 are you currently taking?

Is this your latest test after being on D3 for a while?

And are you taking D3's important cofactors Magnesum (which allows your body to use the D3) and K2-MK7. D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds, Magnesium also 4 hours away from thyroid meds.

**

Vitamin B12 442 Pg/Ml 197 - 771

This is too low. An extract from the book, "Could it be B12?" by Sally M. Pacholok: "We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550". "For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml." You could supplement with sublingual methylcobalamin 1000iu daily to raise your level, and to balance all the B vitamins you'd need a good B Complex as well.

**

Optimising Vit D and B12 may help your symptoms/fatigue and you should probably do that first.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo. Your TSH is good but your FT4 and FT3 are too low but may increase with optimal vitamins and minerals.

If FT4 and FT3 don't improve, then Dr Toft 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 article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor if you feel an increase in Levo dose is necessary if your free Ts don't improve.

[Sheffield6 in reply to SeasideSusie]

I'm still on D3 5000IU which has helped. The GP gave me 800IU but I decided on the 5000IU dose. I've been gluten free for 5 months but don't think it's made any difference. Will look into B12 which looks promising.

[silverfox7]

You are undermedicated as well which won't be helping. The aim is to get the FT4 and the FT3 in the top third or even the top quarter of their respective ranges.

[Highland49]

Also your folate is low, it should be in the high teens to be optimum.