? Correct Levo dosage

[SusieR68]

I was diagnosed with hashimotos late last summer and GPS have been medicating ever since. I now take 125 levothyroxine. I've added my last blood test results, am I right in thinking there is still room for improvement?

[greygoose]

There's plenty of room for improvement! Your TSH is much too high. When you are on thyroid hormone replacement (levo) the aim is to bring your TSH down to one or under.

Your FT4 is under mid-range. It should be at least over mid-range.

[SusieR68 in reply to greygoose]

Thank you greygoose, I thought that's what I read before on here. Now to convince the GP.

[greygoose in reply to SusieR68]

You're welcome.

[ShootingStars]

Hi SusieR68. Oh yes, and then some! You poor thing! You were diagnosed 7-8 months ago and your TSH is still so high? How are you feeling? Even though your doctor did not run the right tests, your TSH is not anywhere near suppressed, as it should be. You are under medicated with TSH at this level. When properly medicated, it should be under 1.0. With Hashimoto's, properly medicated often people find themselves under. 0.50, or a lot less since were coping with not only being hypo but also the autoimmune attack. Double trouble for the thyroid and your body. Serum T4 is does not tell your free and available levels T4, which is what you need to know. Your T3 is missing. In a thyroid panel, the tests are called FT3, FT4, and TSH. Total or Serum tests are the wrong ones. Can you ask your doctor to run FT3 and FT4? Plus both antibodies, TPOab and TGab. These need to be checked, too.

What were all of your levels when you were diagnosed, including antibodies?

[SusieR68 in reply to ShootingStars]

I still feel relatively tired, usually cold, brain fog, but I also have low vit D and B12 which I am also being "treated" for sit off. Plus ferritin is still also low. So things aren't clear cut.

[sunsetalley]

How do you feel now? Do you still have symptoms of hypothyroidism?

Your results say you're under medicated.........

[SlowDragon Administrator]

Also make sure vitamin D, ferritin and folate are at optimal levels. Are you still getting regular B12 injections?

What about diet, are you strictly gluten free? Or tried it.

TSH should be around or just under one and FT4 towards top of range and FT3 at least half way in range. Ask GP for further increase.

You may eventually need addition of small dose of T3, but need TSH down first, vitamins optimal and possibly gluten free too

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. (Patient to patient tip, GP will be unaware)

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]

Professor Toft recent article saying, T3 may be necessary for many otherwise we may need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

[SusieR68 in reply to SlowDragon]

Thanks SlowDragon,

My B12, D, ferritin and folate have all been out, some still are.

Yes I went gluten free just into the new year, so I'm trying as much as possible to self help.

[SlowDragon Administrator in reply to SusieR68]

How much vitamin D are you taking

B12 injections? Or self supplementing? Are you taking a good Vitamin B complex as well

Ferritin, eating liver once a week should help improve

[SusieR68 in reply to SlowDragon]

I have had B12 loading injections, then should be every 3 months, but still had Neuro symptoms, and breathless again so back to every other day injections.I take folic acid, B complex, have as much potassium rich food as possible. Plus ferrous, k2 and 20,000 iu d3.

Without complaining too much, my GP hasn't been very proactive, I've been waiting 2 weeks for a ring back, now he's on holiday until 8th May, I've had to take care of a lot of my issues myself. Unfortunately, the other GPS are worse.