My vitamin D is insufficient and my B12, folate and ferritin levels are lower in range and certainly not at optimal levels. Currently on 75 mcg of levothyroxine but feeling crap - tired, hair falling out, sluggish, anxiety issues.
Seeing my GP on Friday and would appreciate any advice on what I should be pushing for or other things I should be doing to feel better.
Thanks.
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gturner83
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The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in balance in the upper part of their reference ranges, if that is where you feel well.
Your TSH is far too high, and both FT4 and FT3 too low. At the moment it's not possible to say if you have a conversion problem. That would show up with a high FT4 and low FT3, but at the moment your TSH is too high, not enough thyroid hormone to increase your FT4 to see how well you convert.
I’ve researched vitamin d through a group on Facebook so know I need to up that and take K2 and Magnesium with it. I’ve also got iron tablets at home that I should restart taking along with Vitamin c.
Folate should be at least half way through range. Eating Folate rich foods can help, also a decent B Complex containing 400mcg methylfolate eg Thorne Basic B or Igennus Super B.
Active B12 isn't low enough where it's recommended to test for B12 deficiency (that would be <70) but I'm more used to serum B12. You could take sublingual methylcobalamin lozenges 1000mcg to help raise your level. If taking B12 we need a B Complex to balance all the B vitamins.
You can also help raise Ferritin by eating liver regularly, maximum 200g per week. Ferritin needs to be at least 70 for thyroid hormone to work.
Take iron tablets 4 hours away from thyroid meds and 2 hours away from any other medication and supplements.
Your GP said your levels are normal purely because they are in range and that satisfies them without bothering about how the patient feels.
To support your request for an increase use the following information from thyroiduk.org.uk/tuk/about_... > Treatment Options
"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)."
Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing Dionne at tukadmin@thyroiduk.org print it and highlight question 6 to show your GP.
You can say you have taken advice from NHS Choices recommended source of information about thyroid disorders, which is ThyroidUK, but don't mention the Internet or forums, they don't like that.
Suggest you push GP for 25mcg dose increase. Your FT4 should be near top of range (not right at the bottom) and FT3 at least half way in range
Do you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?
Aak for antibodies to be tested, if never been done
About 90% of all primary hypothyroidism in Uk is due to Hashimoto's
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
your vitamin levels are likely low due to being under medicated
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
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)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
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)
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results
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