Am I on the correct dose of levo?: Sorry for... - Thyroid UK

Thyroid UK

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Am I on the correct dose of levo?

Unhole
Unhole

Sorry for hijacking HG @@@ post😳

...I’m on levo 75mcg with a TSH of 2 which the GP says is perfect😟!...have raised antibodies and therefore I believe I have Hashimotos. Auto immune problems are rife in my family. I’m feeling fine but still weak...easily ache and I have lots of joint pain....I’m wondering now after a reply from Greygoose as to wether I’m undertreated...still!🙄....any suggestions would be gratefully appreciated😊

11 Replies
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SlowDragon
SlowDragonAdministrator

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies.

Plus very important to test vitamin D, folate, ferritin and B12. These need to be optimal, not just somewhere within range

Can you add your most recent results and ranges

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

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.

If on Levothyroxine, don't take 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 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. Low vitamins are especially common with Hashimoto's. Food intolerances common too, especially gluten. So it's important to get both TPO and TG antibodies tested at least once .

TSH of 2 suggests you are under medicated. You need FT4 and FT3 tested

Unhole
Unhole in reply to SlowDragon

I have a test result for T3 of 1.3 nmol/L

I need to request sight of my antibody test though I’m told it was raised. 🤔

SlowDragon
SlowDragonAdministrator in reply to Unhole

Do you have ranges on that result

Unhole
Unhole in reply to SlowDragon

Sorry the range is 0.9-2.5 T3 and I’m 1.3nmol/L

SlowDragon
SlowDragonAdministrator in reply to Unhole

Then it's too low. Looking for over 2 ideally.

Unhole
Unhole in reply to SlowDragon

Oh!...can you explain that so I can explain it please?...just it’s within range and that’s what GP quotes😕

SlowDragon
SlowDragonAdministrator in reply to Unhole

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

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

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

If your antibodies are 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

Low vitamin D can cause joint pain

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)

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 vitamin tests, if these have not been done

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Getting vitamins optimal, trying strictly gluten free diet and getting Levo dose optimal so that TSH is around one and FT4 towards top of range, are first steps

If after these, FT3 remains low then, many with Hashimoto's may benefit from small dose of T3

Unhole
Unhole in reply to SlowDragon

Thank you ...that’s useful. I have had a gluten free diet for over 15years due to ‘wheat intolerance’...but only diagnosed under active thyroid Autumn last year😟...I think I have been for many years.....I’m on Vit D high strength tabs prescribed but I still ache. I can easily overdo things and suffer for a few days after. So I’ve asked Gp if I can increase to 100mcgs...I’m waiting a reply!🤞....thank you again😊

SlowDragon
SlowDragonAdministrator in reply to Unhole

Make sure to get vitamin D tested twice yearly when supplementing

Vitamindtest.org.uk

NHS postal kit £29

Also get GP (or Medichecks) test for b12, folate and ferritin

Gluten free diet includes avoiding all barley and rye

It's unusual for a person taking levo to feel well with a TSH over 1. SO 2 might be perfect for him, but obviously isn't for you. Get a copy of the Dr Toft article to take to your next appointment.

Thank you I’ve now just bought his book!🙂

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