I was diagnosed with an underactive thyroid in April of this year and have been on increasing doses (every 6 weeks) of Levothyroxine since:-
I started on 50mcg(Diagnosis TSH was 3.55), then 75mcg (TSH was 2.48) and have been on 100mcg(TSH was 1.97) for the last 6 weeks.
At the time of my diagnosis my Vitamin D was 21.5 and I was put on 40,000u per week for 7 weeks followed by a maintenance dose of 800u which I am continuing to take
I am looking for some advice for test results I have just had(3/9/2018):-
TSH2.84[0.27-4.2
] FT418.4[12.0-22.0]
FT35.03[3.1-6.8]
TGAb<10[0-115]
TPOAb<9 [0-34]
Vit B1255.4[25.1-165]
Folate4.36[2.91-50]
Vitamin D59.3[50-200]
CRP-hs4.89[0-5]
Ferratin222[30-400
]
I am feeling better than I did when diagnosed ,but still have to have a sleep straight after work and also have muscle aches and painful feet which are worse at the end of the day.
I would appreciate any comments anyone may have, as I am a bit confused about the latest TSH reading although I understand it is the FT4 and FT3 that are the important readings once you start taking Levothyroxine.
P.S. I think this forum is excellent, because in my experience GP support for thyroid issues is almost non existent !
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Blokey151263
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Your TSH is higher than what most hypo patients need, generally the aim of a treated hypo patient 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 if that is where you feel well. Your FT4 is 64% through range and your FT3 52% through range, they could be improved and that may make you feel better so an increase in your dose of Levo is worth trying.
If GP isn't keen to increase your dose, use the following information in support of your request:
Dr Toft (leading endocrinologist and past president of the British Thyroid Association, states in Pulse Magazine (the magazine for doctors):
"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 tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.
Ferritin: 222 [30-400]
This is good as it's recommended to be half way through it's range.
Vit B12: 55.4 [25.1-165]
This must be Active B12 with that range and that result is low according to viapath.co.uk/our-tests/act... which says a result below 70 should be tested for B12 deficiency
Reference range:
>70*; * between 25-70 referred for MMA
Check for any signs of B12 deficiency here b12deficiency.info/signs-an... and if you have any then list them and discuss with your GP and ask for testing for B12 deficiency/pernicious anaemia.
Folate: 4.36 [2.91-50]
Folate and B12 work together and this result being very low in range is no surprise. You may not get folic acid prescribed by yor GP, in which case supplementing with methylfolate or a good quality B Complex (eg Thorne Basic B or Igennus Super B) containing 400mcg methylfolate will help.
HOWEVER, don't start supplementing with folic acid/methylfolate/B Complex until further testing for B12 deficiency has been carried out as it will mask signs of B12 deficiency.
Vitamin D: 59.3[50-200]
Your muscle aches and pains are very likely due to this level of Vit D.
It's good that you were given loading doses but the 800iu maintenance dose is totally inadequate. The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L and your current dose wont increase your level. You need to buy your own D3 supplement and the Vit D Council, recommends for your level:
To reach 100nmol/L - 2000 IU daily
To reach 125nmol/L - 3700 IU daily
To reach 150nmol/L - 5800 IU daily
Personally, with your level, I would take 5000iu daily for the next 3 months then retest.
A good D3 supplement is Doctor's Best softgels which contain just D3 and extra virgin olive oil, nothing else
Your doctor wont know, because they are not taught nutrition, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -
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 such as hardening of the arteries, kidney stones, etc.
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 helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
With reference to my post of 3 weeks ago and your comments, I have decided to increase my dose of Levothyroxine to 125mcg (from 100mcg) and was wondering if you could recommend an online serum T3 test .
I would like to check this level as per Dr Tofts recommendation that FT4 can be elevated as long as serum T3 is normal
Since I sent you the post I have found a test that Medichecks do which is T3 (not FT3) is this the test that the article by Dr Toft refers to do you think or am I confusing myself?
Dr Toft is talking about Total T3 (which is the test you saw). FT3 is more useful because when it's done at the same time as FT4 then you can see how good (or not) your conversion is.
FT3 is more useful because it only measures the amount of free T3 circulating. Total T3 measures both bound and free T3.
I think I will have a repeat Ultra Vit test when the 6 weeks at 125mcg is up and see how things look.
Forgive me if I am labouring the point, but from my understanding FT4 can be elevated as long as FT3 doesn't become raised as this would be classed as hyperthyroidism?
According to Dr Toft then FT4 can be elevated. Mine was, but what tends to happen when FT4 is elevated is that reverse T3 is made rather than free T3. It's not hyperthyroidism (that's impossible if you are hypothyroid). In my case my FT4 was way over range, my FT3 was just about 50% through range, so my conversion was poor, I needed less Levo and the addition of T3.
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