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Newbie needing help one year on from hemithyroidectomy

One year after my hemithyroidectomy (due to 1" benign cyst) my endocrinologist has discharged me because my bloods are 'normal' and my symptoms since the op are apparently 'just coincidence' and she referred me for an ECG as it 'might all be caused by an underlying heart problem'. My ECG showed no abnormalities. At my ECG the nurse was brilliant and and admitted that it was a great coincidence that my symptoms started a few weeks after my op...the usual terrible mind fog, wanting to sleep all the time, dry skin, headaches, no zeal for life etc. and sent off for the bloods below. Would anyone be kind enough to look at my results and offer any suggestions for improving my quality of life. (I have been taking B-Complex and D3 which have helped to an extent.) I take 25/50mg levothyroxine alternately.

Vit D 101 nmol/L

Ferritin 38.2 (110 - 307 ug/L)

B12 273 ng/L (145 - 914 ng/L)

folate 9.02 ug/L (3 - 20 ug/L)

TSH 2.7 mlU/L (0.3 - 4.8 mlU/L)

free T4 13.9 (7.7 - 20.60 pmol/L)

free T3 5.2 (4.2 - 6.9 pmol/L)

serum sodium 141 mmol/L (133 - 146)

serum creatinine 48 umol/L (45 - 84)

GFRate >90

Serum C <5 (<10 mg/L)

magnesium 0.96 mmol/L (0.7 - 1.0)

calcium 2.48 mmol/L

glucose 5.2 mmol/L (3.5 - 5.4)

Also have Liver function, Full Blood Count and bone profile but not wanting to bore you!

As a bit of background, looking back to 25 years ago after having children, I had similar symptoms for about 8 years, but thought I was depressed, so I'm thinking that there has been something underlying for a long time.

I really appreciate any help you might be able to offer. Thank you.

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I am on my PC with a large screen monitor, it's impossible to read your results. It's unlikely anyone on a different device will be able to.

Can you please type your results out (include reference ranges) so that we can try and help you.

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Thank you - just realised that and results should be there now :)


TSH 2.7 mlU/L (0.3 - 4.8 mlU/L)

free T4 13.9 (7.7 - 20.60 pmol/L)

free T3 5.2 (4.2 - 6.9 pmol/L)

I take 25/50mg levothyroxine alternately

How long have you been on that dose?

You are undermedicated. 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 if that is where you feel well. Your FT4 is 48% through range and FT3 just 37% through range, both have a long way to go to be near the upper part of the range, and your TSH need to come down to nearer 1.

You should ask for an immediate increase, either to 50mcg daily or even 50/75mcg. Retest in 6 weeks, further increase with retest 6 weeks later if necessary.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at


print it and highlight question 6 to show your doctor.

Further evidence here from Leeds Teaching Hospitals pathology.leedsth.nhs.uk/pa...

Thyroxine Replacement Therapy in Primary Hypothyroidism

TSH Level .......... This Indicates

0.2 - 2.0 miu/L .......... Sufficient Replacement

> 2.0 miu/L .......... Likely under Replacement

Vit D 101 nmol/L

How much D3 are you taking? The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level between 100-150nmol/L so you're close to optimal. Are you taking D3's important cofactors


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 if taking tablets/capsules/softgels, no necessity if using an oral spray

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 if taking tablets/capsules, no necessity if using topical forms of magnesium.


Check out the other cofactors too (some of which can be obtained from food).

Ferritin 38.2 (110 - 307 ug/L)

This is too low. For thyroid hormone to work (that's our own as well as replacement hormone) it's said that ferritin needs to be at least 70, preferably half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

B12 273 ng/L (145 - 914 ng/L)

ng/L is the same as pg/ml*

This is rather low. Do you have any signs of B12 deficiency (bear in mind that taking your B complex - as it contains folic acid/folate - can mask signs of B12 deficiency), check here


I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And 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*."

folate 9.02 ug/L (3 - 20 ug/L)

This is low. What B Complex are you using. Highly recommended are Thorne Basic B and Igennus Super B, both contain the bioactive forms of ingredients, methylfolate is better than folic acid.

All nutrient levels should be optimal for thyroid hormone to work properly.

The others seem to be in range but I can't comment on calcium as the range isn't there.


Thank you so much for all this info - I have been reading as much as possible, but seeing just the relevant bits all in one place is so very helpful.

I've been on 25/50 mg of levothyroxine for about 6 months (was 25 prior to that).

The B Complex I'm using is Country Life 'Coenzyme B-Complex'.

My D3 is not the best quality, so I'll change that for a recommended one and check up on the cofactors.

It's amazing how having someone respond to you in a positive way can lift your spirits! Thanks again :D


Your B Complex contains a very large amount of B6 at 80mg per 2 capsules and the recommended daily amount is 10mg. Long term use of high dose B6 can cause nerve damage. I prefer to err on the side of caution and stick to the recommended amount.

As long as you don't have autoimmune thyroid disease (raised antibodies) then a good quality D3 with just 2 ingredients and no excipients - only D3 and extra virgin olive oil to aid absorption - is Doctor's Best softgels.


Hello Radicalfreedom

Just as a point of reference an fully functioning thyroid would give you daily, approximately 100 T4 and 10 T3.

Considering you have had thyroid surgery, and part removal, I'm amazed that your thyroid hormone replacement is so low.

I can't really add anything else and simply agree with the comments already made.

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Thank you Pennyannie


Getting your Levothyroxine dose increased, plus getting vitamins optimal

Bloods should be retested 6-8 weeks after each 25mcg dose increase

If your GP won't increase dose then you will need to see a better endocrinologist

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

Most "run of the mill" endocrinologists are only Diabetes specialists

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