I was diagnosed with an underactive thyroid about 2 and a half years ago after the birth of my second child. I am currently on 100micrograms of levothyroxine.
My dose was increased last August but i have had a recurrence of symptoms over the past few months. I arranged for a private blood test through Thriva and my gp also did the usual tsh and t4 test.
My results are below:
B12 80.3pmol/l (range 25.1 to 165)
Ferritin 13.2ug/l (range 13 to 150)
Folate 8.49nmol/l (range 8.83 to 60.8)
TSH 1.61mIu/l (range 0.27 to 4.3)
Free T4 16.4pmol/l (range 12 to 23)
FT3 4.14pmol/l (range 3.1 to 6.8)
Anti-thyroidperoxidase antibodies 74.1kiu/l (range 0 to 34)
Thyroxine T4 87.2nmol/l (range 66 to 181)
Anti-thyroglobulen antibodies TGAB 30.6ku/l (range 0 to 115)
25-hydroxy vitamin D 42.1nmol/l (range 50 to 100)
I am currently supplementing with 800ug of folic acid and 25ug of vitamin D a day.
My GP is reluctant to increase my thyroxine, but i am still feeling very tired, hair falling out and dizzy and foggy. I also have pitted and flakey nails which is a new symptom for me.
I have been supplementing with vitamins for about a month now. How long will it take to improve my levels?
Any other suggestions for relieving the tiredness and foggyness?
Written by
Ejsmith
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You are 0.2 inside the range. I would ask your GP to do a full blood count and an iron panel to see if you have anaemia.
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Here is another problem:
25-hydroxy vitamin D 42.1nmol/l (range 50 to 100) [16.8ng/ml] - 25ug of vitamin D a day
25mcg D3 = 1000iu which is just about a maintenance dose for some people with a good level already.
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml). For your current level the Vit D Council recommends taking 4,900iu D3 daily (nearest is 5,000iu)
When you have reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
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).
As you have Hashi's, an oral spray gives best absorption, eg BetterYou, or you could take sublingual drops. Check how much you need to give 5000iu. BetterYou do a combined D3/K2 spray as well as D3 alone.
Did you know you have Hashi's - confirmed by raised antibodies?
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Folate 8.49nmol/l (range 8.83 to 60.8)
I am currently supplementing with 800ug of folic acid
Is this prescribed? I think the normal amount prescribed for folate deficiency is 5mg daily.
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B12 80.3pmol/l (range 25.1 to 165)
This is Active B12. Below 70 would suggest testing for B12 deficiency. Yours is on the low side and I would be aiming for over 100 personally.
A good B Complex containing 400mcg methylfolate plus 400mcg methylcobalamin (B12) should raise both B12 and folate. Consider Thorne Basic B or Igennus Super B.
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TSH 1.61mIu/l (range 0.27 to 4.3)
Free T4 16.4pmol/l (range 12 to 23)
FT3 4.14pmol/l (range 3.1 to 6.8)
My GP is reluctant to increase my thyroxine
You need an increase. The aim of a hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. Your FT4 is 44% through range, your FT3 is 27% through range, plenty of room to increase your Levo.
In support of your request for an increase, refer to:
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
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Also see the information and links given in SlowDragon 's reply to this post
Thank you for this. I visited my GP today to discuss, unfortunately he was quite dismissive of the vitamin issues and has told me the levels were fine. The supplements i am taking are Holland and Barrett versions.
I have never been officially diagnosed with Hashimotos although both my parents have underactive thyroids so i had assumed the case.
I have agreed to go back to the GP in a few weeks to review things. I will aim to optimise my vitamin intake to try and address the deficiency issues.
It's good to know there is scope to increase my levothyroxine.
H&B own brand supplements are generally inferior, with the cheapest and least absorbable forms of ingredients and lots of cheap fillers. You would be better changing to a decent quality brand. Please consider the brands I have mentioned.
As you have Hashi's, then an oral spray or sublingual liquid D3 is advised. If you can't take those for some reason, the next best thing would be an oil based softgel, eg Doctor's Best brand.
As for folic acid, this has to be converted by the body to folate, not all of us can do this, which is why the methylfolate version is advised.
As for your ferritin level, this is absolutely dire and you really should push for further testing. Low ferritin suggests iron deficiency anaemia, you should get this looked into and get proper treatment from your GP. Such a dire ferritin level is not a DIY fix.
SeasideSusie has given her excellent detailed vitamin advice
But also as you have Hashimoto's you may benefit from strictly gluten free diet
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. 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, sometimes 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 or buy test online for under £20, just to rule it out first
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two). Or Jarrow B-right (Large capsules)
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
You've not had much info from your GP as the majority seem to believe that only the TSH and T4 should be tested. Quite a number seem unaware that the aim is a TSH of 1 or lower (many keep it somewhere in the range and maybe up to 5)! For the best results they should test the Free T4 and Free T3 and these are rarely tested but both should be in the upper part of the ranges.
Thank you everyone for your advice. I feel i have a plan of action in relation to my vitamin issues and then a return to the gp for medication review. I have had a full blood count done which the GP said was fine and didn't show me as anaemic but i don't know the levels.
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