Blood Tests - 6 weeks after taking Levo (50mcg) and Calciferol

Severe leg/bone/joint pains and stiffness started late last year 2018. Blood tests in January diagnosed severe deficiency in vit D and hypothyroid/hash oti (antibodies attacking thyroid). Took a 6 week dose of vit D and levels are satisfactory. First blood tests after 6 weeks of taking Levothyroxine and TSH is 3.0 (from 5.5) . Doc kept me on 50mcg dosage. Is it normal for the TSH to go down further in time or will it remain at that level until I up dosage? Leg/bone/joint pains got better initially but the last two weeks appear to be coming back but not with the same avengence as previously. Blood tests by doc this time were taken for vit D deficiency and TSH only. Not T4 or T3 or vitamins. Is this normal?

[shaws Administrator]

You should have had a dose increase and increases continue at 25mcg until the TSH is 1 or lower. Many doctors think if it is 'within range' that we're on sufficient. That's not the case.

As you have hashimoto's going gluten-free can help reduce the antibodies which attack the thyroid gland until person becomes hypothyroid. Due to antibodies it is an Autoimmune Thyroid Disease that you have but treatment is the same as for hypothyroid.

Initially we can feel an improvement but then symptoms return, and that usually indicates that the dose needs to be increase. Doctors should take less notice of the TSH as many believe if has reached somewhere in the range that we're on sufficient but that's not the case.

All vitamins/minerals have also to be optimal and not you've been given Vit D.

Your iron, ferritin and folate should also be optimal.

The aim is a TSH of 1 or lower with Free T4 and Free T3 in the upper part of the ranges. GPs don't usually check the Frees:-

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

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

[Hidden in reply to shaws]

Thanks for your response Shaws.

[SeasideSusie Remembering]

Hidden

Took a 6 week dose of vit D and levels are satisfactory

Leg/bone/joint pains got better initially but the last two weeks appear to be coming back but not with the same avengence as previously.

I gave you information of how Vit D deficiency should be treated according to NICE Clinical Knowledge Summary in reply to your last post

healthunlocked.com/thyroidu...

Did your GP follow this?

What was the dose of the prescribed D3?

What is your new "satisfactory" level?

What dose of D3 are you continuing with?

Are you taking D3's important cofactors?

Once I improved my severe Vit D deficiency to the recommended level, I have found that I need to maintain that by taking 5,000iu D3 daily for most of the year, I can reduce the dose a little bit in the summer.

As for your TSH, when on Levo only, the aim of a treated 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. You should be tested 6 weeks after starting Levo, then every 6-8 weeks with an increase in dose if necessary (25mcg increments) until your levels are where they need to be for you to feel well.

Many surgeries now think that testing TSH is all that is needed once on Levo, unfortunately that doesn't tell them where your actual hormone levels lie (FT4/FT3 are the thyroid hormones, TSH is a signal from the pituitary which tells the thyroid to produce more hormone if it detects there's not enough - in which case the TSH is high). So testing FT4/FT3 really is important but difficult to get done with the NHS, which is why hundreds of us here do our own private testing with labs recommended by ThyroidUK.

TSH is 3.0 (from 5.5) . Doc kept me on 50mcg dosage

You need a dose increase. To support your request for this, use the following information:

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 [e-mail] print it and highlight question 6 to show your doctor.

Also, from NHS 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

[Hidden in reply to SeasideSusie]

Hi SS,

Thanks again for your response.

I believe at the point you gave me the NICE guidelines I had started on a course of medication to treat the Vit D deficiency which was for 6 weeks. The recent blood tests have proved this treatment worked as my levels are in the 'sufficient range'. I shall continue to take supplements though to ensure I don't encounter another episode of severe deficiency.

I shall use the information you have provided from Dr. Toft to inform the GP. Thanks.

[Hidden in reply to Hidden]

A further question if I may? Is it normal in the current situation to be losing weight. I have never lost weight easily and have always had to diet and exercise hard and so I assumed being diagnosed with hypo the weight would be even harder to shift however since I have had these problems I am constantly losing weight and so it seems to be the opposite to the norm or what I thought was the norm? Any thoughts?

[SeasideSusie Remembering in reply to Hidden]

As you become less hypothyroid and your levels become optimal, you should hopefully lose any excess "hypo" weight. Before I was diagnosed I was probably about 3 stone heavier than my normal weight, once I was on the right dose of Levo and my levels stabilised then I lost that extra weight without having to try.