Hi I've had some great advice from this community before so I'm hoping you an help again. I take 50 (mg?) levothyroxine for an underactive thyroid. I was recently tested in a review for my tsh only and it is 3.75.
I've looked at the NICE guidelines and they seem to indicate that I should be aiming in the lower end of the range (0.4 to 2.5). Can anyone confirm if this is right? And also if anyone has any experience of this?
I'm asking because I still have symptoms which I think are related to my thyroid not working properly. So I'm wondering if my dose needs increasing. I know I could ask my GP but they just say it's in the normal range so I'm good. So I like to go with evidence! Thanks for any advice
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Bearfam
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For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Medichecks currently have an offer on until end of May - 20% off
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 are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH under one) and FT4 in top third of range and FT3 at least half way in range
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
NHS guidelines on Levothyroxine including that most patients need somewhere between 100mcg and 200mcg Levothyroxine. Also what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)
For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.
This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.
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)
Thanks for your detailed reply. I'm at work so will read in full later as lots to digest.. But no this is not how I do my tests! I do have low ferratin, vit D and calcium. I actually had an iron infusion recently due to anemia.
GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve vitamin D by self supplementing to at least 80nmol and around 100nmol may be better .
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Vitamin D mouth spray by Better You is good as avoids poor gut function.
It's trial and error what dose each person needs. Frequently with hypothyroidism we need higher dose than average
Your ferritin must have been very low for you to get infusion
Eating liver or liver pate once a week, plus other iron rich foods like black pudding, prawns, spinach, pumpkin seeds and dark chocolate, plus daily vitamin C can help improve iron absorption
The lab "normal" range is way too broad. Both the AACE range (0.3-3.0) and the 1-2 range functional medicine practitioners use, are more reasonable. 3.75 is too high. You have to consider that the T4-only full-replacement figure is in the 1.5-1.7 mcg/kg body weight. If you weigh significantly more than ~30kg, you are being underdosed at 50mcg/day. This pattern of underdosing and paying more attention to TSH than elimination of the patient's symptoms, is seen frequently on this board.
My experience? TSH=0.11 and FT3 ~ mid-range. No, I'm not an anxious wreck, I feel fantastic. I take T3 during the sleep cycle to enforce my T3 circadian rhythm, so my TSH is lower than many people. But symptoms are what matter, and mine are gone. Beware of doctors who diagnose and treat solely by TSH: this is allopathic medicine's attempt to use a one-size-fits-all method, and guess what: it doesn't fit a large minority of patients.
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TSH Reference Ranges in the USA
On NDT and my TSH in a range
Is the TSH normal range even representative?
High TSH, T4 within range 
TSH and T4 range calculator thingy
