Posting on behalf of my mum. She has been taking levo for at least 15 years that I know of. It is only since my investigation of my own levels that she has shared with me that she is having all her hypo symptoms and of course her GP has reduced her levo. She tells me that she felt best when she was on 150mcg and is now taking 75mcg. Unfortunately I do not know what her previous readings were - she is going to ask for copies of her results.
Other PMH of note - she has arthritis and a definite gluten sensitivity.
Results from medicheck last week:
CRP HS -4.12mg/L ( <5)
Ferritin - 65.8ug/L (13-150)
Folate serum - 3.84ug/L (> 3.89)
Vit B12 active - 81.800pmol/L ( 37.5 - 188)
Vit D - 35nmol/L ( 50-175)
TSH - 2.35mIU/L ( 0.27-4.2)
Free T3 4.41pmol/L ( 3.1-6.8)
Free Thyroxine - 14.200 pmol/: ( 12-22)
Thyroglobulin antibodies - 11.900kU/L (>115)
Thyroid peroxidase antibodies - <9.0 kIU/L (<34)
Advise regarding supplementation and levo levels would be gratefully received. I thin that she needs an increase in levo but GP won't so I am going to suggest she sees my endo who put me on T3. Also needs Vit D, but wasn't sure of brand?
Thanks as always.
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Slappiduck
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If it were me, I would correct vitamin D deficiency before adjusting levothyroxine. Also ensure enough calcium rich foods. Your mother may find that will alleviate her symptoms. Folate is also low so supplementing a good B complex would support all the B's. If your mother is post menopausal then the GP and Endo are likely to be cautious about increasing levo as bone density decreases at this stage in life. It's very important to stay on one formulation of levo to keep levels as stable as possible.
She's obviously undermedicated with these results. 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. Her TSH is too high, her FT4 is 22% thrugh the range and her FT3 is 35% through the range. No wonder she has hypo symptoms with those FT4/FT3 levels. She needs an increase in her Levo, 25mcg now, retest in 6-8 weeks, repeat until her levels are where they need to be to feel well.
To support her request for an increase, 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
tukadmin@thyroiduk.org
print it and highlight question 6 to show her doctor.
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
Thyroid antibodies are nice and low so no sign of autoimmune thyroid disease with those results.
Ferritin - 65.8ug/L (13-150)
It's said that for thyroid hormone to work properly (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.
I've also seen it said that for females 100-130 is good. She might want to raise her level a bit and that can be done 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 her diet
She really ought to see her doctor about this, she is folate deficient as it's below range. Don't let her be fobbed off with "it's only a bit under range", if that's the case she should ask what are ranges for if they're going to be ignored, there's a bottom and top limit for a reason. She may be prescribed folic acid, some people do better with methylfolate.
Vit B12 active - 81.800pmol/L ( 37.5 - 188)
Active B12 below 70 suggests testing for B12 deficiency, so she's probably OK as far as that's concerned but if that was my result I'd like it to be over 100.
She could take a good B Complex containing methylcobalamin and methylfolate as these will raise both B12 and folate levels. The methylfolate may be enough to raise her folate level, she will have to decide if she wants to take prescribed folic acid or this. Good brands are Thorne Basic B and Igennus Super B, both contain bioactive forms of ingredients and both contain 400mcg methylfolate at the suggested dose.
Vit D - 35nmol/L ( 50-175) = 14ng/ml
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).
To reach the recommended level from her current level, the Vit D Council suggests supplementing with 4,900iu D3 (5,000iu is the nearest).
Retest in 3 months.
When she's reached the recommended level then she'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. She can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
As she doesn't have Hashi's a good Vit D supplement is Doctor's Best softgels. This is the one I used to raise my severely deficient level and this company usually is the cheapest and has good customer service:
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.
Vitabay Organics do a liquid K2-MK7, and Healthy Origins do a softgel MK7.
If she is on any blood thinners, she should do some research to decide if she should take it. Some articles say that K2 clots the blood whereas it is K1 that is the blood clotting vitamin and K2 is for calcium redirection, but she should satisfy herself.
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).
Don't start all supplements at the same time. Start with one, leave it 1-2 weeks and if no adverse reaction then add the second one. Continue like this. If she has any reaction then she will know what caused it.
I agree with everything Susie has said. In addition to the matter of vitamin and mineral uplift needed your mother is not receiving sufficient thyroid replacement. No wonder she feels tired and suffers hypo symptoms.
The most urgent is to supplement D3 (together with K2 MK7 for a proper distribution of calcium to go to bones and not to anywhere else!!), and Folate. To achieve optimal level of those two vitamins (plus B complex) would be very helpful as their deficiency might be the main cause of her symptoms.
Thank you everyone for your helpful replies. Her GP is as much use as a choc teapot and is refusing point blank to increase her Leno. She is happy to pay to see the endo so I’d be happier if she did that.
I forgot to mention that she has a fast gut transit and doesn’t have much bowel left due to a chronic bowel condition aftee several operations, no doubt that affects her absorption?
I will pass on all the information to her regarding supplants and hopefully she will manage to find a suitable regime.
Thanks again everyone for taking the time to answer.
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