Help understanding results after starting Levothyroxine.

[SB51]

Hello,

I started taking a low dose (25mcg) of Levothyroxine in May and just had another blood test to see how things are going after taking it for 6 weeks.

My blood test results in May (before taking levo)

TSH - 3.77 IU/ml (0.5 - 5.00)

FT3 - 4.17 pg/ml (2.30 - 4.30)

FT4 - 1.14 ng/dl (0.90 - 1.70)

TgAB - 10< IU/mL (<28)

TPOAb - 9< IU/ml (<16)

I should note that my blood was taken late morning and I had eaten before. My TSH was 4.7 mIU/L (0.27 - 4.3) in a previous blood test taken first thing before eating.

My blood test results this month (after taking levo)

TSH - 2.16 μIU/mL (0.27 - 4.2)

FT3 -3.84 pg/mL (2.00 - 4.40)

FT4 - 1.4 ng/dL (0.76 - 1.70)

RT3 - 254.19 pg/mL (90.00 - 350.00)

TgAB and TPOAb - these were tested but I haven't got the result yet. They have always been low/negative (I've had them tested 3 or 4 times)

Annoyingly, I forgot that I wasn't supposed to take my levo before the test so I don't know how much that will have affected the result.

The doctor commented that my Free T3/Reverse T3 ratio is 0.015 and that it should be 0.02 or above. What can I do to improve this ratio? This is my first time having reverse T3 tested so I'm a bit confused by it.

Do you think I should increase my levo slightly to get my TSH to below 2?

Also, my vitamin D has been low in my last 3 blood tests (ferritin has always been good, folate was good in last 2 blood tests and B12 was good this time). I take Doctors Best D3 2000 IU daily but I'm clearly not absorbing it properly. I believe you need other vitamins to absorb vitamin D properly? Can anyone recommend a good vitamin D supplement that also contains these vitamins?

I should also note that my mother and maternal grandmother have autoimmune thyroid disease which is why I started getting blood tests in the first place. My main symptom has always been palpitations which have definitely reduced after starting levo. I have also noted a little weight loss.

Sorry for the long post. I really appreciate any advice you can give me. I am trying to get clued up on all this thyroid stuff but I still find it quite confusing!

[SlowDragon Administrator]

25mcg is only half the standard starter dose of Levothyroxine

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that 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 eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

One in five Hashimoto's patients never have raised Thyroid antibodies

An ultrasound scan of thyroid can help diagnose Hashimoto's

healthunlocked.com/thyroidu...

Suggest you either increase vitamin D dose or try Better You vitamin D mouth spray. This can give good absorption as avoids poor gut function

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

[SB51 in reply to SlowDragon]

Thank you so much for your reply.

I will try increasing to 50 mcg and retest in 6 weeks or so. Am I right in thinking that my FT4 and FT3 are good? They seem to be in the part of the ranges that you said are important.

My ferritin has always been optimal, folate has been optimal in last 2 blood tests and B12 was optimal this time around after being low before. I will try the vitamin D spray, thank you for the recommendation.

I also had a thyroid ultrasound in May and was told I had slight inflammation which could indicate early Hashimoto's but the doctor wasn't too concerned. He suggested another ultrasound in 6 months.

What about the reverse T3? Should I be concerned about that/try to get it lower?

Thank you!

[SlowDragon Administrator in reply to SB51]

Reverse T3 is well within range and even if it wasn't the test doesn't tell you much

We rarely recommend getting it tested....it's very expensive test.

So if it looks like it might be early stage Hashimoto's you may want to try strictly gluten free diet.

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet




(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)




Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

Non Coeliac Gluten sensitivity and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

88% benefit from strictly gluten free diet

thyroidpharmacist.com/artic...

Going gluten free is a strategy that everyone with Hashimoto’s should try. In some cases, we see a complete remission of the condition; in other cases (88% of the time), the person feels significantly better in terms of bloating, diarrhea, energy, weight, constipation, stomach pain, reflux, hair regrowth, and anxiety.

todaysdietitian.com/newarch...

Many clinicians report that eating a gluten-free diet may help improve thyroid function in nonceliac gluten intolerance. “Getting gluten out is primary for patients with Hashimoto’s, even without celiac disease,”

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

healthcentral.com/article/t...

[SB51 in reply to SlowDragon]

Thank you so much for sending those links. I have already started a gluten free diet so will definitley continue with that.

Thank you for the RT3 info, I won't worry too much about getting it tested in future.

[greygoose]

How long before the blood draw did you take your levo? It has probably given you a false high FT4. But it won't affect your TSH or FT3. You should leave a gap of 24 hours between the last dose of levo and the blood draw.

You really do need and increase in dose. When on thyroid hormone replacement, the TSH should come down to 1 or under. So, you are under-medicated.

[SB51 in reply to greygoose]

I took it about 5 hours before. I had read that I should leave a 24 hour gap but completely forgot! I won't make that mistake again. My previous FT4 results were 18.8 pmol/L (12 - 23) last October and 1.14 ng/dl (0.90 - 1.70) in May so not quite in top third? Those were both before I started taking levo.

I will increase to 50mcg and test again in 6 weeks. Thank you so much for your response.

[greygoose in reply to SB51]

You're welcome.

[Ladybex]

I have been taking Levothyroxine 25mcg for 5 weeks and due blood test next week... I’m totally confused but hope to learn more about it on here... hope you go too as it’s a great forum 😊

[SB51 in reply to Ladybex]

It really is a great forum! I would be lost without it! I hope you're doing well on Levothyroxine so far.

[Ladybex in reply to SB51]

A very slight improvement I guess but curious to find out if my Levo will be increased... will update when I know... thank you SB51 😊