In early June I had lowish free T4 (11.2) and normal range TSH (0.73). The reference ranges are TSH 0.3-4.2 and T4 12-22.
We retested early July and free T4 was then 10.2 and TSH 0.96. I started 50 mcg of Levothyroxine just over 7 weeks ago.
Just got my bloods back, including T3:
TSH 0.15 (0.3-4.20)
T4 14.6 (12-22)
T3 5.7 (3.1-6.8)
So to my unknowledgeable eye this looks like over medicated?! So did I never have hypothyroidism to start with?
I do not think you are overmedicated. Your ft4 is 26%through the range and Ft3 70% through the range. Many folks need Ft3 up at that level to feel well. Neither % is overmedicated. However they may not be optimal for you.
Colliebear
Original results in June:
TSH: 0.73 (0.3-4.2)
FT4: 11.2 (12-22)
Suggests Central Hypothyroidism which is diagnosed when TSH is low, normal or slightly raised and low (below range) FT4.
Your results met this criteria. Yes you were hypothyroid.
Central Hypothyroidism is where the problem lies not with the thyroid gland but with the Pituitary (Secondary Hypothyroidism) or Hypothalamus (Tertiary Hypothyroidism).
New results after 7 weeks of 50mcg Levo:
TSH 0.15 (0.3-4.20)
T4 14.6 (12-22)
T3 5.7 (3.1-6.8)
The Levo is working, it's brought your FT4 into range. No you are not overmedicated, your FT4 is actually quite low in range but your T4 is converting and currently making a decent amount of T3 as shown by your FT3 result.
How do you feel now?
With Central Hypothyroidism the feedback loop (pituitary > thyroid) is broken and the pituitary doesn't send the signal to the thyroid to make hormone (the signal is TSH - Thyroid Stimulating Hormone) so TSH remains low. Therefore, with Central Hypothyroidism the TSH becomes irrelevant and it's FT4/FT3 results that should be used to see if you are properly medicated.
Thank you. I feel mostly ok, but still have aching legs/joints, and bouts of extreme tiredness. Also still gaining weight for not much reason.
The GP said it can’t possibly be a central problem as I’ve had the associated hormones tested and there’s no pituitary issues. However I am going to try a different doctor at the practice this week, as when I mentioned that I felt so rough after starting Levo he said “oh that sounds like hyperthyroid symptoms. Or maybe just a coincidental bug”!
If it's not the pituitary, it could be the hypothalamus. The hypothalamus stimulates the pituitary to make TSH. If it doesn't do that, there won't be enough TSH to stimulate the thyroid. But, they never seem to consider the hypothalamus, for some reason.
Some articles about Central Hypothyroidism
endocrinologyadvisor.com/ho...
bestpractice.bmj.com/topics...
ncbi.nlm.nih.gov/pmc/articl...
I feel mostly ok, but still have aching legs/joints, and bouts of extreme tiredness. Also still gaining weight for not much reason.
Possibly because you are undermedicated. Your FT4 is very low in range, the aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well. But as mentioned, with CH you ignore the TSH and go by FT4/FT3. Your FT3 is currently pretty good, but that could very well change. At the moment your FT4 is low but your body is producing as much T3 as possible as it's the life-giving hormone. Eventually that may fall and your FT3 will be low as well as your FT4.
when I mentioned that I felt so rough after starting Levo he said “oh that sounds like hyperthyroid symptoms. Or maybe just a coincidental bug”
You haven't said what symptoms so it's hard to comment on that.
Have you had Thyroid antibodies tested?
Have you had Vit D, B12, folate and ferritin tested?
No antibodies tested, my full range of tests is as follows:
(June)
Vitamin D 60 (no range)
B12 463 (160-925)
Folate 3.2 (2.9-50)
Ferritin 15 (no range)
(July)
Cortisol 325 (172-497)
FSH 4.4 no range
LH 5.4 no range
Oestradiol 503 no range
Prolactin 209 no range
I've just looked at your previous post and see that SlowDragon commented on these at the time so my comments basically repeat what she said then.
Vitamin D 60 (no range)
As you are in the UK then the unit of measurement is likely to be nmol/L (some countries use ng/ml) so 60nmol/L (24ng/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 your current level, based on the Vit D Council's suggestions you could supplement with 3,700iu D3 daily
vitamindcouncil.org/i-teste...
Retest after 3 months.
When you've 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:
There are important cofactors needed when taking D3 as recommended by the Vit D Council
vitamindcouncil.org/about-v...
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.
naturalnews.com/046401_magn...
drjockers.com/best-magnesiu...
Check out the other cofactors too (some of which can be obtained from food).
B12 463 (160-925)
Again there is no unit of measurement, it could be pmol/L, ng/L or pg/ml (the latter two being the same).
If it is ng/L or pg/ml then the following applies:
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Folate 3.2 (2.9-50)
This is extremely low and it's recommended that Folate be at least half way through range.
A good B Complex will raise both Folate and B12. Good brands are Thorne Basic B or Igennus Super B.
Leave off B Complex (or Biotin supplement) for 7 days before any blood tests as it can give false results
Ferritin 15 (no range)
The normal range for females is about 13-150 or 15-300. Yours is obviously at the bottom of the range and SlowDragon suggested that you ask your GP for an iron panel - did you do this? Also a full blood count is needed. These results will tell you if you have iron deficiency anaemia. You shouldn't self supplement with this extremely low level but should definitely have further investigation.
As autoimmune thyroid disease (Hashimoto's) can cause low nutrient levels, testing thyroid antibodies would be a good idea.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
(July)
Cortisol 325 (172-497)
FSH 4.4 no range
LH 5.4 no range
Oestradiol 503 no range
Prolactin 209 no range
I'm afraid I can't comment on these but I see that Greygoose did in your previous post.
Symptoms after a week or so of Levo were extreme tiredness, bad brain fog, aching calves, breathlessness.
If your GP thinks these are symptoms of hypERthyroidism, then sadly he is very ignorant of thyroid disease.
The extreme tiredness could be hypothyroidism or your low ferritin.
Breathlessness could be hypothyroidism or low ferritin.
Muscle cramps and weakness can be hypothyroidism, muscle aches and pains can be low Vit D.
Brain fog is a typical symptom of hypothyroidism.
I doubt the GP fully understands pituitary issues. The NICE CKS guidelines that the GP should follow state that if secondary hypothyroidism (ie caused by the pituitary function) is suspected they should refer urgently to an Endocrinologist for specialist assessment. Suppressed TSH may be the only hormone suppressed but you need a full check by a specialist. Your next problem will be seeing an Endocrinologist that is a pituitary specialist and not a diabetes Dr! Another thing to be wary of is test results within range doesn't mean there's not a problem. As soon as you have one hormone deficiency is should influence their medical decision making.
If I have a decent amount of T3 can I go back to the gym?! I have stopped any exciting exercise at all
Personally I wouldn't. With your very low in range FT4, as I said your body is doing it's best to produce enough T3 to try and keep you well and I don't think that will last, I think your FT3 will start falling at some point. Hard exercise will deplete what T3 you have. You need to get your FT4 up to a decent level.
And you need to optimise your nutrient levels so that your thyroid hormone has a chance of working properly.
No, that does not look overmedicated. Both your thyroid hormones are in range - in fact your free T4 is still rather low, most people need it in the top quarter of the range (around 19). Do you feel well?
Hi everyone, I am now on 75mcg thyroxine (for about 10 days). Yesterday and today I am very dizzy. Does this sound normal?
Joint pain since starting Levothyroxine 
Severe Headaches since starting levothyroxine
New bloods since starting NDT
Bloods after starting Levothyroxine
