Increasing my levo dose didn't improve my situation a lot

[Unforgiven213]

Hello. I am a 20 year old 85 kg male and in the late 2018 I was searching for answers as to why I feel tired all the time, why I sometimes can't breathe properly or have chest pain and headaches.. I did all the tests in the world, many imaging and radiology tests (chest x ray, pituitary gland imaging). Finally I was told that I that I have slightly higher TSH (5.5 which went up to 6.5 in 2 months without medication) and it may be the cause of my problems so I was put on 25 mcg levo for about 3 and a half months. I went back after this period of time, my TSH was at around 3.2 and the doctor has now put me on 50 mcg levo. I feel slightly better than I felt a year ago but I still feel very tired especially in the evenings with no connection to sleep problems, as I tend to sleep very well. All my other thyroid related blood tests came up withing the ranges, TSH being the only one that raised a flag. I also had a thyroid ultrasound made that, in the doctor's opinion revealed that I might have Hashimoto's but no high antibodies values were found in any of my recent blood tests. I also ran tests for folate, ferritin and B12. B12 came out as 396 pg/ml with a normal range of 197-771, Ferritin came back as 49,3 ng/ml with a normal range of 28-365 and Folate was at 3,11 ng/ml with a normal range of 3,00-17,00. Folate and Ferritin seem pretty low values especially considering that I am young and I eat salad and eggs regularly, which I saw that affect Folate levels. My FT3 levels are in the upper half and my FT4 is in the upper side of the range as well, which I have heard that is how they should be. How should I proceed with this information? Should I suppliment folate and ferritin? I am very confused at the moment and I don't understand why increasing my dose doesn't make a difference. How long should it take to feel any kind of difference when increasing the levo dosage in your opinion? Thank you for your time.

[Hillwoman]

Firstly, your initial 25mcg dose of levo is a child's starting dose! You should have started on 50mcg.

Secondly, your GP should have reviewed you and re-tested at 6 to 8 weeks, not 3 months. Not a good start. I would try to keep to a tighter timetable, and insist on repeat bloods at the correct intervals and an incremental dose increase in T4.

Most people who come to the forum find they need to get the TSH down below 1, or even suppressed before they feel better on levo. At that point, if you still feel ill, start a new post, because other factors may be in play.

And there do seem to be other factors you need to attend to as soon as you can: B12, ferritin and folate are all low. It doesn't really matter that they're within the lab reference ranges: as with thyroid function tests, the ranges are not designed to allow optimal treatment for the individual. They can only really be a guide to diagnosis. The clinical picture is the most important factor in deciding what to do next, though increasingly, health professionals are not trained to consider a patient's health in this way.