TSH target - Hashimoto's, early menopause and finally out of range

[Cider_Woman]

Hi there, I would appreciate some guidance/suggestions on the TSH (and freeT3 and freeT4, if appropriate) target number/range I should head towards.

I have Hashimoto's and finally I am now out of range for my TSH so I might be in a position to get some help. However, I was reading on the Thyroid UK site about starting treatment and reference was made to Anthony Toft's findings:

“The consensus is that enough should be given to ensure that levels of T4 in the blood are at the upper limit of normal or slightly elevated and those of TSH at the lower limit of normal, or in some patients undetectable.” He also states, “Although, by taking excessive thyroxine,... there are long-term dangers to the heart and a possibility of increasing the rate of bone thinning and therefore encouraging the development of osteoporosis."

I am at risk of heart disease and bone density as I went through the menopause in my 30's. I think the outcome of Mr Toft's work is that I should be slightly undermedicated. Is that right?

If that is the case, what is that number/range likely to be? And should I be focussing predominately on TSH?

Additionally, I live in Switzerland so I am not in the NHS and I am taking supplements (recommended to me earlier in the year from here: Ingennus Super B (which I will take on alternate days now); Reflex Ferrochel Iron, Betteryou Vit D. These have been great and my hair loss has reversed. In addition, I take Calcium with Vit D for my bones - a recent prescription although I don't take this at the same time as the iron tablets. And I take fish oils as I have RA as well.

Thanks in advance for any pointers you can share before I see the GP on Wednesday.

TSH (0.27 - 4.20)

Nov 19 - 4.36

Jul 19 - 3.52

Mar 19 - 2.63

Feb 19 - 2.92

Jun 18 - 3.116

Jun 16 - 3.6

Dec 15 - 4.33

Jun 14 - 3.13

Apr 05 - 2.2

Oct 04 - 1.2

Free T4 (12.0 - 22.0)

Nov 19 - 14.9

Jul 19 - 14.9

Mar 19 - 13.2

Jun 18 - 11.5

Jun 16 - 14.2

Dec 15 - 12.7

Jul 06 - 13.4

Free T3 (3.1 - 6.8)

Nov 19 - 5.0

Jul 19 - 4.3

Mar 19 - 4.25

Jun 18 - 4.4

Vitamin B6 (35 - 110)

Mar 19 - 131

Vitamin B12 (145 - 569)

Nov 19 - 526

Jul 19 - 344

Mar 19 - 301

Vitamin D25 (>20) - done in Switzerland

Nov 19 - 38.9

Jul 19 - 43.5

Ferritin (30 - 400)

Nov 19 - 86.5

Jul 19 - 79.7

Total cholestoral (less than 5.0)

Nov 19 - 5.8

Jul 19 - 6.2

Jun 18 - 5.95

LDL - Cholestoral (less than 2.6)

Nov 19 - 3.7

Jul 19 - 4.1

Jun 18 - 3.77

HDL - Cholestoral (greater than 1.29)

Nov 19- 1.5

Jul 19 - 1.4

Jun 18 - 1.58

Endocrinology results (all February 2019)

Thyroid-stimulating immunoglobulin (TSI) (range: less than 1.8) – less than 0.3; Thyroid Peroxidase Antibodies (range: less than 34) – 42; Thyroglobulin antibodies (range: less than 115) – 220; Thyroglobulin (range: 3.5 - 77.0) – less than 0.1

[SlowDragon Administrator]

Sorry your post was missed, this is an extremely busy forum

Is your GP going to start you on Levothyroxine?

Standard starter dose is 50mcgs

Bloods should be retested 6-8 weeks after each dose increase (or brand change)

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

the most important result is FT3.....too low a level of FT3 can cause osteoporosis....as can too much

thyroidpatients.ca/2018/07/...

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

[Cider_Woman in reply to SlowDragon]

Thank you. I appreciate your help and the time taken to reply.