Curious T4 dropping

[sbadd]

Im in the process of slowly increasing my meds with hashimotis, just got results from Fridays test and am curious to why the T4 is dropping despite increases? Last test results were on alternating days of 25mcg and 50mcg

[SlowDragon Administrator]

Standard starter dose is 50mcgs....so you are still on tiny dose

Most people eventually need somewhere between 100mcg and 200mcg Levothyroxine

So you need dose increase to at least 50mcg daily......retested 6-8 weeks later

nhs.uk/medicines/levothyrox...

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

Obviously you also need vitamin D, folate, ferritin and B12 tested too if not been done

Even if not starting on full dose, it's likely that you will need this eventually

New NICE guidelines are quite clear on dose by weight

nice.org.uk/guidance/ng145/...

1.3.6. Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

[SlowDragon Administrator]

As you have Hashimoto's are you on strictly gluten free diet?

Can see from previous posts you suffer bloating and gut issues, this is frequently improved significantly on strictly gluten free diet

If 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

chriskresser.com/the-gluten...

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

thyroidpharmacist.com/artic...

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

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) 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

[sbadd in reply to SlowDragon]

Thankyou bloating has subsided from previous symptoms, had celiac test which was negative, im not gluten free, waiting for endo to call regarding latest tests, i got these from my gp earlier so thinking increase definitely, just have to slowly do as get side effects if i increase too quickly, just wondered why t4 dropping from previous tests which i was on even lower dose

[SlowDragon Administrator in reply to sbadd]

Because as we get use to each dose we are then ready for next increase in Levothyroxine

5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. The only way to know if you are gluten intolerant is to try strictly gluten free diet for 3-6 months

[sbadd in reply to SlowDragon]

Ok thanks makes sense, im thinking 2 days 50mcg then 1 day 25mcg but will wait for endo to call