Latest Results, Some Advice Please

[Fluffysheep]

Currently on 75mg of levothyroxine. Still feeling very symptomatic (exhausted, brain fog, gaining weight, joints aching etc), and I have Hashimoto's (confirmed by medichecks test showing thyroglobulin antibodies of 215, and also my one and only endo appointment confirmed the diagnosis) I'm really annoyed as the GP requested T3 be checked for me, but the lab has refused (she did warn me that might happen).

TSH 0.92 (range 0.27 - 4.2). In October it was 1.39 on 50mg levo

Free T4 17.3 (12 - 22). In Octomber it was 13.4 on 50mg levo

I am supplementing B12 (B12 spray and also a general B complex tablet) and vitamin D (spray with K2) as when last tested (July) both were found to be low in range.

I'm guessing GP will ask me if I want to increase levo again (I presume the correct answer is yes?). She is happy to increase as long as my TSH stays in range, even if it's the bottom end, but said if it goes outside she won't increase.

Is this my best option, and wait and see if 100mg actually starts helping me? I do have 14 boxes of 25mg T3 tablets that I managed to pick up in Greece on a recent holiday, however I assume that it is an absolute must that I get my T3 tested to see if I might benefit from them? For clarity, I would not just start taking them, I'm not that silly, but I would be grateful for any advice. I am wondering if I might have a bit of a conversion problem, or if it's just down to not yet being on the correct dose of levo?

I'm so fed up of feeling unwell and not having the energy to do anything, it feels like I've been on levo forever with no change in symptoms. I know the reality is that I haven't, I just got started on such a low dose (25mg in June, upped to 50mg in August, then upped to 75mg in October).

[SeasideSusie Remembering]

Fluffysheep

It's normal for the lab not to test FT3 if the other tests are within range. The hospital lab my surgery uses tests FT3 if TSH is suppressed. My TSH is always suppressed so I get FT3 and FT4 tested every time.

I do have 14 boxes of 25mg T3 tablets that I managed to pick up in Greece on a recent holiday, however I assume that it is an absolute must that I get my T3 tested to see if I might benefit from them?

Yes, you need to test TSH, FT4 and FT3 from the same blood draw. That will show how well you convert. If conversion is good you wont need the T3, if conversion is poor then the T3 can help.

However, you also need optimal nutrient levels before starting T3 and these are:

Vit D - 100-150nmol/L

B12 - top of range for Total B12, or Active B12 then at least over 70, better over 100.

Folate - at least half way through range

Ferritin - half way through range

So if they're not optimal, you need to work on your supplements until they are.

When taking Vit D we also need magnesium as a cofactor, as well as Vit K2. Magnesium helps the body convert D3 into it's active form.

I'm guessing GP will ask me if I want to increase levo again (I presume the correct answer is yes?). She is happy to increase as long as my TSH stays in range, even if it's the bottom end, but said if it goes outside she won't increase.

Is this my best option, and wait and see if 100mg actually starts helping me?

Your FT4 is currently 53% through range. The aim when taking Levo is to get it into the upper part of the range, and FT3 should be in balance with FT4. So I think an increase in Levo is warranted to try and get your FT4 nearer to, say, 75%. This may take your TSH below range, you'll have to wait and see, but if it does and your GP wants to reduce your dose then show her this article from Dr Toft, past president of the British Thyroid Association and leading endocrinologist, who wrote in Pulse (the magazine for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

[Fluffysheep in reply to SeasideSusie]

Thanks Susie. I've already got the article ready for if and when my TSH goes under range. I still don't think my GP will act on it, but I can try.

Is there a specific type of magnesium that is best to go with the vitamin D?

I guess I'll wait and see how the increase to 100mg of levo goes (I'm 99% sure she'll support that) then see how the blood test is 6 weeks later.

[SeasideSusie Remembering in reply to Fluffysheep]

Is there a specific type of magnesium that is best to go with the vitamin D?

As there are many different forms of magnesium, we need to choose the one most suited to our needs:

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

There are, of course, topical magnesium gels and creams, and also Epsom Salt baths.