Hi all, found you invaluable with my hashimotos. I have been on 50mg thyroxine for a year and a half, have been more tired recently and a few faints where had high bp. Did wonder about b12 issues and predict maybe need more thyroxine. Would appreciate your expertise.
TSH 3.71 (0.27-4.2) ( last was 4.1 in June)
Free T3 53 pmol/l ( 31-68)
T4 18.6 pmol/l (12-22)
Ferritin 79.8 ug/l (13-150)
Folate serum 5.28 ug/l >3.89
Vitamin B12 active 55. 4 mmol/l (37.5-187.5)
Vitamin D 25.2 nmol/l ( 50-175)
Thyroid perixidase antibodies 70.2 Kiu/l ( <34)
Thyroid antibodies 173 Kiu/l (<115)
Thanks for any help in advance 👍🏻😉
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Saz88
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You are right about everything, saz. I'm surprised your T3 is as high as it is because your TSH is over range from our standpoint. Normally a fair T4/T3 would keep that TSH lower and preferably under 2.0. 50 mcg of levothyroxine is hardly enough after a year and a half and if they judge it by TSH it's appearing you lack enough hormone.
Your vitamin D is drastically low and taking 5,000 i.u when mine was that low barely raised my level so I'm not sure why that happens. Perhaps you will have more success.
B12 and methylfolate is another supplementation I would suggest.
Your Ferritin looks good but it can be a false high reading if you have inflammation. It's another dilemma. Taking a digestive supplement with meals may give you better metabolism of minerals and other nutrients. Your status is not as good as it could be but I'm sure you can improve.
Your vitamins are all terrible most likely because you are under medicated for thyroid
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
NHS guidelines on Levothyroxine including that
most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
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.
See SeasideSusie many detailed replies of vitamin levels and how to improve
1.3.3 Offer levothyroxine as first-line treatment for adults, children and young people with primary hypothyroidism.
1.3.4 Do not routinely offer liothyronine for primary hypothyroidism, either alone or in combination with levothyroxine, because there is not enough evidence that it offers benefits over levothyroxine monotherapy, and its long-term adverse effects are uncertain.
1.3.5 Do not offer natural thyroid extract for primary hypothyroidism[1] because there is not enough evidence that it offers benefits over levothyroxine, and its long-term adverse effects are uncertain.
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.
1.3.7 Consider starting levothyroxine at a dosage of 25 to 50 micrograms per day with titration for adults aged 65 and over and adults with a history of cardiovascular disease.
To find out why the committee made the recommendations on managing primary hypothyroidism and how they might affect practice, see rationale and impact .
1.4 Follow-up and monitoring of primary hypothyroidism
Tests for follow-up and monitoring of primary hypothyroidism
1.4.1 Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis.
1.4.2 Be aware that the TSH level can take up to 6 months to return to the reference range for people who had a very high TSH level before starting treatment with levothyroxine or a prolonged period of untreated hypothyroidism. Take this into account when adjusting the dose of levothyroxine.
Adults
1.4.3 For adults who are taking levothyroxine for primary hypothyroidism, consider measuring TSH every 3 months until the level has stabilised (2 similar measurements within the reference range 3 months apart), and then once a year.
1.4.4 Consider measuring FT4 as well as TSH for adults who continue to have symptoms of hypothyroidism after starting levothyroxine.
and if you have any then list them to discuss with your GP and request further testing for B12 deficiency and pernicious anaemia.
Folate serum 5.28 ug/l >3.89
This is rather low and would be better in double figures. A good B Complex such as Thorne Basic B or Igennus Super B will help, as will eating lots of folate rich foods.
Do not start the B Complex until further testing of B12 has been carried out if necessary, it will mask signs of B12 deficiency and skew results.
Vitamin D 25.2 nmol/l ( 50-175)
This is 0.2 above severe deficiency. As your GP to consider treating with loading doses of D3.
"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 25 nmol/L.
For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.
* Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."
It also says:
"Treat for vitamin D insufficiency if serum 25(OH)D levels are in the range of 25–50 nmol/L and the person:
* Has a fragility fracture, documented osteoporosis, or high fracture risk.
* Is being treated with an antiresorptive drug for bone disease.
* Has symptoms suggestive of vitamin D deficiency.
* Is at increased risk of developing vitamin D deficiency in the future, for example because of reduced sunlight exposure.
* Has raised parathyroid hormone levels.
* Is taking an antiepileptic drug or an oral corticosteroid, or is on long-term treatment with other drugs known to cause vitamin D deficiency, such as colestyramine.
* Has a malabsorption disorder (for example Crohn's disease) or other condition known to cause vitamin D deficiency, such as chronic kidney disease."
If GP wont give you loading doses then come back and I will point you in the right direction to treat yourself. Please let us know what your GP is going to do and I will give you further information about the important cofactors needed when taking D3 and what you should do when loading doses have finished.
Wow seaside Susie thank you so much for spending the time to send a detailed response..... will follow your advice and be back in touch otherwise. Such a great resource 👍🏻
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