My T4 always remains low even in Levo. The doctor never increased my dose as my TSH was always within limits. For example for the past 4 years my TSH level as been between 0.6 and 2.0 and my T4 between 13.4 and best 15.0
I have never felt much better than before I started Levo. I know optimal T4 would be over 18.0 so when I had a blood test a few months ago and my TSH was 0.8 and T4 14.1 U asked for an increase in my dose from 50 to 75mcg. (This was after me pointing out low T4). After about 5 weeks I felt a little more energy. Around week 8 I had a blood test which showed a T4 of 17.0 but also an increase in my TSH to 1.9 which surely should have gone lower? Any idea folks as to why that would occur. Mentioned to my Doctor who did notice the increase in TSH and said that was unusual but didn't elaborate. Appreciate any input. Thanks.
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Munroedundee1
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When very under treated everything stops working ...including pituitary. TSH is pituitary hormone
Fluctuation in TSH suggests Hashimoto's too
50mcg Levothyroxine is only a starter dose
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.
Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
Now you are on 75mcg Levothyroxine you need to get FULL Thyroid and vitamin testing
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels and thyroid antibodies if antibodies have never been tested
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.
So it's important to get TPO and TG thyroid antibodies tested at least once .
Reading your previous posts you look like poor converter of FT4 to FT3 and need high Ft4 in order to get high enough FT3
As per Prof Toft explanation here
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"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)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
How much vitamin D would you recommend to maintain a level of 88? Also if B12 level is 754 should I reduce my B complex vitamin? I was taking a decent brand of a multivitamin to maintain trace elements. It has only a minimal amount of B vits and only half the RDI of Vit D
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