Levothyroxine dose question

[bma4]

Hello. I've been on Tirosint 75 for 2 years after being diagnosed hypo. Recently started having hyper symptoms; trouble sleeping, weight loss, sweating more. Tested levels, TSH is 1.6 Free T4 is 1.6 (range is .8-1.7). Could the higher free T4 be causing the sleeping issues? A few months ago my Free T4 was .9 and I wasn't having the issues with sleep...

[SlowDragon Administrator]

Just testing TSH and FT4 is completely inadequate

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

Do you have Hashimoto's?

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?

Insomnia is often low FT3 and/or low vitamin D

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

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

[bma4 in reply to SlowDragon]

It’s interesting you mention vitamin d3. I’m historically deficient. During summer my levels were 60-70, once October hit my levels got down to 30s even with supplementation. I take 5000 iu everyday.

[SlowDragon Administrator in reply to bma4]

bma4

Have you tried vitamin D mouth spray?

Can give better absorption

Do you also supplement magnesium?

[bma4 in reply to SlowDragon]

I have not tried the spray. I do take magnesium; 240mg before bed

[SeasideSusie Remembering in reply to bma4]

During summer my levels were 60-70

* Is the unit of measurement nmol/L or ng/ml?

The Vit D Council/Vit D Society recommend a level of 100-150nmol/L or 40-60ng/ml.

I take 5000 iu everyday.

* What form of D3 do you take - tablets, capsules, softgels, oral spray?

* Is that all year round or just in the winter?

* Do you also take D3's important cofactors - magnesium and Vit K2-MK7? Magnesium is needed so that the body utilises D3, it's required to convert Vit D into it's active form.

[bma4 in reply to SeasideSusie]

Ng/ml. Capsules, all year round, yes I take magnesium, roughly 240mg before bed

[SeasideSusie Remembering in reply to bma4]

Tablets and capsules are the least absorbable form, unless the capsules contain some kind of fat (eg olive oil) to aid absorption. Oil based softgels give best absorption out of all D3 supplements that are swallowed and absorbed through the gut, the oral spray is absorbed through the mucous membranes in the oral cavity and bypass the stomach.

So your summer level of 60-70ng/ml is actually above the recommended level but toxicity is not a problem until it goes over 100. Your winter level of 30ng/ml is too low and would be better at 50ng/ml, so 5,000iu D3 would normally be enough if you are taking a form that is well absorbed.