Hi everyone, looking for your advice/opinion, I’ve just had some bloods back -
TSH 15.25 (range 0.35-4.94)
Free T4 11.7 (range 9-19.0)
T3 3.5 (range 2.6-5.7)
In Nov 2019 my TSH was 0.49
On levo 50 & 75 alternate days, does it look like I’m under medicated?
Thank you
Yes. 50 mcg is a starter dose of levo. Once on a sufficient dose of levo TSH should be 1 or lower. Both your FT4 and FT3 are low in range.
Thanks for the reply 🙂 My TSH was 0.47 in November, my Gp hasn’t a clue what to suggest. Seeing endo in March so maybe up my dosage to 75 then 100 might explain rapid weight gain as well.
Bollieforme
The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.
You have Hashi's and it's common with Hashi's for test results to fluctuate.
Have you tried a gluten free diet as previously advised?
Supplementing with selenium l-selenomethionine 200mcg daily can help reduce antibodies.
Some Hashi's information :
hypothyroidmom.com/hashimot...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
Hi Susie yes I’m taking selenium and doing ok with gluten free, not sure I’m converting or have enough T3 I will up my levo. My Gp is not much help as my antibodies are very high, I find out more from reading info on this site! Thanks for your reply x
Important to test vitamin D, folate, ferritin and B12, especially as now very hypo
When were these last tested?
What vitamin supplements are you currently taking, apart from selenium
Vit D, B12 and magnesium and selenium, trying with gluten free as much as I can
vitamins ideally need testing twice yearly
Gluten free diet needs to be strictly gluten free.....watch out for cross contamination....don’t share butter, jam, cutting board. Separate toaster for GF toast etc
Obviously you are very under medicated and need 25mcg dose increase in levothyroxine and blood retested 6-8 weeks time
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet.
healthunlocked.com/thyroidu...
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 is in top third of range and FT3 at least half way through range
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
I don’t have antibodies but from what I’ve read on here being gluten free is all or nothing and even a crump left in a toaster can ruin it for you.
Crumb or crumpet? 😂🤣😂
Crumb! It’s an all or nothing thing. You can introduce it slowly to make it easier to change but it won’t be effective until you are completely gluten free
Yeah I knew it was crumb - the typo just amused me!
Ah just noticed what I put!
I’d call it a masterstroke of a typo it’s given me a good laugh!
Yes!
Do you have your blood test at the same time of day? TSH fluctuates through the day. Best tested as soon as possible.
Had test a week ago late morning, my TSH has gone from 0.49 to to 15.25 in two and half months. I was diagnosed 14 months ago with Hashimotos. Have been on levo all this time on various doses currently on 50/75. Gp is clueless really. I’m seeing a new endo next month and feel maybe I should be asking for the meds for T3 but I’m not sure if that’s what I need. This problem seems so complex and I never seem to know where I am at. Like most people just want to feel better.
OK but what time was the low TSH taken?
At midday
Right. Check out TSH circadian rhythm. Always go early morning for highest TSH tests.
I have no idea what that is as I’ve not heard of that before I will look into it, thank you
Circadian rhythm is the technical term for how our bodies change every 24 hours. For example most people are wide awake in the morning and sleepy in the night. Thyroid hormones and TSH vary through the 24 hours too, especially TSH. Probably that at keast partly explains your strange results.
You also need to leave off thyroxine for 24 hours before testing. Then take it straight after the test. If you take it not long before testing it will give a false high
But don't mention it or fasting to doctor or plebotamist!
You will need to gradually increase the Levothyroxine dose in 25mcg increments until that TSH goes right down (0.2 - 0.5 and free T4 and free T3 are in the upper third of their range, according to eminent endocrinologist Dr Toft). It is a slow haul because Levothyroxine is a pro hormone that is converted to T3, the active form, but this takes some time, hence the next blood test being 6 weeks when it will be obvious if an increase is needed. Any faster increases and you might end up on too much medication - horrible. Sometimes the endocrinologist might do a 50mcg increase if they think numbers are way too low but 25mcg is more likely. Replacement dose as previously stated is anywhere between c.100/125 and 200mcg - we all vary but your dose is way below that and clearly inadequate. Once you get optimised the symptoms should alleviate but you are miles off at the moment. If you are optimised and still feel hypothyroid then T3 may be needed - but it is darn hard to get prescribed. I think the timing of your blood test is unlikely to have caused such a big discrepancy in the two TSH readings, but early morning is best and if you have all tests at that time in future they will be more reliable for comparison.
I hope that makes things a bit clearer. Getting your dose correct is not complex at all - if only doctors were better educated in how to go about it, it ought to be straight forward!
Extremely under medicated.
Absolutely essential to test vitamin D, folate, ferritin and B12
Did endo or GP do these yet?
If not get tested ASAP
Privately if necessary
Have you had coeliac blood test to rule out coeliac?
Trying strictly gluten free diet helps or is essential for thousands of Hashimoto’s patients
ncbi.nlm.nih.gov/pubmed/286...
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
endocrine-abstracts.org/ea/...
Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.
ncbi.nlm.nih.gov/pubmed/186...
There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,
Folate supplements can help lower homocysteine
ncbi.nlm.nih.gov/pmc/articl...
Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.
Low ferritin frequent in hypothyroidism
Blood Results 
Blood results
