All in range since I started treatment 7 years ago but my fatigue and brain fog have never really improved, I can only cope with 12 hrs a week at work. I've been on 50mcg levothyroxin for 7 years, GP refuses to increase because my bloods are "normal". Ranges are in brackets.
Many thanks in advance.
JUNE 2013. Thyroid peroxidase antibody....216.6 iu/mL (0.0-50.0).
DEC 2013. TSH...2.8 uU/ml (0.35-5.50). Free thyroxin index...11.2 pmol/L (7.0-17.0)
JAN 2018. TSH....3.53 mU/L (0.35-5.50). Free T4...10.7 pmol/L (7.00-17.00)
Maybe see a different GP. Use the following information to support your request for a dose increase:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (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
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
You can also refer to NHS Leeds Teaching Hospitals who say
As you have Hashi's, what are your current levels of Vit D, B12, Folate and Ferritin, Hashi's can cause low levels which means that thyroid hormone can't work properly. Are you gluten free and supplementing with selenium, some members with Hashi's find this helps.
Thank you SeasideSusie, I will read all your advice more fully as soon as I have the energy and time. I am almost gluten free, I'm working on cutting it out all together. I am si B12 and taking vit D mouth spray and folate ans iron tablets.
First step is to get vitamin D, folate, ferritin and B12 tested.
Either via GP or privately
Low vitamin levels affect how we use thyroid hormones and these four need to be optimal
With Hashimoto’s It’s EXTREMELY common for them to be very low and this frequently causes TSH to remain lower than should be
Vitamin D at least over 80nmol and around 100nmol may be better
Folate at least over ten
B12 at least over 500,
Ferritin at least half way through range
Clearly you are under medicated and still hypothyroid
Ft4 is only 54% through range
Ft3 only 30% through range
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.
Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists
You may need to need see an endocrinologist to instruct GP to increase dose
But FIRST need to get vitamins tested and if very low supplement to optimal
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten intolerance. Second most common is lactose intolerance
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find strictly gluten free diet reduces symptoms, sometimes significantly. Either due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying strictly gluten free diet for 3-6 months
If no noticeable improvement, reintroduce gluten and see if symptoms get worse
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.
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.
Hi, know only too well how you feel. I have had an underactive thyroid since I was 42, I am now 67....I'm on 100mcg Levo, sorry I cant help on what's normal ranges or not...best contact someone in Admin on this site and they will advise. Good luck.....
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