Not ovulating but thyroid optimal?

[Ljdaly74]

Just got this months bloods back below. Does thyroid look close to optimal now? Have increased from 50 to 75 to 100 mcg Levo over past 6 months or so. I am trying for 2nd baby and my progesterone blood test showed i didnt ovulate I was sort of hoping my thyroid was cause but I think my results are quite good.

Thyroid function test

Serum TSH level 0.32 mu/L [0.3 - 5.0]

Serum free T4 level 10.2 pmol/L [7.9 - 16.0]

[Angel_of_the_North]

No, doesn't look optimal and no free T3. FT4 is only 28.4% through range and for mot people needs to be at least 50% (around 12) - many need it higher in order to make enough FT3.

[Ljdaly74 in reply to Angel_of_the_North]

Oh ok thanks for reply, so you think increase levo by another 25mcg? The tsh is already very low though, do you think increase would be ok?

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

Do you always get same brand of levothyroxine

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

Do you have Hashimoto’s?

Ask GP to test vitamin levels

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 as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

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

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

There’s an offer today

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[Ljdaly74 in reply to SlowDragon]

Thanks, yes am hash/hypo, have had vits tested and discussed on here, all ok apart from vit b and ferritin which am now supplementing, ft3 was low.

Had bloods drawn first thing before food, and took levo 24hrs beforehand.

Do you think i should increase 25mcg levo to 125mcg? Not sure i would want tsh going any lower though?

[SlowDragon Administrator in reply to Ljdaly74]

TSH is irrelevant. Most important results are Ft3 followed by Ft4

Ferritin needs much improvement

[SlowDragon Administrator in reply to Ljdaly74]

Suggest you reread all this previous post

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Looking at previous post

Clearly ferritin is a problem

GP must retest full iron panel Every three months when supplementing Ferrous fumerate

As you have Hashimoto’s are you on strictly gluten free diet or tried it

[Ljdaly74 in reply to SlowDragon]

No not strictly gf diet. I was hoping if medicated properly i wouldnt have to :/

[SlowDragon Administrator in reply to Ljdaly74]

Sorry doesn’t work that way.....being strictly gluten free often helps improve symptoms and may help improve thyroid and vitamin levels

[SlowDragon Administrator]

Improving nutrients improves conversion

healthunlocked.com/thyroidu...

Also ....guidelines by weight might help push for dose increase.....depending on how much you weigh

Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

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.

BMJ also clear on dose required

bmj.com/content/368/j

Post re how to push for dose increase in levothyroxine

healthunlocked.com/thyroidu....

[Ljdaly74 in reply to SlowDragon]

Thanks. Judging by the weight I should on 75mcg more at 175mcg!

[SlowDragon Administrator in reply to Ljdaly74]

So you likely need to continue slowly increasing levothyroxine and extremely important to improve vitamin levels at same time

Strictly gluten free diet frequently helps or is absolutely essential

[Ljdaly74 in reply to SlowDragon]

Endo sent below response. I had increased to 125mcg levo as had spare but endo wants to keep me at 100. Think have scuppered chance of increase dose to maintain good results t4 results which is over 60% through range :/

"Thank you for your message today, sent as Advice Conversation. I note the query about thyroid replacement therapy. I have read the email exchange you included with the message and I have seen the blood test results. The email exchange includes advice to aim for serum TSH in the lower part of the reference range. This is in line with standard practice and our local practice also. The last blood test result included TSH 0.08mU/L (which is below the reference range). I agree that on the basis of the available information, there is no indication to increase the dose of Levothyroxine."