Advice needed for recent results. Thyroid/Vitamin levels concern. Any help much appreciated.

[JPM90]

Hi all

First post in a while. I was diagnosed with Hypothyroidism in Jan 2019. At the time my results were:

TSH: 4.41 (0.27 - 4.2)

FT3 : 5.02 (3.1 - 6.8)

FT4: 16.8 (12 - 22)

GP started me out on 50mcg levothyroxine Ive been currently on 100mcg for last 5 months. Ive been also working on improving my vitamin levels since being diagnosed.

Fast forward more than year to Results as of April 29th 2020:

TSH: 1.39 (0.27 - 4.2)

FT3 : 3.94 (3.1 - 6.8)

FT4: 20.8 (12 - 22)

Current Vitamin levels:

Vitamin D: 92 nmol/l (50-175)

Ferritin: 133 ug/l (30 - 400)

Follate serum: 50 (0 - 68)

B12 active: 140 pmol/l (37.5 - 188)

I am still feeling very fatigued and tired. Despite getting my vitamin levels up, my FT4 level has improved but FT3 level has actually decreased from when i was diagnosed.

I took the DI02 test 3 months ago but they found i had no genetic predisposition for a decreased T3 synthesis.

I take my Levo in the morning on an empty stomach and dont eat anything until 60/90 mins later.

Any advice on possible next step would be much appreciated. Should i be looking to try adding some T3 to see what would happen? I would need to purchase privately most likely since my GP wont refer me to an endo given my levels are in the normal range.

Kind regards,

John

[Lora7again]

My elderly Dad is on 100mcg a day so unless you are elderly you need an increase of 25mcg if you are still having symptoms.

[SlowDragon Administrator]

Suggest you first try 25mcg increase in levothyroxine

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



please email Dionne at

[e-mail]

[SlowDragon Administrator]

Also ....guidelines by weight might help push GP for dose increase

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

[JPM90]

Many thanks for your replies. Ill push for an increase to 125mcg and hopefully ill feel better after a while on the increased dosage