I was hoping someone could help me with my medichecks results please.
I am on 100 of levo daily since Jan. Prior to that I was on 50. I think my tsh was around 1 after I started the 100 and I felt decent. Over the past 2/3months I have become symptomatic again and have daily migraines. I ordered a medichecks test and the results are as follows
TSH 3.9 (ref range is 0.27-4.2)
Free T3 3.76 (3.1-6.8)
Free Thyroxine 15.5 (12-22)
I am waiting on a call from my gp and preparing for them to say I am fine but was wondering if my free T3 etc were ok?
I have Hashimotos and PA.
Any advice welcome. Thanks so much
Written by
sugarbee1981
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Those results show that you are currently undermedicated. The aim of a Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in theupper part of their reference ranges. Obviously your TSH is far too high as it's very close to the top of the range, your FT4 is just 35% through range and your FT3 is a mere 17.85% through range.
You could do with an increase in your dose of Levo, 25mcg now, retest in 6-8 weeks.
Presumably you followed the advice about how to do thyroid tests we always advise here:
* No later than 9am
* Last dose of Levo 24 hours before blood draw
* Nothing to eat or drink before test, just water only
Are your nutrient levels optimal - Vit D, B12, Folate and Ferritin - these are often low or deficient when Hashi's is present.
Here is some evidence 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
Thank you for this info, it is really helpful and I feel more armed to speak to a GP about it. Crossing my fingers it's my own GP calling back as he is a teaching dr so listens but the others tend to go simply by bog standard ranges so good to have this info to help.
So I spoke to a dr there who asked me to come to surgery for blood tests tomorrow. I explained about the tests I had and the levels but she wants to check again. Additionally, she mentioned when I was in with nurse in jan my BP was high(only time it ever has been) but I was in with gp later on in that afternoon and it was back down again. She said this could be why I am having daily headaches. Even still, I thought high BP could be a byproduct of undermedication of thyroid. But I will go for the tests as she is running a full panel of things then will print all you have sent me to take to appointment.
Absolutely essential to regularly retest vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking
Have you had coeliac blood test
Your results suggest you are under medicated and need 25mcg dose increase in levothyroxine
Also ....guidelines by weight might help push for dose increase
Even if we frequently 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
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.
Hi, thank you. I also have Pernicious anaemia so have been on hydroxycobalamin injections 8weekly for 19years but have been considering the SI route.
I take folic acid and Vitamin D tablets daily as I have been deficient in both before. I also take a magnesium supplement.
I have had a coeliac test many moons ago which was negative. I am quite overweight and my weight keeps climbing despite a good vegetarian diet and calorie deficit. Very frustrating as drs see my weight and say it is the cause. I am a realist- it certainly doesn't help but there are other factors also as to why I feel unwell.
Thanks for the help. Going on weight my dose should be way higher.
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct 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
As you already have had negative coeliac test ...
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
With Hashimoto’s we frequently have MTHFR gene variation and many Hashimoto’s patients struggle to utilise folic acid
What was latest folate result?
Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial. This is recommended for anyone who has B12 injections...helps maintain levels between injections and keep other B vitamins in balance
B vitamins best taken in the morning after breakfast
Igennus Super B complex are nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks
Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
Not sure what the most recent folate and vitamin d results were as havent had them tested in a long time but when my vitamin d deficiency was diagnosed my level was something shocking like 8.
I take Vitamin D 3,200 iu tablets and have the better you spray as backup. I take just folic acid tabs so will look into what you recommended. I will be getting folate etc tested tomorrow and will post when I get them.
My drs seem to be under the impression that hashis and PA aren't connected which is madness as all my issues seem to come from stomach
I am killed with acid reflux but cant take tablets for fear of causing more issues with stomach.
You know so much. Thank you for such detailed replies.
Acid reflux should improve on high dose levothyroxine....getting all four vitamins optimal and frequently strictly gluten free diet helps significantly or is absolutely essential
Hi, I spoke to a GP and she insisted on a retest so I got one done last Friday and my TSH is 3.47 despite being on 100mcg of levo. Dr says it's fine as in range and she will retest in 6wks time. Going to ring up for consultation on monday and discuss the discrepancy with how they are treating me and the NICE guidelines.
That’s exactly why there’s over 108,000 members on here
Most GP’s haven’t read guidelines
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
tukadmin@thyroiduk.org
New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking Levo thyroxine
If not ..guidelines by weight might help push 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
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.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
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