I've had an underactive thyroid for approx. 10 years now and have never felt anywhere near 'normal' and have been highly symptomatic throughout. My GP thinks I am fine as had lots of blood tests and all 'in range'. He thinks my symptoms are likely to be Chronic Fatigue Syndrome/Fibromyalgia, but I believe my thyroid isn't appropriately medicated and not optimal and I also believe I have adrenal insufficiency, but I'm currently trying to battle with an endocrinologist to get the right testing and support.
I also had a synacthen test which looked at cortisol rise only (NOT ACTH):
Beginning Level- 315 nmol/L
30 mins after injection- 610 nmol/L
And lastly, I had a saliva cortisol test:
Waking- 9.36 nmol/L (6-21)
12pm- 2.92 (1.5-7.6)
4pm- 2.09 (0-5.5)
Bedtime- 3.2 (0-2)
I believe my vitamin D and vitamin B12 aren't optimal and I don't believe my thyroid levels are optimal either. I'm not sure what's going on with my cortisol as it's really quite low on 3 points and high on 1. I think the synacthen test rules out primary adrenal insufficiency, but I think it might well be secondary adrenal insufficiency (especially because of my existing thyroid problems).
I'm not sure what potency of vitamin D and B12 I should look to take to get my levels to optimal...
Any opinions most definitely welcomed!!
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Louise1610
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These results tell us that you are undermedicated. The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
These results tell don't suggest autoimmune thyroid disease (Hashimoto's) as your antibody levels are fairly low.
Ferritin- 94 ug/L (13-150)
Your ferritin is at a good level.
B12 Active- 75 pmol/L (37.5-188)
Active B12 below 70 suggests testing for B12 deficiency so yours is just about OK but I'd want mine over 100.
Where is your Folate result, B12 and folate work together.
A good, bioavailable B Complex should be enough to raise your B12 level and will also help either raise or maintain your folate level. Consider Thorne Basic B or Igennus Super B.
Vitamin D- 69 nmol/L (50-175)
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,000-4,000iu D3 daily
Retest after 3 months.
A good, well absorbed, reasonably priced D3 supplement is Doctor's Best D3 softgels which contain only 2 ingredients - D3 and extra virgin olive oil.
Some members like an oral spray which is absorbed through the mucous membranes in the oral cavity, eg Better You but it does have a lot of excipients.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
I can't comment on your Serum Cortisol test but I believe it's low for a 9am sample. However, you saliva test is not the best, it only tests cortisol and DHEA should also be measured at the same time. Also two of the four results have reference ranges that don't make sense. Ranges are based on healthy people, if someone really did have a level of zero they would either be very ill or dead.
Optimal levels for saliva cortisol are:
Waking: Top of range.
Noon: 75% through range.
4pm: 50% through range.
Bedtime: Bottom of range.
Your results show that your first 2 samples are too low, your bedtime sampe is too high and who knows about your 4pm sample with that range.
I already take 75mg Levothyroxine and was wondering whether I should ask the GP to try 100mg and retest, so thank you for confirming that bit!
I don't know if this makes any difference to pills recommendations, but I had a gastric bypass Nov 2018 and have been wondering whether malabsorption has contributed at all to the pills that I currently take. I'm also not sure whether changing to Tirosint instead of Levothyroxine would help at all.
I already have a 3 monthly injection of vitamin B12, so I was surprised when my levels were still showing quite low, but I will look at those supplements you have recommended.
Here are my latest Folate results:
Serum folate level- 9 ug/L (3.4-15.8)
I have various tests from both the GP and private from Thriva and Medichecks- I never know which tests are most important to look at. I've had full blood profiles with iron. electrolytes and all sorts, but I think they're all in 'normal' range. The B12 and D, along with my thyroid seem to be the most obvious to me.
I got my cortisol tests from Medichecks and did wonder whether 0 as the bottom of the healthy range was realistic! I will be sending the results of the saliva test to the endocrinologist as there's definitely something amiss.
I am also asking the endocrinologist why he thinks I might have underactive thyroid because if it's not autoimmune, and I've never had any surgery/radiation, etc., it doesn't leave a lot of reasons why it might be!
I am also asking the endocrinologist why he thinks I might have underactive thyroid because if it's not autoimmune, and I've never had any surgery/radiation, etc., it doesn't leave a lot of reasons why it might be!
Although autoimmune thyroid disease (Hashimoto's) is the most common cause of hypothyroidism, there are many other causes, and many of us here are hypothyroid without Hashi's, surgery or radiation. Other causes can include:
Genetic - thyroid gland may not develop properly in the womb, may be totally inactive or partially inactive.
Environment - iodine deficiency, selenium deficiency, environmental poisons such as mercury, fluoride (not naturally occurring fluoride but the toxic waste fluoride added to toothpastes, water, etc).
I wonder if you could have a look at my last full set of iron results in October 2019 and see if you think these are ok?
Serum Iron level - 15 umol/L- (9-30)
Serum transferrin level- 2.7 g/L- (2-3.2)
Serum TIBC- 68 umol/L- (45-81)
Transferring saturation index- 22%- (15-50)
Serum ferritin level- 94 ug/L- (22-322)
I'm trying to determine all of the supplements I definitely need to take and which ones might be ok with just a standard multivitamin!
Based on your information so far, I am looking at adding Vitamin D3 3-4000IU for 3 months (and retest), B complex, Magnesium and K2-MK7. I will be continuing to take my probiotic. Should I still take a basic multivitamin for the others?
Serum iron: 55 to 70% of the range, higher end for men - yours is 28.57% through range
Saturation: 35 to 45%, higher end for men - yours is 22%
TIBC (total iron binding capacity) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours are 63.59% and 58.33% through range respectively
Ferritin level- 94 ug/L- (22-322)
Strange that your ferritin level is the same as your current one even though the range is a lot wider.
Your Serum Iron is just very slightly low and Saturation a little low, but your TIBC and Transferrin are just over mid-range, I don't think anything is too drastic. If those were my results I'd be eating iron rich foods - liver, liver pate, black pudding.
**
Should I still take a basic multivitamin for the others?
I am not going to advise against what your nutritionist has said, and I realise that a gastric bypass affects absorption of vitamins, but I will just point out what is always mentioned here about multivitamins.
Multivitamins are not recommended for a few reasons:
They tend to contain the cheapest and least absorbable forms of ingredients - this is particularly so with cheap supermarket, own brand and high street brands.
They usually contain too small a dose of the active ingredients to help raise low levels.
They often contain things that we should be tested for first and only supplement if we are deficient (eg iodine, calcium, Vit D, iron).
If they contain iron then this affects the absorption of the other ingredients because iron needs to be taken 2 hours away from any other supplements.
I've had a look at your supplement, assuming it's the Tesco A-Z multivitamins and minerals:
Vitamin D - 10.00µg - this is 400iu which wouldn't raise the level of a sunburn flea. However, you know that you need 3000-4000iu daily.
Vitamin K - 75.0µg - this doesn't mention which form of Vit K. There are two forms - K1 and K2. K1 is the blood clotting form and K2 is the form needed to direct calcium to bones and teeth as mentioned previously. K1 is the cheapest and when the form of Vit K is not mentioned it's usually K1 that is included. K1 should be avoided by people on blood thinning medication as it aids blood clotting.
Thiamin (Vitamin B1) - 1.10mg
Riboflavin (Vitamin B2) - 1.40mg
Pantothenic acid - 6.0mg
Vitamin B6 - 1.40mg
These B vitamins are just standard 100% of RDA which may or may not be enough.
Folic Acid - 200µg - folic acid is not usually recommended, it needs converting to folate. Many people do better with the converted form - methylfolate which is included in most good quality B Complex supplements. For a low level then 400mcg is the usual dose.
Vitamin B12 - 2.50µg - such a tiny dose it wont help a low level. There are two forms of B12 - cyanocobalamin and methylcobalamin. Cyanocobalamin is not the best form, it's recommended to take methylcobalamin. A good b Complex will contain 400mcg of methylcobalamin. This supplement doesn't say which form of B12, it will be cyanocobalamin because it's cheap.
Biotin - 50.0µg - No problem with that. Just remember that any supplement containing Biotin should be left off for 7 days before any blood test.
Vitamin C - 80mg - no problem with that except that it's quite a small dose. To help with the immune system and support adrenals you'd need more like 1000mg daily.
Calcium - 200mg - this should be tested before supplementing.
Magnesium - 100.0mg - this is the magnesium oxide form which is the least absorbable and generally used as a laxative. This form is not really recommended.
Iron - 14.0mg - should be tested before supplementing. Will affect absorption of everything else, if iron is needed it needs to be taken 2 hours away from other supplements.
Zinc -10.0mg - should be tested. Needs to be in balance with copper. It is also the zinc oxide form which is not recommended, this form is used in nappy rash cream.
Copper - 1.00mg - should be tested. Needs to be in balance with zinc.
Iodine - 150.0µg - should be tested and only supplemented if found to be deficient.
Selenium - 55.0µg - this is the Sodium Selenite form which is poorly absorbed. Recommended forms are selenium l-selenomethionine or yeast-bound selenium.
Even if your nutritionist does recommend a multi, I would have thought he/she would have recommended a good brand.
I'm glad the iron levels are pretty much ok and nothing to worry about at least!
Surprisingly enough, I think the nutritionist recommends the same multi-vitamins for all bypass patients the same (regardless of health conditions!), and Tesco is one of the main ones she recommended alongside Centrum, but at the time, Tesco ones were cheaper and I didn't really know any different so just took them! I don't think that choice has helped me whatsoever!
- Vitamin D3 3-4000IU (I've not decided which is better between Doctors Best and BetterYou oral spray containing K2 as well)
- Vitamin K2-MK7 (separately as Vegevaro 200mcg capsule, if not choosing the BetterYou spray)
Which do you think is the better option considering bypass- Doctors Best softgels and Vegevaro or the combined BetterYou spray? I think they are all meant to be well-absorbable!
- Magnesium (I thought this one was a good option- amazon.co.uk/Magnesium-Abso... - I was mostly focusing on Magnesium Malate for me personally)
If I am going to take the above supplements, then I'm not sure I see a vast amount of benefit in continuing to take that Tesco multi-vitamin as well! I get the main ones in appropriate doses I need in the list above, plus adding a little more Vitamin C to get closer to 1000mg could be a good idea.
I don't think from my results and what you've said that my Iron needs supplementing at this point, so will leave Iron off the list but will make sure I test maybe once a year to check.
So for the others (Calcium, Zinc, Copper, Iodine, Selenium)- unless I get blood test results to show they are low, I think I will leave these alone for now.
Is there an ideal way to go about starting on a few different supplements? Can I start on all of them at the same time? Or should I be phasing them in? I take my Levothyroxine straight away in a morning and have been taking all my current supplements before bed- should I take all of the new supplements at bedtime still?
Thank you for all of your help so far- this group is proving vastly valuable!!
Which do you think is the better option considering bypass- Doctors Best softgels and Vegevaro or the combined BetterYou spray?
I honestly don't know enough about bypass surgery to give an opinion. As the oral spray is absorbed through the mucous membranes and bypasses the gut, this may be the best thing. However, not all the supplements come in spray form so it will be a case of see if improvements are made, if not then change the supplement to another form.
Is there an ideal way to go about starting on a few different supplements? Can I start on all of them at the same time? Or should I be phasing them in?
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
I take my Levothyroxine straight away in a morning and have been taking all my current supplements before bed- should I take all of the new supplements at bedtime still?
Some supplements compete with each other. Generally advised is for B vitamins to be taken no later than lunchtime, this is because they can be stimulating and we don't want them affecting our sleep. So either with breakfast (observing the 2 hour after Levo advice) or with lunch.
D3 and K2 are fat soluble. If taking an oral spray then you can take at any time, no need to particularly keep away from Levo due to it bypassing the gut. If you take softgel form then D3 should be 4 hours away from Levo and take with a bit of extra fat (eg chunk of cheese, cracker and butter, full fat yogurt). Vegavero K2 doesn't contain fat so take that with the fatties meal of the day or, again, with the fat mentioned for the D3. I keep my D3 softgel and my Vegavero K2 apart so that they don't compete for the fat.
Magnesium is often advised to take at bedtime (or in the evening) as it can be calming and aid sleep. Magnesium should be taken 4 hours away from Levo. If you used a topical gel or cream then that could be used any time.
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
IBS often an issue
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
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 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.
Do you always get same brand of levothyroxine?
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. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
I've never been given test results for thyroid antibodies in the past and I'm doubtful that the GP ever tested them- even when I was first diagnosed. I've asked for my full record online recently (and if that fails, will make an official Data Subject Access Request under GDPR regulations to obtain all of my records), so I can see what tests they did at the time they diagnosed me. I've been on 75 mg since not long after they began me on medication and it's only since I've taken a much better hold on my own health, that I've realised how much they haven't told me and left me to continue to suffer.
I've never had a thyroid scan- is that a routine thing that should happen when you initially get diagnosed?
I have wondered about gluten free, but didn't want to do it if it would make no difference, but the evidence keeps building to support doing just that, so I think those links you've sent will be very useful! Having a Coeliac blood test is also a good shout- I didn't know it was quite that cheap actually, so will look into that as it would be good to rule that out.
I occasionally get different brands of levothyroxine and sometimes the 25mg tablet can be a different brand to the 50mg tablet! I would like to think that if I am going to try 100mg, that I can either take 2 of the same 50mg tablets or 1x 100mg tablet, so would reduce the difference in brands for each dosage of tablet.
I do take my levothyroxine straight away in the morning with water and leave at least an hour before breakfast. I take my vitamins before bed- currently 1 x vitamin D 1000ui, Tesco multivitamin/minerals x 2 (as advised by nutritionist after gastric bypass), and just started a probiotic (bio-kult boosted).
I paid a lot of money to see Dr (Edited by admin) at the insistence of a hormone doctor in London. He was pompous, knew it all, didn't listen, focused on my weight only and told me I needed bariatric surgery and declared my thyroid fine.
I would never recommend anyone take any notice at all of him or what he says. He made me cry with shame and distress.
That was 2 weeks after the referendum. I have just recently found out that I have the faulty Dio2 gene. He never bothered with anything like that.
Blimey- he sounds awful! (Although, I haven't found a good doctor or endocrinologist yet that doesn't speak to you like you're stupid or lying/exaggerating/it's all in your head sort of thing!)
It makes it so much worse when you pay so much money and they turn out to be useless or just don't really care!
I was always a normal slim weight until my thyroid went kaput and then packed it all on within maybe a year or so to become morbidly obese and every appointment I went to ended up with me going through my symptoms and the doctor always rounding their way back to saying that it would be a lot better if I just lost the weight. So, here I am, lost all my weight after gastric bypass and all of the symptoms are still there- shocker!
No doctor or consultant should be so rude and inconsiderate.
What is the faulty Dio2 gene? Is that the one where you don't convert T4 to T3?
Did you manage to resolve your thyroid problems or are you still battling?
Exactly right. He was awful. I felt an utter failure. Like you I had been slim and active and always on the go and suddenly everything fell apart. The weight piled on very fast and I had horrible symptoms. Doctor's wouldn't diagnose me.
The hormone doctor I saw for HRT sent me to him. As happened to you, I was told it was my weight that was the problem. The weight was a symptom. I told him that!
The Dio2 gene tests does indeed look for a fault in the gene that is necessary to create an enzyme that converts T4 into T3 yes. I have inherited it from one family member. My thyroid blood test results vary quite wildly sometimes (not Hashimoto's) and never as expected. For example if I increase my T4 from this point 125mcg a day, I feel very anxious and jittery yet my T3 goes down.
No, I haven't got well again yet. Still a battle. 7 years and counting.
I'm presuming you went privately to that doctor as the NHS GPs/Endocrinologists weren't helping you? Are you seeing any doctors now or are you battling it alone?
The first endo I saw refused to see me and told me 'if I want to see an Endo, get referred to a different hospital!', then the 2nd one, without any consultations, sent me for 1 test, then when that was normal, discharged me (still with no consultations), so I've just emailed the 2nd one's secretary with all of the things I would have asked him, if given half a chance! Let's see if he responds!!
The Dio2 gene is interesting- although really not ideal when you have it! I'm surprised that you have the gene, but they still refuse to help you. What will it take for them to really sort it out?!
It does seem like a lot of thyroid patients just muddle on alone because of failings by doctors and keep getting told that it's normal to feel this way because of X (weight, depression, age, etc.). I've been hypo for around 10 years now and only in the last year have I had enough of this 'new normal' and I refuse to accept this as normal for the rest of my life! Only in the last year- and mainly in the last few months, have I learnt so much from online forums like this and others and there's still vast amounts still to learn!
I do come up against some strange/annoying resistance from work or friends/family because they think the doctor knows best, they are the experts and if they've said all is fine, then I should trust it and crack on like normal and not keep pushing as it must be just me being hypochondriac/depressed etc., but it's not them with all of the ongoing symptoms!
Anyway, apologies for the rant- I'm feeling very passionate about all of this at the moment and the distinct lack of help from NHS docs/endos!
I hope you do eventually find a good level of health- keep going and there will be something you'll find (on this forum or others) that will help things click into place and really help! I've only been on here maybe less than a few weeks and already got so much usable information to try!
My GP wouldn't diagnose me so I'd not seen an endo. I paid privately because the private HRT doctor suggested it. I couldn't get decent HRT help from the GP at the time either.
I've gone it alone for a long time. I've seen various people to try to sort out my complete lack of energy. I've self treated with NDT and T3 and not got well, although I came close with NDT around 5-6 years ago. So when I got the chance to try Levo I did. Very little improvement and a lot more problems. Eventually I asked my GP to refer me to an endo. I checked the list on here and selected an endo at Oxford. It was arranged. Had to wait ages of course. Got there and saw someone completely different, young and pleasant and useless. Dismissed. I was fine because my bloods said so. Ie they were in range.
Then I went private and see a man who at least seems to understand and have ideas. he's helped me improve insulin resistance and we were experimenting with Levo doses to see if we could improve my results before thinking about about adding in T3 and then the pandemic happened and I've missed my appointment with him. I've since had the gene test done. I need to get my act together and book to speak to him on the phone. But I don't find phone consultations very good at all.
It's all complicated because I suffer from atrial fibrillation as well and recently spent 11 months stuck in it. After a cardioversion in February I am supposed to be back in normal rhythm but it's too fast so I'm on a beta blocker. I have a fast heart rate in the 90's with low T3. That's not supposed to happen. Also, Afib makes thyroid docs freak out and T3 makes cardiologists freak out. It's not a comfortable place to be.
Wowzers, you do have a few different problems going on at the same time! I'm sorry to hear that it's all going a bit mad! It should really make it even more important to resolve if you already have some awful conditions that are probably made worse by not being appropriately treated for hypothyroidism! Interesting that you tried NDT and T3 as people usually do a lot better on those. Levo is definitely not the best, by far- my opinion!!
I know how you feel about phone consultations- they're just awful and impersonal. You can never get everything across and there's a lot of subtext you just don't get over the phone as you do in person! I don't believe we will be returning to 'normal' anytime soon, so I suppose you might have to bite the bullet and book a call in with him- would he do Skype or a video call instead?
Even if they do freak out, it's completely unacceptable to just do nothing about it, it should prompt them to work together to resolve it!
Menopause muddied the waters back at the start. I didn't realise what it was and how it would affect everything else. Now I see a really good private menopause expert and my HRT is stable, that's one thing ticked off. Yes I have metabolic syndrome now. I think that's because the thyroid isn't right. The new endo has made a difference to that.
I did do OK on Armour back in the day. I can't remember why I stopped it. Scared I think. Now it's been reformulated. Then another previous HRT doctor put me on NP Thyroid in place of a tiny dose of Levo that she had me on but she gave me too little I realise now and I had terrible anxiety with it. I had to stop it because I was such a mess. I should have increased the dose but she didn't know that and I wasn't capable of thinking straight at the time so back to Levo I went and worked up a bit. I have also tried T3 only. But that was probably my mistake there. I should have tried it with Levo. That's what's next on the map I think.
I hope he will do Zoom or Skype or FaceTime by now. At first he was reluctant but he must have had to adapt and find new ways by now. It gets so disheartening that sometimes I can't be bothered to push for a while and time drifts by.
Good to get something ticked off the never-ending list at least!
I've heard some NDTs aren't quite as good as they were previously, but I haven't gotten that far yet to even potentially try a different medication yet. I've asked the Endo for a small increase in Levo or equivalent in Tirosint to see how that works out first! I think you are meant to keep upping NDT every few weeks until most of your symptoms are gone and retest your levels, so staying on too low a dose probably caused your side effects to remain or get worse! It's all good with hindsight as there's many things I would have done differently had I known this stuff in the past!
T4 and adding T3 might be a good option if he is willing to do that.
I think you should definitely ask for Skype/Zoom as he will have had many other requests by now, so nothing to lose by asking again- it does make it a lot better than phone call only. It is difficult to keep pushing when you feel so bad, and really, I think doctors hope that you just get tired and give in, so it makes their life easier. I swear that I am trying to be the biggest pain in the a** to my doctor so he knows I won't give in until I feel better!! I don't want to feel ill for the rest of my life, and neither will you- getting the motivation is difficult but it can really be worth it I'm yet to see any improvements but I'm really positive about the plan I've got in place so far! It's all about doing your own research, building a list of questions and suggestions for the doctors and making a plan of action- that does make you feel a bit better than being in no man's land
I didn't know anything about the thyroid list or this forum back then. And he was head of something thyroid related at the time, so considered to know his stuff. He was so arrogant. There was no follow-up of any kind.
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