Help hair loss

[Asmaafzal]

Hi everyone I'm facing severe hairloss and I'm almost blad even I can't stop comb. Please HELP ME, having hypothyroidism taking 75mcg,recently I have done blood test gp said nothing wrong in lab report suggested biotin, I'm taking from two weeks but still no difference attaching lab report as well

[Lalatoot]

Your results show that you need an increase in levothyroxine. When on levo your tsh should be down around 1 or lower. Your ft4 is on the low side at 14.2. It should be at least over halfway through the range so 17 ish.

[Asmaafzal in reply to Lalatoot]

Gp said no need to increase the dose but for your suggestion I will discuss it again

[SlowDragon Administrator]

Your results suggest you are under medicated

TSH 3.02

Ft4 14.2 (10.5-24.5)

Ft4 is only 26% through range

TSH too high

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients 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.

nhs.uk/medicines/levothyrox...

Also note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

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

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.

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Vitamins

All abnormal

RBC

healthline.com/health/rbc-c...

MCV

medlineplus.gov/lab-tests/m...

MCH

healthline.com/health/mch#l...

MCHC

healthline.com/health/high-...

Important to test vitamin D, folate, B12 and ferritin regularly

Ask GP to test vitamin D, folate and B12

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Hair loss frequently linked to low iron levels

[Asmaafzal in reply to SlowDragon]

I'm 35yrs old thank you soo much for your guidance this will help a lot I will discuss this with my gp

[Asmaafzal in reply to SlowDragon]

One more thing I have lost weight around 15 kg with dietitian now I'm 58kg

[SlowDragon Administrator in reply to Asmaafzal]

Are you vegetarian or vegan?

[Asmaafzal in reply to SlowDragon]

Non vegetarian

[SlowDragon Administrator]

See from your profile your British Asian

Are you regularly supplementing vitamin D and testing twice year

Low vitamin D is widespread in BAME community

ncbi.nlm.nih.gov/pmc/articl...

[Asmaafzal in reply to SlowDragon]

No haven't done vit D

[SlowDragon Administrator in reply to Asmaafzal]

Do you not supplement vitamin D at all?

Not even in the winter?

adc.bmj.com/content/86/3/147

[Asmaafzal in reply to SlowDragon]

I'm taking ofently specialy in winters

[SeasideSusie Remembering]

Asmaafzal

Despite your full blood count saying "no action", please discuss with your GP, there are so many flags there.

High red cell distribution width

High red cell countBottom of range haemoglobin

Low MCV

Low MCH

Low MCHC

Ask for an iron panel, ask your GP to consider iron deficiency/anaemia. I'm not diagnosing, just pointing out that these mean something.

[Asmaafzal in reply to SeasideSusie]

OK sure