Posting recent results and question on T4

[maplewood]

SERUM FERRITIN 21 (20-100), B12 186 (115-1000), TSH 6.5 ( 0.35-4.7), T4 9.4 (7.8-21). Needless to say i feel pretty rubbish. Thanks to slow dragon i now know where i am aiming for with TSH and B12 (started suppliments) but does anyone know about the ferritin and T4 levels i should be aiming for. Also do you think my low mood/emotional outbursts and bone pain in my hands and feet are related to my low levels. GP has just told me to increase my thyroid meds to 50mg as to be fair i was only taking 25mg. They said it was better to take that then nothing but clearly it did not do me a great deal of good. Back to the drawing board in some respects but thanks to you guys lot better informed. Any ideas how long it will take before mood etc improves. Thank you as always xx

[SlowDragon Administrator]

It takes at least 2-3 weeks on increased dose before start to see slow improvements in symptoms

Then as your body gets ready for next dose increase, symptoms can start to return after about 6-8 weeks

Thyroid Bloods should be retested 6-8 weeks after each dose increase

Always get same brand of levothyroxine at each prescription

Ferritin is very low

Ask GP for full iron panel test for anaemia

Improving ferritin levels

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

What are you supplementing for low B12?

Have you had vitamin D tested?

[maplewood in reply to SlowDragon]

I am taking all my supplements that were low last year as GP told me to stop in september so i am supplementing B12, Vit D, Iron, Folic Acid.

[SlowDragon Administrator in reply to maplewood]

So you need to test all these at least annually

B12 is very low considering you are supplementing

What exactly are you taking for B12?

And folate often better than folic acid

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of 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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

[fuchsia-pink]

No surprise you feel bad

Most of us need our TSH to be less than 1 and our free T4 and free T3 (if you have it tested) to be at least in the top third of the range and often in the top quartile. Nutrients should generally be at least half way through the reference range

The good news is that you have a diagnosis, and an increase in levo. Keep re-testing bloods every 8 weeks after a dose increase until you feel well and have a nice high free T4 reading.

Good luck x

[Nanaedake]

Bone pain can be due to low vitamin D. Have you had it tested?

[SlowDragon Administrator]

Problems tolerating levothyroxine often seems to come about if started on too low a dose and/or left on too low a dose too long

Standard starter dose is 50mcg and dose increase upwards as fast as tolerated

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

More modern thinking is to start most people on full dose. ...though some people find this too much to start on

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...

Very important to test vitamin D

vitamindtest.org.uk

Post results when you get them

[penny]

I’ve read on this site that starting on 25mcg of levothyroxine makes things worse as this is too low a starting dose (unless other complications).