I got my latest results this evening and wondering if anyone can comment on them. I've been taking 125 mcg of levothyroxine since the beginning of May. Additionally I have been supplementing with D3, C, Magnesium, K2, and a B-complex vitamin. My GP prescribed slow release iron tablets before Christmas but my levels haven't increased by very much since my last test results in March.
In terms of ongoing issues I'm still feeling quite tired and lacking my get up and go. My hair is falling out too and I'm struggling to lose any weight.
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gayle83
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I agree with Lalatoot, you need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks.
The aim of a treated hypo patient on Levo, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges if that is where you feel well.
Don't worry about low TSH, it's not a thyroid hormone, it's a pituitary hormone, the thyroid hormones are FT4 and FT3 and it's those results that tell us if we are optimally medicated.
Try eating liver regularly to help raise your Ferritin level, maximum 200g per week due to it's high Vit A content, or liver pate or back pudding and other iron rich foods.
Is there anything I can show my GP or refer him to with regards the aim to get T4 and T3 in the upper part of the reference ranges? Unfortunately I don't eat red meat. I'll try upping my intake of other iron rich foods.
There’s very little that actually talks about Ft4 or Ft3 results
But plenty of info saying to keep increasing dose until on full replacement dose according to weight
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.
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
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
See box
Thyroxine replacement in primary hypothyroidism
Also suggests that ft4 should be in top third of range
I’m working on the iron. It just seems to be taking forever. This is the highest it’s ever been but still far from ideal. I’m on slow release iron as I can’t stomach any of the other types my GP has prescribed.
Iron can be one of the most difficult to raise I think.
In general I would say that since May is quite a short time in thyroid treatment terms, where everything moves very slowly. It can easily take 6 months to get a dose adjusted until it is right for you, and that's for people who are pretty lucky.
Best practice is to have a blood test and adjust the dose every 6 weeks, though we often wait quite a bit longer on the NHS. I'd say the simplest rule of thumb to follow in the first instance is to move towards the freeT4 being close to the top of the range, as Levothyroxine contains T4 and it should rise as your dose increases. Keep rising by 25mcg each time until symptoms resolve or the freeT4 is slightly over. It's only then if you don't feel better that you need to start thinking about T3. But most people should feel better just by rising freeT4.
My GP prescribed slow release iron tablets before Christmas but my levels haven't increased by very much since my last test results in March.
Having poor absorption of iron is extremely common and people just have to be patient. I had serum iron below range and ferritin which was bumbling along at the bottom of the range. It took me 21 months to raise my ferritin to mid-range which is what I consider to be optimal. My serum iron has never reached optimal.
Is your doctor still prescribing? What exactly is he prescribing?
It is possible for prescribed iron supplements to be bought without prescription in the UK. They can only be bought in pharmacies with the approval of a pharmacist. If one pharmacist refuses to sell them to you just go to another pharmacy and ask again. I've been refused just once, by a pharmacist in Boots.
Oops - just remembered - prescribed iron supplements in the UK can be bought online too although I've never done it myself. Try Ebay.
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