Results

[raine-wager]

Results all look good to me, b12 and d were top of the range last time but I still wake up wanting to go back to sleep .

Dont know where to go next..

[SeasideSusie Remembering]

Raine-wager

With FT4 50% and FT3 45.95% through their respective reference ranges there is plenty of room for an increase in your dose of Levo.

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 ranges if that is where you feel well.

What is your Ferritin level?

[raine-wager in reply to SeasideSusie]

Ferritin was 195 folate 11.2 in may, I've just had potassium back its low 2.9

[SeasideSusie Remembering in reply to raine-wager]

I can't comment on your potassium result but your Ferritin is not low so there doesn't seem to be any problems with your nutrient levels so it looks like an in Levo is the right thing to do.

[raine-wager in reply to SeasideSusie]

Thanks

[SlowDragon Administrator]

Had a quick look through previous posts, couldn’t see any thyroid antibodies tested

Do you have Hashimoto’s?

Are you on strictly gluten free diet ?

Do you always get same brand of levothyroxine?

guidelines on levothyroxine dose 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...

[raine-wager in reply to SlowDragon]

I dont have hashimoto's as far as I know, and not on gluten free. It's taken 2 years to get to this dose. I cant function in the heat, but I also feel cold when others dont, hair still thinning skin very dry. I get orthostatic intolerance, breathlessness and cant loose weight. Nails have lines on, fluid retention, and voice has deepened, I dont have any lump on my neck. My blood pressure is on the low side most of the time. Heart rate seems ok now, with pacemaker. I have got arthritis but not too painful. The only things that have improved are my memory and my mood.

[SlowDragon Administrator in reply to raine-wager]

Suggest you test BOTH TPO and TG antibodies

List of private testing options

thyroiduk.org/getting-a-dia...

If antibodies are negative that doesn’t rule out Hashimoto’s

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Arthritis suggests may be Hashimoto’s

Gluten free diet helps many with arthritis...as well as high percentage of Hashimoto’s patients

Low potassium....eating a banana daily may help,