I have a month taking Sam e, full spectrum omega, and iron for my mood swings of anger and irritation. I see some progress but I think it’s too soon to tell. I also use hemp oil for anxiety as needed. I’m seeing my endocrinologist this Friday. Do you think adding T3 can help with my persistent fatigue ? I’m on Levothyroxine 50mg for the last three months for hypothyroidism. My previous post has my older lab results. And detailed journey of the last 3 years if you would like to read. Thank you guys for your help.
TSH 1.10 Range (0.40-4.50)
T4, FREE 1.1 range(0.8-1.8)
Vitamin D 25 -OH total 36 range (30-100)
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Bloods should be retested 6-8 weeks after each dose increase
Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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.
But to help tolerate getting levothyroxine dose increased you can work on improving low vitamin levels yourself
Never supplement iron without doing full iron panel test for anaemia first
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
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.
Thyroid disease is as much about optimising vitamins as thyroid hormones
Weight
Is that 142 kilo? Or 142 pounds?
Either way, you are going to need dose increase in levothyroxine. Increase in 25mcg steps and retest 6-8 weeks after each dose increase
I just finished reading all the articles. Very informative, thank you again. Since 2018 I’ve tested in the lowest range in d3 and ferritin. This explains why I feel fatigue. It’s funny 😄 so many dr visits and nothing made since nor improvements. To find everything in those articles made my day !!!!! God bless you and this forum.
Just curious when I purchase the iron and d3 what mg should I pick ? I’ve been taking 1 pill of 25mg of iron for the last month. I don’t like eating meat or chicken really. Do you suggest me take 3 pills instead ? As for D3 I’ve been taking 1 pill of 5mg daily.
Just wondering if you may know why I feel so tired and irritated after increasing the d3 supplement? Also after taking the levothyroxine I get hot flashes now ? Is this linked to the supplement ? I started taking the d3 5,000 iu mid day with a meal two weeks ago. After a couple of days I changed to every other day because I realized the D3 is causing the extreme fatigue and irritation. I also increased my iron to 50mg. I contacted my dr and she prescribed 5mg of t3. I will not take this until retesting in a couple of weeks like you suggested. Giving it time for my iron and d3 to increase. You suggested increasing the levothyroxine 25mg. I thought it was best to take the supplements a few weeks first. Do you think I can just increase it now, may it help with the fatigue and irritation ? Additionally taking the d3 at night ?
I forgot to mention as well I have loss my appetite. I have an increase need for sleep after taking d3 during the day, but insomnia at night. I take the levothyroxine on an empty stomach at bedtime.
The Endo said to take the iron supplement and follow up in March to see if my fatigue improves. She said my thyroid labs were optimal. After two weeks I contacted her and explained about the raise of extreme fatigue. She prescribed the 5mg t3. Do you think my levels improved that fast making me over medicated with the levothyroxine 50mg or what you suspect it is ? I appreciate help. Today is my alternate day so I didn’t take the d3. I do not feel fatigue yet, but I didn’t sleep last night. Crazy insomnia and felt hot.
My ferritin came in at 22 and I couldn't do much at all without feeling faint and fatigued.
I started to feel better when my ferritin reached around 40 and I now understand for optimal heath and full utilisation of Levothyroxine I need this mineral up at around 100 :
I now maintain and supplement ferritin, folate B12 and vitamin D myself, and my health and well being is much improved. It did take time building up and now I take daily supplements so not to so down that slippery slope again.
Thank you. Are there any particular brandS you recommend for the supplements ? I’m glad to hear your health has improved. Looking forward to giving the supplements a shot and see improvement too . I can’t continue feeling tired all the time. Especially with my 3 boys. I need all the energy I can get.
Well I think if you read up on the subsection "Vitamins and Minerals " you'll see a good few posts and I read both SeasideSusie and SlowDragon both of whom know more than me :
However I couldn't tolerate the iron tablets so purchased Solgar Gentle Iron, Spatone Liquid Iron and found Asda sell little pots of frozen chicken livers. They are very clean and mild in taste and I now just maintain my level with 1 pot a week. Once defrosted I flash fry in a little olive oil and whizz down into a pate, and I keep it in the fridge taking a spoonful each morning, possibly with a little dollop of mayo to help this medicine go down.
I just noticed that I am taking solgar gentle iron 25mg too. Should I take two tablets instead of one? I wonder why my ferritin is low if I take this already.
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More lab results! Still normal
Thyroid results still feel bad 
Still feeling Awful, but results are improving
Lab results help. Feeling plataued 
New results. Still feel 'Meh'
