Underactive Thyroid & Ovulating

[mitchellrose54]

My levels are getting so much better but still I am not ovulating 😔 does anyone have any advice? Not sure my Dr would prescribe clomid as already have children

[SlowDragon Administrator]

Absolutely essential to regularly retest vitamin D, folate, ferritin and B12

Plus TSH, Ft4 and Ft3

Do you have autoimmune thyroid disease - aka Hashimoto’s?

Previous post 3 months ago

healthunlocked.com/thyroidu...

Recommended getting full testing done

Just testing TSH is completely inadequate

TSH over 1 is often too high

Blue horizon or Thriva offer DIY finger prick test of full thyroid and all four vitamins

Essential to test thyroid as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

How much levothyroxine are you currently taking

Do you always get same brand?

[SlowDragon Administrator]

Post from 5 months ago ...guidelines on dose by weight you said you would need 100mcg levothyroxine

Is this how much you are now taking

Obviously still important to get FULL thyroid and vitamin testing, especially before TTC

If your vitamin supplements contain biotin you need to stop these a week before all blood tests as biotin can falsely affect test results

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

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...

[SlowDragon Administrator]

You never replied to any of these questions

What are your most recent thyroid and vitamin results

[mitchellrose54 in reply to SlowDragon]

I haven't done a vitamin test

[SlowDragon Administrator in reply to mitchellrose54]

Do you have autoimmune thyroid disease also called hashimoto’s diagnosed by high thyroid antibodies (or by ultrasound scan if both antibodies tests are not high)

Low vitamin levels are extremely common on Levothyroxine

Essential to regularly retest vitamin D, folate, ferritin and B12 at least annually

Always test thyroid levels as early as possible in morning before eating or drinking anything apart from water and last dose Levothyroxine 24 hours before test

[mitchellrose54 in reply to SlowDragon]

I'm not sure my doctor would do these tests (as explained previously) perhaps I should look into it privately. But how does this affect sense of smell????