I have just got my results, roughly 4-5 weeks after the last blood test. Have been taking 75mg T4, b12 complex, b12 large supplement, floradax plus iron supplement, . vitamin D 400iu
My results are:
TSH: 1.18
Free T3: 3.68 (3.1-6.8) pmol/L
Free thyroxine 14 (12-22) pmol/L
Ferretin 53 ug/L (30-400)
Vitamin B12 Active 108 pmol/L
Vitamin D 90.5 nmol/L
low CRP, thyroxine antibodies.
So I'm wondering what people reccomend. I have important exams coming up in a month? Should I stop that large vitamin B12 supplement? and jjust have the complex.
My thyroid still looks a bit low to me, but is it building up or something?
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I am currently on 50mcg T4, I am male, 25, and I had a blood test, after not exercising for a few days. I take my levo in the morning, I had the test at 9am and hadn't taken my dose for that day.
I recently had a high dose 6 week course of corticosteroids a month ago, so I was worrying about my adrenal hormones, not my thyroid. My DHEA is very low.
But my thyroid results don't look good and I have high cholesterol—does anyone know if it is very likely related? a quick google search says there might be a correlation. I have been eating well, apart from maybe a lot of coconut oil/olive oil and have a good BMI 21, don't smoke etc. But my body is defintely still out of whack from steroids/deficiencies, a viral infection i had earlier this year.
Can also someone give me advice about if I should change thyroid dose? and if so by how much, as I am currently not under doctors care due to covid, but will be in a few months. Should I go up by 25mcg? or is that too much/ little.
I have had quite a few health issues this last year, so have been used to not feeling normal, although these other issues have been improving, I still have low iron and b12, but now I am supplementing.
Cheers.
TSH 2.23 mIU/L (Range: 0.27 - 4.2)
**Free T3 3.10 pmol/L (Range: 3.1 - 6.8)**
**Free Thyroxine 12.900 pmol/L (Range: 12 - 22)**
Adrenals
**DHEA - S: 2.770 umol/L (Range: 4.34 - 12.2)**
Cortisol: 489.000 nmol/L (Range: 166 - 507)
Cholesterol Status
**Total Cholesterol X 5.51 mmol/L (Range: 0 - 5)**
**LDL Cholesterol X 3.33 mmol/L (Range: < 3)**
Non HDL Cholesterol 3.91 mmol/L (Range: < 4)
HDL Cholesterol 1.60 mmol/L (Range: > 1.1)
Total Cholesterol : HDL 3.44 ratio (Range: < 4)
Triglycerides 1.28 mmol/L (Range: < 1.7)
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You are very undermedicated. The aim of a Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
Recent illness and taking steroids is going to mess with your thyroid levels anyway. We should wait a couple of months after an acute illness before testing.
High cholesterol is a symptom of hypothyroidism, when optimally medicated this should sort itself out, but I wouldn't have said your results are that bad, two are very slightly over range. Coconut oil and olive oil are good oils.
Can also someone give me advice about if I should change thyroid dose? and if so by how much, as I am currently not under doctors care due to covid, but will be in a few months. Should I go up by 25mcg? or is that too much/ little.
Surely your GP surgery is accepting phone calls? With my surgery you ring in the morning, the doctors have a triage meeting mid-morning and decide who needs a face to face appointment, who needs a telephone appointment and who should be referred to the pharmacy. They are doing routine monitoring blood tests under very carefully controlled conditions.
Thanks for your reply. So you don't think the cholesterol is that worrying? and I should wait longer at 50mcg before increasing?
I have been having reduced kidney function, which i'm most worried about as you can't improve it, so wonder if hypothyroidism maybe making it worse.
The problem is I went private for my hypothyroidism and they no longer run that private practice, so I'd have to start from scratch explaining to the NHS, and I don't really want to go through rigmarole as I just started an intense university term. I had been on 50mcg T4 for a year and a half, so never expected there to be a problem
We should only increase Levo in 25mcg increments. So start with an extra 25mcg and retest in 6-8 weeks, if necessary you can then add another 25mcg, or maybe 12.5mcg. Just see what your levels are then and reassess.
I'm so sorry what your going through. But I can tell you from my own personal and others experiences that I read on this and other forums heart, kidneys, liver, skin, brain etc. Another words all of our well being all depend on optimal thyroid levels .
Thanks!! Ok that's kind of reassuring as things have to improve now with more levo.
I was feeling a bit hopeless as i didn't know why i was still unwell, and let my diet slip last 2 weeks. But now I am motivated by prospect of improving all my bloods.
My kidneys unfortunately aren't great, only issue I ahve which I think is pretty serious/non reversible. My creatinine is 123 nmol. But hopefully thyroid may help, and stop it getting worse, I don't know by lowering cholesterol which makes arteries better or something?!
Our thyroid dose has a huge influence on our cholesterol as well as everything else. I did not realise it myself up until I was on a more optimal dose for myself.
Having nutrients like Vitamin "D"/K2, B-Complex, B-12/folate, Iron/ferritin if you test low, is very important it helps our thyroid meds work better for us.
SeaSideSusie has *Excellent* posts with vitamins that help us and much more.
SlowDragon has *Excellent posts on how helpful it is for many of us to go gluten free and much more.
The posts are very valuable and very worth reading.
Thanks, yes I have found them both unbelievably helpful on this thread, and I am following SlowDragon to the letter, and I am gluten free. I've been rereading their posts, as there is a lot of info. My tests caught me completely unaware, everything was out of range pretty much on medichecks biggest test.
Do you know if b12 folate iron, actually affect natural thyroid levels, ie affect the thyroid results.
I know you say it helps the med work better, I'm wondering as I'm deficient in all of these, or at least have been very deficient the last year.
Can I ask what change in T4 dose was getting to optimal for you, and what was the cholesterol change?
I'd be interested, as I'm wondering if I can expect big changes with 25mcg increase.
I'm a TT patient. Being that I no longer have my own thyroids I totally depend on my thyroids in a bottle. I was dosed with very high T4 meds sole after surgery . That gave me many symptoms from palpitations ,insomnia, fatigue, heat/cold intolerant etc. I had to lower my T4 dose to make room for a very needed T3 . I am not a good T4 to T3 converter and adding T3 made a huge difference for me.
I found that increasing/decreasing by 12.5/25 mcg T4 is very helpful for me.
And increasing/decreasing 2.5 mcg T3 is very helpful for me. Sometimes even 1.25 mcg T3 can be very helpful too.
What I found very helpful too was splitting my T4 2x/day and T3 /3x/day. A small dose of T3 prior to going to sleep helps me with deep sleep.
Give your body time to acclimate to new changes. Journal your symptoms with each change. Very helpful.
I have just got my results, roughly 4-5 weeks after the last blood test. I have been following your schedule. 75mg T4. 1 thorne B complex, and b12 1000 supplement you recommended. And lots of iron 25mg supplementatoin a day. I take 400iu vitamin D a day. On the day of the test, I took my thyroid in the morning. and the test was at 2:30pm. I didnt change any of my vitamin supplements before the test
My results are:
TSH: 1.18
Free T3: 3.68 (3.1-6.8) pmol/L
Free thyroxine 14 (12-22) pmol/L
Ferretin 53 ug/L (30-400)
Vitamin B12 Active 108 pmol/L
Vitamin D 90.5 nmol/L
low CRP, thyroxine antibodies.
So I'm wondering what you reccomend. I have important exams coming up in a month? Should I stop that large vitamin B12 supplement? and jjust have the complex.
My thyroid still looks a bit low to me, but is it building up or something?
I have just got my results, roughly 4-5 weeks after the last blood test.
It would have been better to wait 6-8 weeks as that amount of time is needed for levels to stabilise.
On the day of the test, I took my thyroid in the morning. and the test was at 2:30pm.
Thyroid tests should be done no later than 9am with last dose of Levo 24 hours before the test. By taking your Levo before the test you have a false high FT4, by doing the test in the afternoon your TSH is lower than it would be at 9am. Early morning appointment is essential when looking for the highest possible TSH to avoid a dose reduction or looking for a dose increase.
1 thorne B complex, and b12 1000 supplement you recommended. And lots of iron 25mg supplementatoin a day. I take 400iu vitamin D a day. ..... I didnt change any of my vitamin supplements before the test
If you didn't leave off y our B Complex for 7 days before the test you possibly have false results. When Biotin is used in the testing procedure (which most labs do) and we take Biotin as a supplement or in a B Complex, this can give false results.
We should also leave off iron supplements for 7 days before any iron test and they should be done fasting (so early morning is more convenient for a fasted test).
It's difficult to say if any of your results are accurate.
Let's say your B12 level is accurate, you no longer need a B12 supplement, you should be fine with just the B Complex now.
The aim of a treated Hypo patient of Levo only, generally, is for TSH to be 1 or below with FT4/FT3 in the upper part of their reference ranges. IF your results are accurate (and we don't know if they are, and you tested too soon) then your FT4 and FT3 are too low which would suggest an increase in your dose of Levo.
Ferritin needs to be higher - recommended is half way through range - try eating liver every week, no more than 200g due to it's high Vit A content.
Vit D is close to the recommended level of 100-150nmol/L so I'd continue with the D3 (making sure you also take magnesium and Vit K2-MK7, important cofactors), and retest in 3 months. I actually think your D3 dose is very low, it's a child's maintenance dose, so it wouldn't hurt to increase that to 1,000iu which is more of an adult maintenance dose.
Hi SeasideSusie, many thanks for your prompt reply.
I am a bit concerned about thyroid, as I do have important exams coming up. If my test can only be falsely high, not falsely low. Should I be increasing by 12.5mg?
Ok Yes my vitamin D has decreased since the last test, even though taking 400 iu. My iron I will keep supplementing—I have been supplementing for ages.
If my test can only be falsely high, not falsely low. Should I be increasing by 12.5mg?
As I said, you didn't give enough time for levels to stabilise.
If they are falsely high there is room to increase by 25mcg but you may want to be more cautious and only increase by 12.5mcg.
Yes my vitamin D has decreased since the last test, even though taking 400 iu
As that is a child's maintenance dose, it's never going to raise and probably wont even maintain an adult's level. During October-March we can no longer make Vit D from the sun here in the UK, so this is the time that most people could do with supplementing with D3.
Do you also take magnesium and Vit K2-MK7?
Do you know what is optimal active B12?
For Active B12, below 70 is suggestive of testing for B12 deficiency. So anything over 70 would be considered OK. Personally I prefer over 100 (considering the range is 37.5-188).
Thank you very much for your detailed answers. Perfect, I am really feeling so much better than a few months ago so hope I'm on the right track. And that's all down to the answers on here last time!! the thyroid +vitB. + iron supplements have helped.
I don't think they were falsely high, as I feel better than last test, which was only a bit lower. But I do think they maybe slightly sub-optimal, so would a 12.5mcg increase be sensible? ?even though I haven't waited long enough. I have put on a bit of weight (2kg), so not sure if that's significant for dosing but will try and lose a few kgs.
Ok Yes I was a bit weary of going high with vitamin D, as I have kidney problems, and used to take lots of vitamin —it probably wasn't related, but there is a study of one guy who took like 10000 a day, and damaged kidneys. But I think if my levels have decreased from 100 to 90 I might double it to 800IU. I do take vitamin K2,low dose, and haven't been taking magnesium–sometimes sporadically for sleep.
That's interesting about the B12, as I was taking a B complex, 1000mg supplement and floridax, I'm hoping removing the 1000mg supplement will be good.
I'm thinking of changing my regimen to 800 iu vit D, up from 400. Removing b12 1000, and increasing thyroid from 75mg to 88mg (3/4 of 100 pill). Let me know if any of this is not a good idea.
On the day of the test, I took my thyroid in the morning. and the test was at 2:30pm.
Free T3: 3.68 (3.1-6.8) pmol/L
Free thyroxine 14 (12-22) pmol/L
Last dose of Levo should be 24 hours before test. You don't say what time you took your Levo but let's say got up at 7am and took it then, that would be 7.5 hours before your test, so your FT4 is higher than it would be if you'd taken your last dose 24 hours before the test which is always advised here.
If your results are accurate and if those were my results, I'd be increasing by 25mcg. However, they're your results and I can't decide for you, I'm not medically trained so you'll have to make up your own mind if you want to do it slowly at 12.5mcg at at time or go for 25mcg.
Putting on weight means that you are not optimally medicated.
Magnesium is required when taking D3 because it helps the body convert D3 into it's usable form, so it makes sense to take it regularly.
increasing thyroid from 75mg to 88mg (3/4 of 100 pill)
How are you going to split a 100mcg pill accurately? 75mcg is 3/4 so are you confident that you can cut the pill into eighths to get the extra 13mcg? It might be better to work out how to get an average of 88mcg. 88mcg x 7 days = 616mcg, the nearest would be 625mcg made up by taking 100mcg on 5 days then 1 day at 75mcg and 1 day at 50mcg.
haha, ok. Sorry I'm supposed to be a mathematician lol. I forgot I'm taking 1.5 50mcg pills at the moment. So I guess Ill be taking 1 and 3/4 now. !!
Yes I definitely took my thyroid in the morning, probably about 6-7am, does it really make a lot of difference? I thought T4 is kind of like a reserve hormone, and the T3 is more variable, so as mine is still low, I'm thinking I definitely merit at least 12.5mcg.
Oh really, you would go up by 25mcg? I'm a bit weary just because I've got exams coming up and don't want to be an insomniac or something, and want to have a smoother transition. I do find it surprising my thyroid barely increased after going up 25mcg, but maybe it does take time, at least I'm in the right ball park now, and I'm hoping I'm not too suboptimal at 88mcg to harm performance.
I imagine I probably do need 100mcg as that is a more typical dose, and am going to splash out on blood tests over the next year and a half to get all this right.
Yes I definitely took my thyroid in the morning, probably about 6-7am, does it really make a lot of difference? I thought T4 is kind of like a reserve hormone
Yes, it is a storage hormone but taking a dose will peak in the blood 2-4 hours after ingestion so you want to avoid testing anywhere near this time as you will be getting a reading when T4 is highest in the blood, which is why we advise last dose 24 hours before test and do the test under the same conditions every time to compare accurately, i.e. blood draw no later than 9am, last dose 24 hours before.
Biowarrior - Had you had anything to eat or drink before your tests?
For both thyroid and cholesterol testing, it's best to do so fast, first thing in the morning. I see you hadn't had your Levothyroxine, but was is 24hrs since the last dose?
Eating or drinking before a cholesterol test can skew the results; depending in what and how much was eaten or drunk, the influence can make quite a difference.
Hi, yes it would be roughly probably 25 hours before the last dose exactly. Would that explain anything?? As I'm really thinking of looking at increasing my T4.
I hadn't eaten anything that morning, I probs last ate at 8pm the night before.
As you've been on 50mcg for a year and a half , how do these latest thyroid results compare to your 'usual ' results on 50mcg ?,
On the face of it ,FT4/FT3 do look low and like an increase in dose could be needed , but perhaps it was too soon to test if you've been unwell and on other medications.
If you were doing well on 50 mcg previously then i would be tempted to wait a bit longer, a month ? and just look after yourself (convalescence !),and do another test before you changed dose . Your FT4 hasn't changed much , but your FT3 is much lower, . BUT the body sometimes does this naturally as part of being ill, and if you don't mess with it, the higher TSH is asking thyroid to produce more hormone , and also to convert more T4 to T3 through the deiodinases at cellular level. I assume if you change doses while body is trying to level T3 up again then you will just confuse it.
Having said that 50mcg does seem a very small dose.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
About 90% of primary hypothyroidism is due to autoimmune thyroid disease
Low vitamins linked to low Ft3. Your Ft3 is right at bottom of range
Ask GP to test vitamin levels (and thyroid antibodies if not been tested yet)
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Ok thanks a lot for all that info—that's amazing. I'm kind of hopeful that I can change some of these things and things should get better for me, just by correcting thyroid, b12 and iron.
So my current plan is to increase by 25mcg, take 2 pills of b12 complex (amazon.co.uk/Thorne-Researc..., and continue iron supplementation. And retest in 4 weeks, just because I have an important set of exams in December, so would like to know I'm on the right track.
But you think I may need more than 25mcg in the future? I thought 100mcg was full replacement.
I did do the 24 hours before test, I have been very cold etc. but thought it was something else.
I really hope I haven;t done too much damage and I can improve my kidneys and blood vessels
I had the full medichecks test and vitamins came back
Folate - Serum 6.91 ug/L (Range: > 3.89)
Vitamin B12 - Active 59.100 pmol/L (Range: > 37.5)
Vitamin D 100.00 nmol/L
I was taking floridax for 3 months, which has b12. But I hope 2x thorne B complex is enough.
My iron is still deficient but I am supplementing and it has gradually gone up into the range.
Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS
May be better to take one Thorne B complex and separate B12
taking a B12 supplement and a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
T4: 75mcg (25mcg increase) or go to 100mcg (50mcg). I do kind of ened to perform as I will have some very important exams in 2 months. But know a slower increase is probably more sensible for getting the right level in the long run.
Thanks genuinely for all your help. I'm taking it all on board as need to be performing better in 6 weeks.
One last quick question. Is my folate ok? So my active b12 is 59, but 70 would be optimum?
I wonder how quickly I'll see improvements , I'm hoping 2 weeks maybe, I'll still stick with floridax, but it seems a bit redundant now if I'm taking so much b12/ iron.
Things are actually starting to make a bit of sense looking back. I only felt better this year when I started floridax as I was so deficient in iron/b12 after the virus. And recently I have been low energy if i exercise regularly and have had to leave the library several times and go home because i was too cold and I was having baths in day to warm up. But I still think maybe things are out of whack after my corticosteroid treatment. As I felt fine then, Although it gives you a lot of energy and it was in height of summer.
Sorry to reply to your old posts, there was a lot of info the other day!
I was taking floradax 20ml a day the week prior to the test(no b12 supplements). I don't think it has biotin, but has b12 69% Nutrient reference value.
Hello SlowDragon, I hope you see this. I have just got my results, roughly 4-5 weeks after the last blood test. I have been following your schedule. 75mg T4. 1 thorne B complex, and b12 1000 supplement you recommended. And lots of iron 25mg supplementatoin a day. I take 400iu vitamin D a day. On the day of the test, I took my thyroid in the morning. and the test was at 2:30pm. I didnt change any of my vitamin supplements before the test
My results are:
TSH: 1.18
Free T3: 3.68 (3.1-6.8) pmol/L
Free thyroxine 14 (12-22) pmol/L
Ferretin 53 ug/L (30-400)
Vitamin B12 Active 108 pmol/L
Vitamin D 90.5 nmol/L
low CRP, thyroxine antibodies.
So I'm wondering what you reccomend. I have important exams coming up in a month? Should I stop that large vitamin B12 supplement? and jjust have the complex.
My thyroid still looks a bit low to me, but is it building up or something?
You need 25mcg dose increase in levothyroxine and bloods retested 6-8 weeks later
Fortunately your results do still show you are under medicated
But at next test make sure to
A) stop vitamin B complex (or any supplements that contain biotin) a WEEK before ALL BLOOD TESTS
B) always test thyroid levels as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 HOURS BEFORE TEST
Though really bloods should be done 6-8 weeks after each dose increase
But results show you are ready for next dose increase in levothyroxine
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.
Really sorry to keep pestering you—I'm thinking of maybe going to 100mg rather than 88mg, as now I know my results, I feel like I do have hypo symptoms (maybe placebo) . The only reason I'm weary is I dont want to have insomnia or anxiety so I can't do my exams, I do have 3 weeks to see how things go before.
I had 2 questions:
1.)Say if I did go straight to 100 from 75mg, I am doing a light jog for an hour every day, which may be using up thyroid. is the risk of it being way too much and me having hyper symptoms a lot, or would it just be mild as it's only a small dose increase and I definitely wasn't hyper on 75mg for 4 weeks
2.) I don't really get how it works, as I was on 50mg and now even 75mg is too little, but my T4 did bump up from 12 to 14 in 4 weeks. Does the body adapt and always need more until you are at full replacement? If that's the case won't I need 125mg if I am 72kg? My T4 is 14, so is optimal 17?
I think I may need lesss T4 than other people as I recall having average T4 and above range T3 when on grains of thyroid.
Levothyroxine is a storage hormone, so you can take different dose on different days. Generally people don’t notice, occasionally if sensitive it’s better to take same dose everyday
Currently you are taking 88mcg everyday?
Why not increase to 100mcg 3 or 4 days a week and stay on 88mcg the other days
Assuming all ok, after 6-8 weeks, either retest, or increase to 100mcg everyday
Definitely retest thyroid levels after 6-8 weeks on 100mcg levothyroxine
Important, if possible, to always get same brand of levothyroxine
Make sure all thyroid testing is done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Remember to stop taking vitamin B complex a week BEFORE all blood tests
"i thought 100mcg was full replacement ?" Who told you that ?
There is no standard 'full replacement'. Thyroid hormone replacement is a much more complicated system than that idea allows for. There is a huge amount of variation in individuals TSH,FT4/FT3 levels in health, so it's highly unlikely that every one would be well on a standard replacement dose . I see all sort of different Levo doses on here (usually in the 75-150 range, but not always). It's about what you need to be well.
I read in one of those studies that 100 was more than full replacemeny I guess a absorbance etc. And as it's replacement it's not a constant stream of when you need it. Also it's about your activities as if I did no exercise I would probs be okish on 50. But I've been cycling/running a fair amount as I'm 25 .
from histories on here , i do not find that men usually need more than women. (but there are not so many men to compare) Also some lightweight people take more than some larger people.
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.
Isn't it overkill to start at a full replacement dose for subclinical? (I thought subclinical was like my results above, TSH 2.5 or above and/or bottom of range T4/T3). Surely that will suppress a thyroid that could probably have outputted more and then you will always need that dose
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.
Many people need to start at 50mcg and slowly increase upwards
Hey quick question, I went straight up to 75mg last week, I do have way more energy etc, but I feel a bit too anxious, stimulated, like emanating a bit from heart, and sleeping less than I would expect. Obviously it's great, but don't want to be supraphysiological as probably not good for long run, especially with my kidneys, and feels more energy than normal.
Do you think it will settle down , like my body is adjusting , or I should try only a 12.5mg increase (50+12.5)??,
I only have 100mcg pills at the moment, so also don't know how accurately i'm splitting, and think I did take more for the first 2 days, as I was not really thinking.
I think its been 5 days, I've done exercise every day, where before I wouldn't have been able to. 2 days I took closer to 100 and then 3 days 75 . Only the last two days have i really noticed the anxiety.
I'm going to order some 50, so I can better adjust in that 50-100 range. I do want to get a test in only 4 weeks as I need to perform for this university term's exams in december.
So it’s almost certain that cause of your hypothyroidism is autoimmune thyroid disease (Hashimoto’s)
Are you currently on gluten free diet?
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
My boyfriend has hypo and his results are the same as yours with high cholesterol too. He's also on 50 mcg T4. I keep telling him he needs to increase. Like others have said here, if you sort out your thyroid all the other issues will improve.
Really, my instict is I feel it being associated with thyroid issues means it can't be good?I know that cholesterol food thing is nonsense. I'll have a look.
im secretly hoping it will help my health (kidneys) if i do get the cholesterol dwon.
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