I must admit, I am confused as my levo dose remains at 75mcg and thought that NOT taking my b complex for a week would mean a dramatic change in the results. I should be encouraged I suppose as the results are going in the right direction but I am puzzled.
Any thoughts or advise would be gratefully received,as not sure if I should ask GP to increase dose to 100mcg as TSH IS still too high.
Written by
sobs1962
To view profiles and participate in discussions please or .
Yes, ask for a dose increase . TH is still much too high; free T4 is only 54% through range and free T3 is a feeble 24% - indicating you don't convert brilliantly either.
No nutrients tested since May but have been supplementing with b complex, vit d + k2, magnesium and have been taking ashwagandha since June and and hoping that it is doing what I desperately hoped it would and that things will continue to improve. Will speak to doctor next week if I can manage to get an appointment!! Due to have repeat bloods done again in January at hospital ordered by endocrinologist. Can only carry on doing what I have been for the last 3 months and hope I start to feel better as feeling tired and always cold are my main symptoms and was like that even on 125mcg of levo. Thanks for your support,it's really appreciated.
Absolutely you need 25mcg dose increase and bloods retested again 6-8 weeks after each dose increase
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)."
(That’s Ft3 at 58% minimum through range)
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
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Thanks for that will send that email to Dionne. Unfortunately, there's very little or no chance that they'll a) increase the dose or b) retest after 6-8 weeks as that would take me to the end of December/beginning of January and have appointment on 13/01/2021 to have bloods done at hospital. It seems at the moment that GP practices are using the pandemic as an excuse to do as little as possible and the endocrinologist wasn't much help either and just suggested I take a selenium supplement from Holland Barrett at 200mcg twice daily which I think is too high a dose and I've read that 50-60mcg is adequate daily amount and that too much can lead to toxicity.
Nutrients last tested on 15/05/20 and have been taking Igennus Super B complex, Better You Vit D + k2,Calm magnesium powder and ashwagandha 1600mg per day since June but the GP will NOT test those unless they think it is necessary and as were all within range that just won't happen. My depression is the worst it has been for many years and I'm convinced it is due to my thyroid. Can you suggest a better quality selenium supplement as I know it is vital for conversion but can't be sure I will absorb enough due to probably having low stomach acid from 20+ years of taking omeprazole but not taken since February this year. Also still on 20mg of Propranolol daily.
No idea about this as only one reading done in blood and not saliva as believe it should be done 4 times through saliva but that's the NHS for you just do the absolute minimum but is no where near adequate.
As the Regenerus test is £83.00 will need to save up money,as unable to work at moment due to health.
I talked to the endocrinologist about that but says may not be able to absorb enough selenium as has to go through gut and suggested a selenium supplement but will wait and see if increase in levothyroxine does the trick when I have my bloods re-tested in January and may supplement then if T3 is still low.
Source some extra levo and top up before Jan. it’s a long way off. That way you’ll learn what you need to feel better too. I think levo is cheap and available.
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
Getting dose increase in levothyroxine is first step
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
Are you currently taking Teva?
Teva, Aristo and Glenmark are the only lactose free tablets
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap. Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Cannot take any brand of levo except Mercury Pharma and have brand specific prescription. Stopped taking omeprazole in February this year and started taking levo in morning again as it seems to be working better like that. Interesting article regarding TSH levels but my TSH levels have been what they call "suppressed" in the past and my T4 has been " over range" and my levo dose has been decreased but NO T3 has been tested on those occasions. They clearly do NOT understand that if T3 is within range, even if T4 is higher than range and TSH is suppressed that it is not necessarily a dangerous scenario, which is why testing T3 is so important.
With regards to ashwagandha,it's function is to calm down the adrenals and can get rid of free radicals that affect production of reverse T3 and therefore improve conversion.
If your taking omeprazole yep your stomach acid will be low and consequently poor absorption of nutrients and more. Why are you taking it, is it because an ulcer or acid reflux a sign of low stomach acid not high. If its just acid reflux, its because the sphincter has relaxed due to low stomach acid and let's some up the oesophagus sorry its a case of use it, or lose it. You can increase your stomach acid by supplementing with BetaineHCL with Pepsin, may want to consider a digestive enzymes supplement too.
Thyroid levels yes TSH is too high, FT4 is about right ideally 18 FT3 ought to be about 6.0-6.2 if everything is converting properly, you may have high RT3 and antibodies, given the omeprazole you may have systemic candida overgrowth which may well be the root cause if its in the thyroid. Stomach acid does more than break foods down, it also controls candida, adds a positive ionised charge to nutrients to attract to an alkaline body, low B vitamins is also another indicator, low B vitamins leads to high homocysteine which comes with it's own problems.
Thanks for your reply. I stopped taking omeprazole 9 months ago and was taking it for very long time as I was drinking heavily for a long time and GP out me on it to protect me from an ulcer due to my drinking. I no longer drink alcohol as it just doesn't agree with me at all. As far as b vitamins are concerned I have been taking Igennus Super B complex for the last 5 months and haven't had my nutrient levels tested since May and due for more bloods to be done in January which are being done at hospital and have been ordered by the endocrinologist,but whether they check vit d, b12,folate and ferritin remains to be seen but will ask, when I go. Regarding homocysteine, will do some research into that.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Thyroid blood test results.
Latest blood test results 
Help with Blood Test Results
Advice on recent test results
Another test with different results 
