Hi, I wondered if someone would take a look at my recent results please. I had an increase of 25mcg Levothyroxine,
as advised by this brilliant site ,to bring my TSH level down from just over 2 to what it is now. I’m pleased with the present level of 0.85.
I still feel my energy levels are low and would appreciate any advice please on the results printed.
Thanks in anticipation.
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
What vitamin supplements are you currently taking.
Vitamin D could be higher around 80nmol and around 100nmol maybe better
Ft4 is only 44% through range
Ft3 is only 19% through range
Helpful calculator for working out percentage through range
Most people on just levothyroxine will need Ft4 at least 60% through range. FT3 is most important result and is still very low
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
Do you always get same brand of levothyroxine
Hi Slow Dragon... Thankyou for your input.
I have a B12 injection every 3 months( I realize this is thyroid site) My B12 inj was due , and so was surprised that it it was still showing a high of 753.
I used to take bit D3 nasal spray but did not take over summer months.
I don’t take any other supplements.
I’m really sorry but I don’t understand the advice given regds T3 etc.
Do you feel my Levothyroxine should be reduced back down to 50mcg. I realize you can only advice and that you are not medically trained but you understand such a lot.
Is it possible to have advice in layman terms. Thankyou
I had my bloods taken at 10.30(only time available) I had only water and it was 24hours since taking Levothyroxine. I have been on the same brand of Levothyroxine (Teva) from the start of treatment.
Thankyou
You need another dose INCREASE
Ft4 is still too low and Ft3 even lower
Ideally another 25mcg increase in levothyroxine upwards
NO! SlowDragon is saying that you are still under-medicated 
Your TSH is a message from the pituitary to the thyroid telling it to work harder if you are hypo - at which point TSH goes up; so a lower TSH should mean you are producing more of the thyroid hormones you need. But the free T4 and free T3 results tell you what the thyroid is actually doing - and a low in range reading means: not enough yet. Additionally, the free T3 result is much lower in range than the free T4, suggesting you don't convert brilliantly - but it may do better as your free T4 increases; and for free T4 to increase, you need to increase your levo.
Try and get an extra 25 mcg a day - and re-test in 6 - 8 weeks (always early morning blood draw, 24 hours from previous levo) and carry on increasing levo - regardless of what your TSH does - until you get free T4 up to 75% through range ... and see how you feel and what free T3 is doing at that point. Good luck x
Thanks so much Fuschia Pink
Looking at previous posts this test was done on 75mcg levothyroxine
75mcg is only one step up from starter dose
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.
Also here
cks.nice.org.uk/topics/hypo...
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
Thanks to Slow Dragon and Fuschia Pink
Suggest you see/speak to GP and request dose increase in levothyroxine
They may be reluctant because TSH is quite low
Be ready with guidelines on dose by weight (assuming that your weight suggests you need dose increase)
Ferritin is rather low at 53
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
List of iron rich foods
Links about iron and ferritin
irondisorders.org/Websites/...
drhedberg.com/ferritin-hypo...
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.
Improving vitamin D to at least around 80nmol
Thyroid disease is as much about optimising vitamins as thyroid hormones
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