I am looking for a private practitioner /endocrinologist in London to prescribe me with T3 hormone. I

[MariaZetta]

Hello. I am new here. I have hashimoto and i have been on Levothyroxine for 5 years now. I started with 50mg and i now take 75mg. I feel worse every year , i have pains all over my body,palpitations, i lose my hair, i gain weight even on diet. I keep having alot of blood tests privately because this can't be normal. Everything comes back within the normal range. Vitamin levels B12, D3 very good. The only result is a bit low is my hematocrit and high antibodies . I would like to see a practitioner that can prescribe, me T3 and T4 hormone and can advice about the dosages and monitor me in London. Can you please recommend someone?

[SlowDragon Administrator]

Welcome to the forum

First thing is can you add your most recent thyroid and vitamin results and ranges

75mcg levothyroxine is only one step up from starter dose of levothyroxine

So very likely under medicated

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable and many many people can’t tolerate Teva brand (only one that makes 75mcg tablet)

Exactly What vitamin supplements are you currently taking

High thyroid antibodies confirms autoimmune thyroid disease, aka Hashimoto’s

As you have Hashimoto’s are you on strictly gluten free diet?

If not you need to get coeliac blood test BEFORE considering a trialing strictly gluten free diet

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 commonwith Hashimoto’s and gluten intolerance is often hidden issue

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

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

[SlowDragon Administrator]

Low ferritin/iron often linked to hairloss

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

[MariaZetta in reply to SlowDragon]

Thank you so much for your time. I can see you are very well informed with everything. My last blood tests were in August/September some blood tests in the UK and some in my country (i had to pay to check F3 and FT3 as my GP says they don't check it) I was taking 50mg Levothyroxine (eythyrox, it was working for me Tsh under 2) Then i decided to cut dairy and i started drinking soya milk. After 8 months i was feeling awful and my thyroid levels were very bad. TSH and antibodies very high. All this because of soya milk. I stopped it now.

I am avoiding gluten. I am not coeliac, i am not gluten intolerant but i have the gene.

I take multivitamis, vitamin D, acidophilus, selenium, calcium,magnesium and zinc.

Since my last blood tests in September i saw an endocrinologist and put me on 75mg of levothyroxine. I feel better but i didn't lose any weight and i don't know if i can convert it without the t3.

Vitamin B12, D and folate all great levels. Ferritin slightly low.I can't upload my results so i will write them down.

T3 0.95

T4 6.82

TSH 5.32

FT3 2.88

ANTI TG 7

ANTI TPO 1085

Thank you for all the information above. It is extremely helpful.

[SlowDragon Administrator in reply to MariaZetta]

How long have you been on 75mcg levothyroxine

Bloods should be retested 6-8 weeks after EACH dose increase

As fuchsia-pink says 75mcg is only one step up from starter dose. You are likely to need further increase (s)

Dose is only increased in 25mcg steps

Please add ranges (figures in brackets after each result) to your results above

The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of how low TSH is) ...important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

Low vitamins are due to being under medicated and low vitamin levels tend to lower TSH

Essential to regularly retest vitamin levels and supplement to OPTIMAL levels

High Thyroid antibodies confirms Hashimoto’s also called autoimmune thyroid disease. Good to hear you are on strictly gluten free diet, this helps high % of Hashimoto’s patients

[MariaZetta in reply to SlowDragon]

I have been on 75mcg since September. I need to repeat my blood tests soon.

[SlowDragon Administrator in reply to MariaZetta]

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[SlowDragon Administrator in reply to MariaZetta]

Please add actual results and ranges on vitamin D, folate, ferritin and B12 too

What vitamin supplements are you currently taking

[MariaZetta in reply to SlowDragon]

Ferritin 9.05 normal range 13-150.000

D2 = 81

Folate 8.4

B12 = 497

I use supplements from Holland and Barrett and multivitamins wellwoman from Boots without iodine. Vitamin D 10.000 weekly 1 capsule. Trying my best

[SlowDragon Administrator in reply to MariaZetta]

GP/endo should be doing full iron panel test for anaemia

Ferritin is BELOW RANGE

Highly likely to need iron supplements or possibly iron infusion

humanbean may pop along to comment on iron levels

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

dailyiron.net

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.

Thyroid disease is as much about optimising vitamins as thyroid hormones

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to MariaZetta]

Folate 8.4

B12 = 497

Please add ranges on these

[SlowDragon Administrator in reply to MariaZetta]

It’s necessary to avoid absolutely ALL soya, including soya lecithin

Soya can badly affect thyroid

[fuchsia-pink]

Welcome to the forum

You're still on a very low dose of levo - only one dose up from a starter dose ...

Do you have your most recent blood results to share (along with lab ranges as these vary from lab to lab). Obviously free T4 and free T3 are the key ones if you are thinking of adding lio to your levo.

Have you had key nutrients tested - ferritin, folate, vit D and B12? Your levo works best when these are good, but GPs don't get training on nutrition so don't generally test these unless prodded [I have had some success with my GP by saying these are the tests recommended by Thyroid UK]

It the actual results, and position in range that matter. Far too often we are fobbbed off by a GP saying the results are "in range" or "normal" when you are aiming for "optimal" .... x

[shaws Administrator]

Welcome to our forum MariaZetta.

You can copy/paste a section from above into your personal page so that you don't need to repeat your history. Just click on your name which will take you to your page. This enables members to look at it before responding (if necessary) to future posts.

If you want to look at your past questions/answers in future you just click on your name and it takes you to the appropriate page. SlowDragon has given you very good advice,

Doctors only seem to be interested in the TSH alone and this means (Thyroid Stimulating Hormone) which is from the pituitary gland, whereas we, the patients believe that they should also test the Free T4 and Free T3 instead of just T4 and T3.

Many doctors seem to believe that a low TSH means we've become hyPERthyroid and reduce our dose of hormones but we usuallyfeel better when it is around 1 or lower.

hormonerestoration.com/

[SlowDragon Administrator]

“ I am looking for a private practitioner /endocrinologist in London to prescribe me with T3 hormone.”

Until on decent full dose of levothyroxine, and always same brand of levothyroxine and all four vitamins optimal, it’s too soon to consider adding T3

Many people find Levothyroxine brands are not interchangeable.

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

dropbox.com/s/6h3h0qi4eqwi6...

Teva poll

healthunlocked.com/thyroidu...

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.

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

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

[humanbean]

Ferritin slightly low.

Ferritin 9.05 normal range 13-150.000

Your ferritin (iron stores) isn't just "slightly low" it is deficient and is one reason why you will be feeling terrible. If you are taking T4 (Levo) it needs to convert to T3 (the active thyroid hormone), and that just won't happen very well if your iron and ferritin levels are low.

You need to supplement iron. You can buy prescription-strength iron supplements without prescription in the UK from pharmacies with a pharmacist's permission. If one shop refuses to sell you what you want just go to another chain of pharmacies or an independent pharmacy. I use Tesco Pharmacies, Lloyds Pharmacies and independents. I have been refused once by Boots.

The level of ferritin which is optimal for many is mid-range or slightly over mid-range. With the range you've given above a level of about 80 - 100 will suit many people. Some people raise their level a little bit higher, up to about 120 or 130. Don't go over the range. Iron is poisonous in overdose.

You really need to monitor your iron and ferritin results regularly while supplementing iron so that you know if anything is going wrong. See this post for info on what can go wrong and why regular testing is essential :

healthunlocked.com/thyroidu...

For information on what people can supplement with, see this reply I made to another member on the subject :

healthunlocked.com/thyroidu...

If you get a full iron panel test done then post the results and reference ranges in a new post and ask for feedback.

Good luck.

Edit : I forgot to mention...

Iron supplements need to be taken a minimum of four hours away from any thyroid hormones.

[MariaZetta in reply to humanbean]

Thank you