My TSH was last recorded at 0.67
I'm on 75mcg Levo
Symptoms are still; brain fog, weird feelings in the head from time to time, drunk feeling, sometimes shortness of breath.
Last Dr stated possible combination treatment for the t3 however needs t3 test first.
So what's considered normal range?
Kind regards
Depends on the lab, but my lab's range is 3.1–6.8 pmol/L and on 125mcg levo (T4) and 25mcg lio (T3) my FT3 was 6.8 at my last test.
Hi may I ask, you take the whole dose(25mcg lio) at once or split it?
I split it into two doses. I take 12.5mcg when I wake up and then 12.5mcg at around 3pm.
As high as it needs to be to resolve your symptoms. Aim for the higher part of the range. Your T4 has to convert to FT3 for your body to use it in the cells. Anyone on Levo (T4) should find out how well they are converting to FT3. You are still on a low dose of Levo so you could also try an increase if you find you are converting fairly well.
Important to test Ft4 and Ft3 together
All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Ideally both Ft4 and Ft3 should be over 60% through range
If Ft4 is too low, you need dose increase in levothyroxine (regardless of your low TSH)
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
Hello, had my Ft3 results back today.
Firstly there was some confusion over whether they'd even taken my ft3, as when I requested them they only had ft4 available.
After a wild goose chase they messaged me saying that they dd test it after all. (I always get suspicious because know they don't like testing on NHS, out of fear of prescribing liothyronine maybe🤔)
Anyway test results according to NHS are:
TSH. 4.3
T4 15.1
T3 4.8
(Normal)
I requested antibodies testing TPO etc l, they declined to test.
I told them about TEVA brand may not be good for me, they ignored that.
I told them my folate was low, maybe an increase from 5mg, they ignored that.
Back to square one with them.
This battle is difficult.
Best they've given me a physical with the nurse, BP etc tomorrow morning.
Oh and they recommend me seeing a psychologist, as it might all be on my head.
Symptoms of brain fog, off balance, shortness of breath and fast heart rate was ignored by Dr.
I told them if it isn't my thyroid then book me in with neurology department.
Their answer was speak with a counsellor first.
Fed up.
Please add ranges on these results (figures in brackets after each result)
TSH is FAR TOO HIGH
So contact GP for 25mcg dose increase in levothyroxine
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
Good evening.
We've spoken on a few occasions now.
This morning I attended the hospital for full blood tests and physical examination.
The used ECG to check heart, basic neurological tests, and n evidence of lung issues (due to my breath shortness)
Those tests came back all "normal"
So it's back to the Thyroid, awaiting my t3 and t4 tests but a specialist has stated to up levo by 25mcg going from 75 to 100.
Slow process as I'll need to now wait 8 to 12 weeks to see of there's any improvement.
I've taken your advice in regards to 'Super B Complex' supplements l, as I had low folate back in September.
The battle continues...
We can’t rush hormones
It takes 6-8 weeks for each dose to have full effect
On plus side you have found this forum early on
So have learnt already the importance of OPTIMAL vitamin levels
You need to know if you have high thyroid antibodies
Did you get access to your test results online yet?
About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high TPo or high TG thyroid antibodies
About 9 out of 10 hashimoto’s patients are female
Liam Gallagher of oasis has Hashimoto’s
Wondering....have you recently (in last 2 years) stopped smoking ?
Presumably you haven’t had thyroidectomy or RAI for hyperthyroidism (Graves disease)
Have you had iron and ferritin levels tested?
Frequently low iron/ferritin causes shortness of breath
Presumably you aren’t vegetarian or vegan?
Low ferritin is extremely common when hypothyroid
Never supplement iron without doing full iron panel test for anaemia first
Post discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
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.
restartmed.com/hypothyroidi...
Post discussing just how long it can take to raise low ferritin
healthunlocked.com/thyroidu...
Thyroid disease is as much about optimising vitamins as thyroid hormones
Roughly how much do you weigh in kilograms?
This will give an indication of the likely dose you will eventually need to increase to
Rare to need less than 1.6mcg per kilo
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
bestpractice.bmj.com/topics...
Some people need higher dose than guidelines if have gut malabsorption or lactose intolerance
Recommend using a weekly pill dispenser for levothyroxine
And separate one for vitamins
Makes it much easier to see/remember to take daily dose
Come back with new post once you get vitamin D result
And remember to stop taking vitamin B complex a week before ALL BLOOD TESTS (biotin in vitamin B complex can falsely affect test results)
Did you track down previous B12 result?
Recommend self supplementing to improve low Folate (and B12 as well)
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
B vitamins best taken after breakfast
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
amazon.co.uk/Super-B-Comple...
Or Thorne Basic B is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Low B12 symptoms
b12deficiency.info/signs-an...
taking a B12 supplement as well as 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.
B12 sublingual lozenges
TSH should be under 2
gponline.com/endocrinology-...
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Politely but firmly request that dose of levothyroxine is increased to 100mcg
Be prepared to quote guidelines. Stand your ground
When you get prescription for 100mcg you may need go/ring round different pharmacies to get the brand of levothyroxine you require
Recommend you get BOTH thyroid antibodies alongside thyroid levels when you retest 6-8 weeks after increase in dose levothyroxine up to 100mcg
Meanwhile getting vitamin D tested - £29 via vitamindtest.org.uk
Or
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
Far too soon to consider adding T3
Your likely to see very low Ft4 and/or low vitamins as been left so under medicated
We only consider adding T3 once Levothyroxine dose has been increased up to full replacement dose (1.6mcg per kilo of your weight) or if can’t tolerate increasing levothyroxine any higher
Before considering adding T3 (which is much harder to manage and extremely difficult to get prescribed) it’s always best to get levothyroxine dose fine tuned and all four vitamins optimal
A) this can significantly improve conversion of Ft4 to Ft3 so that you don’t need T3
B) vitamin deficiencies causes symptoms in their own right
C) if cause of thyroid disease is autoimmune (Hashimoto’s or Graves’ disease) then frequently strictly gluten free diet helps or is essential BEFORE considering adding T3
D) lactose or dairy free may be necessary as well, or instead of gluten free
E) frequently dose of levothyroxine isn’t tweaked finely enough and often not high enough dose. Ft4 should be at least 60-70% through range, regardless of how low TSH drops
F) always get same brand of levothyroxine. Otherwise at each prescription dose is slightly different. Different brands are not bio equivalent
Nether levothyroxine or T3 will “work” if vitamin levels are deficient.
NHS only tests and treats deficiencies
But we need optimal vitamin levels ....this usually requires self supplementing to maintain optimal vitamin levels
Vitamin levels need testing regularly
Being under medicated on too small dose of levothyroxine leads to low stomach acid.
Low stomach acid leads to low vitamin levels
Low vitamin levels tend to lower TSH and raise Ft4, but causes poor conversion and very low Ft3
Low Ft3 tends to lower vitamin levels further
Come back with new post once you get results
What is considered optimal free t3 levels? 
What do you think of my T3 level?
Starting T3 - what to expect
Increasing TSH with normal T3 levels. 
What to expect from T3?
