I've been on 100mcg Levothyroxine for a while but have started experiencing difficulty maintaining/losing weight, a very itchy rash on my hands (which I've had previously when my TSH was above 1) and extremely cold extremities/Reynaud's syndrome on feet and hands. I've also felt generally a bit weak and not had my usual level of stamina for exercise and assume this is all down to my TSH being higher than it has been when I've felt really well.
I've previously had iron issues but am taking a Ferrous Fumarate supplement and currently have Ferritin of 85ug so I'm assuming the symptoms are still more likely to be TSH related. I also take a 1000IU Vitamin D3+K2 daily.
I had a full thyroid panel done on Thriva yesterday and see that my TSH has increased to above 1 (see below). I've found I feel my best when it's below 1, or ideally below 0.5, so I want to approach my GP about increasing my Levo to either 125mcg or 150mcg but am unsure which? Is it better to make small adjustments (eg 25mcg) and see where that leaves me after around 8 weeks?
Here are my most recent bloods from Thriva:
JANUARY 2021 results:
FT3: 4.74pmol/L (normal 3.1-6.8)
FT4: 17.8pmol/L (normal 12-22 pmol/L)
T4: 88.3 nmol/L (normal 66-181nmol/L)
TSH: 1.1mIU/L (normal 0.27-4.2mIU/L)
TgAB: 51kU/L (normal 0-115kU/L)
TPOAb: 14.5kIU/L (normal 0-34kIU/L)
Ferritin: 85ug/L (normal 13-150)
Vitamin D: 77.6nmol/L (normal 30-175)
Folate: 12.9nmol/L (normal 8.83-60.8)
JANUARY 2020 results:
FT3: 4.84 (normal 3.1-6.8)
FT4: 19pmol/L (normal 12-22)
T4: 94.8nmol/L (normal 66-181nmol/L)
TSH: 0.363 (normal: 0.27-4.2)
TgAB: 52.1 (normal 0-115)
TPOAb: 9.02kIU/L (normal 0-34)
Ferritin: 130ug/L (normal 13-150)
Vitamin D: 65.5nmol/L (normal 30-175)
Folate: 11.2nmol/L (normal 8.83-60.8)
Really I'm just wondering whether to ask my GP for a 25 or 50mcg increase in my meds? I'm thinking maybe a 25mcg increase first?
The GP is mostly clueless about thyroid issues, so I just need to be able to put my point across and convince them and then they're usually just happy to go with my suggestion!
Grateful for any advice.
Thank you
Izzy
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Izzywizzy124
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I'd ask for an extra 25 mcg - but be aware that some (quite a lot of?) 25 mcg packets are Teva brand ... it does no harm to have different brands of levo IF you get on with them fine, but Teva is the Marmite brand: lots of people don't get on with it; some others actively prefer it and some (like me) don't mind one way or another. It is lactose-free but has mannitol in it, which seems to be the thing that people dislike. So if you know you don't get on with Teva it may be easier to ask for 50 mcg and halve the tablets x
There are other people that make 25 mcg but remember Northstar 25 mcgs are Teva (the other Northstar packs aren't) - it's just anecdotally here lots of people seem to end up with Teva when they need 25 mcg (and I've been given them myself - in Teva packaging which at least is more obvious!)
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)
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
Thank you. This forum has provided so many more answers than my GP ever could.
My current brand of Levo is Mercury Pharma but is does vary at my pharmacy.
Will look for a good B-complex and up my vit D to 2000IU daily.
Unfortunately the lab couldn't process my B12 this time, so that's missing.
I guess our thyroxine needs can just change over time and that might be what's causing the TSH rise? Or do you think there's something my lab results suggest could be messing with the TSH? I take my Levo last thing at night as it's hard to fit in during the day around caffeine consumption (2 morning coffees & 2 afternoon cups of tea) and iron supplements (which need to be 4hrs apart from other medication).
Taking levothyroxine at bedtime often gives best results
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
Currently on Mercury Pharma but I have been given Teva before. It varies.I didn't take my thyroid meds or vitamin D for 24hours before my blood test. It was done in the morning and while I didn't have any food beforehand, I did have a cup of tea with milk. Not sure if that makes much difference.
Just had the conversation with my GP about increasing my dose. They’ve somewhat reluctantly agreed to increase by 25mcg and reassess in 8 weeks. They clearly weren’t convinced by me saying I feel better with a TSH below 1. It’s all about normal ranges for them 🙄
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
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
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.
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Reasonable NDT increase?
Latest blood test results (30/03/21)
Decreased TSH since vaccines 
Thyroid blood test results - very low vit d and high TgAB
Could I have your opinion on these results please? 
