I have several previous posts about my thyroid- I feel I’ve had thyroid symptoms for years then had to have a hemi-thyroidectomy in Feb 20 due to multi-nodular goitre. I started Levo shortly afterwards when my symptoms started increasing and my TSH increased to over 6.
I saw an endo privately in Oct as I still wasn’t feeling great and I had tried to optimise all my Vits as much as I could. At that time I was on 75mcg Levo and my results were Oct 20: TSH 1.98 (0.27-4.2) Ft4: 16.6 (12-22). My Vit D was 70.
The endo increased Levo to 100mcg and asked me to retest end of Jan, he said the aim is to get your TSH under 1 which I thought was surprisingly sensible! He said if that doesn’t work we could try adding T3.
So, I’ve now been on 100mcg Mercury Pharma Levo for 10 weeks, I’ve been taking good quality B12, B complex and Vit D (I stopped the B well before testing). But I haven’t been feeling that great again. I’ve just got my latest results back, and my TSH hasn’t moved, and my FT3 and FT4 are both falling again! I’m really confused. When I first started Levo I seemed to respond really well.
The latest result is in the photo. And below is the result from before I was on Levo at all, just for reference:
Well your results show you need next 25mcg dose increase in levothyroxine
Roughly how much do you weigh in kilo?
guidelines on dose levothyroxine by weight
Even if we frequently 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 eventually on, or near full replacement dose
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.
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.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
New 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
please email Dionne at
tukadmin@thyroiduk.org
Dose levothyroxine is only increased up in 25mcg steps
Your FT3 went down 4.5 to 4.09 and your FT4 went up from 13.2 - 14.2. Since you don't have your RT3 it 'appears' that your not converting from FT3 to FT4. You need two things to be optimal to convert 1) Cortisol (have you have a 24 hour saliva cortisol test done? 2) Iron (TIBC/%Saturation/iron/Ferritin) have to have "all" 4 labs/blood draws. Any inflammation in the body whether it comes from gluten or any GMO's (toxins) will not help the Thyroid/hormones do their job but you probably already know this.
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Help with results please!
Help with results please.
Help please with medichecks blood results
Help interpreting results please.
Help with my results please?
