Having a phone call tomorrow to review medication, so please can I ask what anybody thinks I should ask, still having days where I am tired and needing an afternoon snooze.
Bloods march 2021
TSH. 0.39 (0.27-4.2)
FT4. 16. (12.0-22.0)
FT3. 4.5. (3.1-6.8)
Bloods June 2020
TSH. 0.05
FT4. 16.7
FT3 4.5. Same ranges
I have been on 75 Levothyroxine since Jan 2020, diagnosed November2019
Thank you for any advice.
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
Essential to test vitamin D, folate, ferritin and B12 at least annually
When were these last tested
What vitamin supplements are you currently taking
Is cause of your hypothyroidism autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies
How much do you weigh in kilo
Results suggest you are under medicated
Ft4 is only 40% through range
Ft3 slightly less at 38% through range
So good conversion but in need of dose increase
Most people fell better when Ft4 and Ft3 are at least 60% through range
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
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.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Thanks for the reply
Last ferritin tested oct2020 58.64 (15-150) was 14.05 in jan20.
Vit d 175 (50) June 20
Serum B12 664 (197-771) jan 20
Serum folate 10.4 (3.3-19.3) jan 20
Yes to Hashimotos, weight around 68kg
Supplement with zinc 15mg,
selenium 200mcg
Spatone 5mg iron
B12 10mg
Vit c. 500mg
Magnesium 375mg
Vit k (mk 7) 100mcg
Vit d 25 during winter 10 during summer
Friendly bacteria
Bilberry,lutein and zeaxanthin
So guidelines of 1.6mcg per kilo of your weight
Weight 68kilo x 1.6mcg = 108.8mcg as the likely daily dose levothyroxine required
760mcg in total, per week - so you might require an extra 50mcg levothyroxine per week
As GP to follow guidelines and increase dose to 100mcg everyday and retest 6-8 weeks after each dose of levothyroxine
Forgot to say, Blood test was done before food and drink and 24hrs from last dose.
Hello Nat ;
I see from your profile we are diagnosed with Hashimoto's AI thyroid Disease.
Looking at the above your results haven't really changed much and since you still have some symptoms of hypothyroidism maybe a 25mcg increment in T4 will help you .
Your T4 is coming in at just around 40% through the range and your T3 is well balanced and coming in at around 38% : and generally we feel better when both T3 and T4 are in the top quadrant of their ranges so I think I would be asking for a dose increase in your T4 thyroid hormone replacement.
The accepted conversion ratio when on T4 Levothyroxine only is 1 / 3.50 - 4.50 - T3 / T4 : with most people preferring to come in at around 4 or under :
So to find your conversion ratio when on T4 only you simply divide your T3 into your T4 and we get 3,50 showing excellent conversion of the T4 into T3.
Sadly if your doctor only looks at the TSH there maybe a conversation about your TSH being too low and an increase in T4 not advised.
Too low a level of T3 and you have symptoms of hypothyroidism whilst too high a level of T3 and you my well have symptoms of hyperthyroid.
Quite where your level of T3 needs to be for you to be symptom free is not known, so as you still have tiredness and that pm slump it sounds like you need a bit more thyroid hormone replacement to get you through the rest of the day.
Optimal conversion of T4 into T3 can be compromised by lowish levels of ferritin, folate, B12 and vitamin D - and whilst your conversion doesn't currently look to be a problem, since you have an autoimmune thyroid disease, it's worth keeping an eye on your core strength vitamins and minerals.
Thanks for the reply, I am hoping to get an increase as lower ft4 on 75 Levothyroxine than when I was on 50 Levothyroxine.
Yes, ok then - it's the first necessary step.
You may also feel less tired when your ferritin reaches higher in the range :
I've found I feel at my best with a ferritin of around 100 ;
Results going up and down advice please
New results - grateful for any input
Blood Test Results.
Test results
