Hi everyone and thank you for the wealth of information on here. I was diagnosed with hypothyroidism in Aug 2020 and have been trying to educate myself about it all.
When diagnosed my TSH was 35 point something. My latest test results from this month (on 125mcg levothyroxine, tested at 7.45am fasting and before taking meds) were TSH 3.37 (range up to 4.2) and T4 21.5 (range up to 22). GP doesn’t test T3.
GP wouldn’t increase my thyroxine (says it could cause palpitations and I’m in the normal range) but I understand from here that the TSH should be more like 1-2 especially as I would like to try to conceive and don’t have much time left (I’ll be 40 this year). I do have one child, aged 6, then had a miscarriage in 2017 and haven’t been able to conceive since then - I suspect this thyroid problem has been brewing all that time.
GP did some other tests last some week as I still feel rubbish (fatigue, hair loss, cold, low mood etc etc) and I think these are the relevant ones - everything came back ‘normal’ so they won’t do anything:
Serum ferritin 60 ug/L (range 13-150)
Serum folate 7.5 ug/L (range 3.9-26.8)
Serum vitamin B12 395 ng/L (range (197-771)
I’m going to get a medichecks test incl vitamin D, antibodies etc. But should I start supplementing anything now? And/or should I have another try at getting the GP to increase my levothyroxine?
Many thanks for any advice you can give.
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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
Which brand of levothyroxine do you currently take
Do you always get same brand
Folate and B12 will need improvement by self supplementing, starting after next test
Thank you for replying so quickly. Currently taking 100mcg Aristo and 25mcg Northstar, but have had various different brands - whatever the pharmacy has in, I guess.
Will get the private test organised and come back with results, if that’s ok.
Northstar 25mcg is Teva Teva brand upsets many many people
Both Teva and Aristo are lactose free.
Are you lactose intolerant?
Many people find Levothyroxine brands are not interchangeable.
Different brands are not bio equivalent. 100mcg in one brand will give different results from 100mcg in different brand
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
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, Aristo and Glenmark are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
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
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
When you say that some people don’t get on with a particular brand, what sort of effects does it have? I’m not sure how I’d identify whether it was having any side effects. Definitely haven’t had any sickness, or anything like that.
Some of us find a brand change causes issues and some of us don’t. I’d been on Teva from the start, and had no problem with it, but it obviously upsets so many people I wondered if I should try to change. By sheer fluke that very month I was given Mercury Pharma. I found it was no different to Teva, so I don’t need to worry about changing.
Hopefully SeasideSusie will be along to comment on your vitamins as they all need supplementing.
Ferritin is recommended to be half way through range, so 82 with that range, although I've seen it said 100-130 is good for females. I would like mine to be 100 (I'm working on it, long way to go 🙄).
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Serum folate 7.5 ug/L (range 3.9-26.8)
Folate is recommended to be at least half way through range so 15.5+ with that range. Eating folate rich foods can help, as can a good quality bioavailable B Complex such as Thorne Basic B or Igennus Super B.
Serum vitamin B12 395 ng/L (range (197-771)
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml (or ng/L which is the same) because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Some people with a level in the 300s have been found to need B12 injections.
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
I would suggest you wait until you've had the Medichecks thyroid/vitamin panel. They do the Active B12 test which is a more useful test than the Total B12 test your GP has done. The Active B12 test measures the amount of B12 that is free and available to be used by the cells.
Being a bit of a beginner on this forum I can’t understand why your TSH is that high when you’re on Levothyroxine and your T4 is high. I would suggest a private test to see where T3 is. Choose a test that does vit D at the same time, unless GP will do it.
Are you on the appropriate dose of levothyroxine for your weight? 1.6mcg levo per kilo of weight. It’s just a guide - you may need more or less - but if you need more this might persuade your GP. If it doesn’t get you an increase you may need to see an endo.
But it’s probably worth getting vit D tested and improving the vitamin results you have got before anything else.
I’m about 67kg so that would be about 107mcg and I currently take 125. But never realised that different brands are effectively different doses. How confusing!
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