hello everyone and hoping you all are well. I have been on levo 50mg for a month feel the same no change at all in any of my symptoms but here are my bloods:
Vitamin D (25 Hydroxy) - Final - 06/05/2021 05:07
Vitamin D 65 nmol/L Deficient : < 25 nmol/L
Insufficient : 25-50
nmol/L
Consider reducing dose: >
200 nmol/L
Cortisol (Blood) - Final - 05/05/2021 16:28
Cortisol 157 nmol/L Note amendment to reference
range 01/02/16
following recommendation
from kit manufacturer.
New reference range:
6-10am: 133 to 537 nmol/L
Midnight: <150 nmol/L
Ferritin - Final - 05/05/2021 20:50
Ferritin 40 ng/mL 13 - 150
Folate (Serum) - Final - 05/05/2021 20:52
Folate (serum) 17.7 ng/mL 2.9 - 20.0 Note new reference range
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These are the important bits for thyroid function test, and it means your fT4 (free thyroxine) is very low in range, (only about 10% ) so an increase in Levo (T4) is needed.
They should be aiming for the top half of the range at least
Your TSH is still too high for a treated patient on Levo.. they should initially be aiming to get it under 2 (at most )and possibly under 1 as that is what many people need to fell well on Levo. So TSH also indicates an increase in dose is still needed
Note * the time of this test was late in the afternoon, meaning the TSH will probably have been even higher than 3.42 if it had been tested first thing in the morning.
fT3... too soon to tell much, as you are still on very low dose of Levo... see what it's like when TSH is below 1 and fT4 is much better than it is now.
.....however if you are unlucky, a GP might look at these results and say "they are all in range now, so stay on the same dose"..... which would be a mistake, unless you happen to feel fine on 50 mcg .
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Also, if this is your first time on Levo, 50mcg tends to be the basic starting dose. You may need 2 or 3 more adjustments until they get your bloods to the level where they should be. Once there, it's just the maintenance dose. It does take time, but unfortunately, it's not a process that can be rushed and is usually increased in 25mcg increments each time.
No need for shame (i remember that year fondly ... i accidentally sewed my needlework to my skirt at school that year, it took the teacher an hour to unpick it before i could go home ) feel old now !
hopefully someone else will have something intelligent to add about your other results x
Thank you for the detailed response. I had my bloods done at 8:45 on an empty stomach with my Levo dose at 7 am the day before. The nurse taking my bloods wanted me to wait to get as close to 9am as that is when she says cortisol is at its highest.
I was always a very strict vitamin taker but when I started Levo I wanted to see what my actual body is doing and not have it masked by my supplement.
I am a vegetarian.
I do not have my brand to hand it’s a brown box( hahaha does that help!)
I am assuming it will take another two or even three months before T3 will be looked at as a possible add on?
Should I start back on vitamins? I have my consultation today with the consultant and as far as I know he was trying to check with these bloods if I have Colieac but I am not sure about Hashmoto? I think my adrenals might have an issue just as I do crave salty and caffeine in cycles and have anxiety/panic attacks and also even though I drink 2/3 litres of water a day my urine smells very strong.
Lets see what the Dr says but you know what I was most looking forward to this forums diagnosis and reflection as sadly you are more learned than many GP’s. I am very lucky to be seeing a specialist though.
Likely to need several further increases in levothyroxine over coming months
Important to get vitamin levels optimal and maintain at optimal levels
As vegetarian it’s likely difficult to maintain good iron and ferritin levels without iron supplements
But if supplementing iron you will need full iron panel test 2-4 times a year to check iron isn’t too high
Obviously will need vitamin B complex too
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.
THANK YOU so much slowdragon! So by my weight being 110kg I am assuming a dose of 160mg is what I would have to get to and to get there in 25 increments would take 6 months I guess. Should I ask the endo if he would consider starting me on a higher dose?
My mum was also diagnosed very late in life, she was a lucky few who had armour prescribed but this was 20 years ago. When does the blood work/symptoms illustrate that t3 is also needed?
Reading all the stories on the forum it is very clear that a large majority of people take a version of NDT and seem to have good results. I guess I am scared of self-medicating and thought I would try the Doctor led route. My doctor did say that he would be able to prescribe T3 if I need it but I just wanted to understand when that decision would kick in… maybe I’m being presumptuous and I know many people do not need T3 and respond well to Levo by itself.
Ok so after my consultation. Dr said my meds would increase but that he was sing to get it under 2.5 not under 2 as stated here...I'm a little worried i did ask should it be under 2 . He said my vitamins were all wonderful!! He said my cortisone is not likely to be a problem but i asked for the test i am not sure of the name, where they inject a drug and check after an hour. I'm hoping my insurance covers it. He is saying 75mg will be enough to get my TSH lower but as per the guidelines i thought it would be nearer 100 or even 125 am i missing something i asked if I would need more and he kind of dissmissed my concern.
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