Finally receiving treatment - what to expect?

[JonnyA]

I'm a 36 year old male and I've posted on here a couple of times recently trying to make sense of various blood tests and symptoms. Having had strong suspicions of hypothyroidism for the last 3 years, I've finally found a specialist prepared to offer treat / medicate me. My latest blood tests results were:

- TSH - 4.9

- FT4 - 18.9 pmol/l [12 - 22]

- FT3 - 5.2 pmol/l [3.1 - 6.8]

- TPO Antibodies - 13.4 IU/ml [0 - 34]

- TG Antibodies - 12.6 IU/ml [0 - 115]

Vitamin D was also very low. As a starting point, I've been prescribed:

- Levothyroxine 25mcg daily

- High Strength Vit D - 10000Iu for 6 weeks, then down to 2000IU per day

- Selenium - 100-150mcg daily

- Zinc - 10mg daily

Given my FT3 was low-ish in the context of a high TSH and moderately high FT4 I had wondered whether NDT might have been an appropriate course today, however the doctor felt that I would benefit from Levothyroxine. I realise that 25mcg is very much a starting dose, a bit of a 'dip your toe in the water' if you will.

I am being retested in 6 weeks, but what, if anything, should I expect in the intervening period. What are the odds of feeling some symptomatic relief (primarily from weight gain, fatigue, brain fog, cold intolerance and depression) in that time? Will I more than likely need to go up to a higher dose before feeling any better?

Thoughts and experiences appreciated. Thanks!

[Nanaedake]

Were you taking any levothyroxine when you had these blood tests?

FT3 - 5.2 pmol/l [3.1 - 6.8] FT3 is not low judging by these results, especially if you were not taking any meds. FT4 is comfortably in range, I often see results above the top end of the range on here.

You don't give a range for TSH so we can't tell where it is in the lab range. 25mcg is a very tentative dose but given that FT3 is highish in range it seems sensible. It's not high TSH that gives symptoms but rather low FT3 and yours is OK.

You don't say how low vitamin D is as you haven't given results or range.

Have you had a thyroid ultrasound to determine health of the gland? You haven't got thyroid antibodies judging from your results so you may not have a thyroid condition.

It could be low vitamin levels causing your symptoms and possibly affecting the pituitary gland response? You'll have to just see what happens. If it were me, I would not be hasty to take levothyroxine but rather get vitamin D levels sorted out and retest. I'd also want a full blood count, iron levels checking and other factors ruled out that could affect pituitary response. I'm no expert though!