I was diagnosed with Hashimoto's 4 years ago and have been on 75mg levo for the past 3 years, but wonder if I need to now push for an increase (my weight has gone up significantly since original dose was prescribed). I know that my GP won't be keen as the endo I was referred to 3 years ago said 75mg was the optimal dose for me. But I cannot lose weight (2 stone overweight and slowly gaining), and have severe thinning hair - so thin on the top of my scalp that I have numerous bald patches and a parting of >1cm.
I've followed Isabella Wentz's Hashimoto's protocol from Nov 2020, but it doesn't seem to have made any difference, except my vit B levels are now too high!
I'm also in perimenopause so having HRT (estradiol gel 1mg/progesterone tabs) - this has definitely helped my anxiety, insomnia and mood, but still no difference to hair.
Bloods from 10th June are:
CRP HS 0.8 mg/l (0–5)
Ferritin 65 ug/L (13–150)
Folate -serum 8.4 ug/L (>2.9)
B12 194pmol/L (25.1–165)
Vitamin D 83 nmol/L (50–200)
TSH 2.65 mIU/L (0.27–4.2)
Free T3 3.8 pmol/L (3.1–6.8)
Free thyroxine 18.6 pmol/L (12–22)
Thyroglobulin antibodies 37.5 IU/mL (0–115)
Thyroid peroxidase antibodies 219 IU/mL (0–34)
Thanks in advance for any advice,
Musette
Written by
musette
To view profiles and participate in discussions please or .
I’m not surprised you feel unwell musette, as your dose is insufficient…. Definitely push for an increase. I did not feel well until my TSH was ‘significantly’ under one and my T3 higher in the range.
Apparently, after starting HRT, thyroid function should be tested because it can cause the need for an increase of thyroid medication. Was this done? The information is on the Thyroid Foundation's website.
TSH 2.65 mIU/L (0.27–4.2) The aim is a TSH of 1 or lower
Free T3 3.8 pmol/L (3.1–6.8) Too low. The aim is a T3 towards the upper part of the ranges.
Free thyroxine 18.6 pmol/L (12–22) - could be higher
Thyroglobulin antibodies 37.5 IU/mL (0–115) - going gluten-free can help reduce antibodies.
Thyroid peroxidase antibodies 219 IU/mL (0–34) going gluten-free can help reduce antibodies.
Thyroglobulin antibodies (TgAb) are proteins that can be measured in your blood. Thyroglobulin antibodies are made by your immune system. They are often used by your immune system to find and fight foreign proteins (proteins not normally found in your body).
As you have Hashimoto’s are you on strictly gluten free diet?
If not get coeliac blood test done BEFORE trialing strictly gluten free diet 3-6 months minimum
Your currently under medicated and need dose increase in levothyroxine
Ft3 is currently only 19% through range
Most people when adequately treated will have Ft3 at least 60% through range
How much do you weigh in kilo approx
Use guidelines to get dose increase
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 all so much for taking the time to reply. Well looks like I’ll have to go back to GP and try to persuade them to increase my dose. I’ll def mention the bmj guidelines so thanks for signposting those. Re: gluten free - I was strictly gluten free for 4-5 months from November last year but as I didn’t really notice any improvement I’ve slipped a fair bit recently. I did have a coeliac test 3 years ago when I first saw the endo who diagnosed hashimotos but it was negative. Would I need another one? I thought a negative test was definitive…
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Eliminate Gluten. Even if you don’t have Hashimoto’s. Even if you have “no adverse reactions”. Eliminate gluten. There are no universal rules except this one.
That’s so interesting about gluten. The endo specialist I saw was totally scathing about going gluten free - although he wasn’t very helpful generally so I guess not a surprise he didn’t advise it. I did a food intolerance test (through a company listed on here), and results showed reactions to egg and yeast only. Will go back strictly gluten free and see if that helps.
Hi your GP should have checked your bloods yearly and if the bloods show you need to go up or down you will then be told. Your GP won't put you on a higher dose until bloods are done, so ask your surgery for a blood check.
My hair was also a problem so I'm taking 200 mcg Selenium supplement once per week. Not more than that because I figure I'm getting some from my diet but maybe not quite enough. I've been taking it since February and it seems my hair is staying on my head. When I vacuum clean the carpet cleaner brush isn't chockful of wound up hair anymore. And thebath tub plug hole doesn't need to be de-wigged as frequently. When my hair was falling
out like crazy, I had to remove huge amounts of hair from the plughole because the tub
was draining slowly. It was that bad.
Also selenium is required for the enzyme that cleaves an iodine off T4 to make it T3 which
is the active form of the hormone. I'll be getting blood testing done in July so I'm curious
to see how the fT3 is these days. Does the selenium make any difference?
I'm also taking a bit of zinc in a preparation that contains a very small amount of copper to
keep things in balance. 15 mg zinc + 1 mg copper.
Also retinol 25,000 IU once per week because as a hypo person, it's not likely I am good at
making retinol (vitamin A) from beta carotene. Plus there really isn't any source of retinol
in my diet since liver is off the menu due to my haemochromatosis gene. My ferritin
gets over range if I eat too much high iron food and I have to donate blood to get it down.
Plus vitamin D3, K2, B complex, and lutein for the eyes.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Help in understanding results.
Latest blood results advice please
Help interpreting blood results?
Help with blood results before speak to gp
