The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
Your TSH is almost at the top of it's range, far, far too high. Your FT4 is just 33% through range and your FT3 is a mere 19% through range, both far too low.
You need an immediate increase in your dose of Levo, 25mcg now and retest in 6-8 weeks. I imagine you will need at least one further increase, possibly more, always retesting 6-8 weeks after an increase to see where your levels then lie.
You need to speak to your GP and use the following to support your request for an increase:
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
How can blood tests be used to manage thyroid disorders?
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Occasionally patients only feel well if the TSH is below normal or suppressed. This is usually not harmful as long as it is not completely undetectable and/or the FT3 is clearly normal.
There are also certain patients who only feel better if the TSH is just above the reference range. Within the limits described above, it is recommended that patients and their supervising doctors set individual targets that are right for their particular circumstances.
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Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
You can obtain a copy of this article from Dionne at ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
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Your raised TPO antibodies do suggest autoimmune thyroid disease, known to patients as Hashimoto's which is where the thyroid is attacked and gradually destroyed.
Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It's essential to test Vit D, B12, Folate and Ferritin and address any problems. You are welcome to post these results, including reference ranges (plus units of measurement for Vit D and B12), for comment and suggestions for supplementing where necessary.
In addition to the dose increase SeasideSusie says you need (seconded by me!), please also see if the GP will check key nutrients - ferritin, folate, vit D and B12. A lot of us hypos are deficient and need supplementing - and you need these to be good to get properly well.
I've had some success with my GP by saying that these are the tests recommended by Thyroid UK - but be warned, the Vit D is the hardest to get on the NHS x
Hi sorry for late response the brand's I'm taking are accord 50mg and teva 25mg.Could you explain why I'd need coeliac before eliminating gluten? So much information out there saying gluten is bad for thyroid function. I spoke to a doc yesterday regarding my results, they couldn't be less interested and basically said there's lots of over reactions regarding thyroid disorders! She did agree to a fasted blood test to check cholesterol as according to the last doc I spoke to it was slightly raised, the doc yesterday said it wasn't but she'd book me in anyway because it's been requested by a previous doc! My blood pressure is at the top of normal, she dismissed that too. I asked if raised blood pressure and cholesterol are linked to thyroid she told me possibly but let's see what the results of my fasted blood test are before we discuss that. Sorry I'm ranting, thank you again for your advice it's proving valuable 😊
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
REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
Finally had a telephone consultation with a gp. Felt like I was being rushed and not able to fully explain my issues.She did agree to the increase of levo although she did say it goes on the weight of the patient so I had to quickly weigh myself first!? No interest in my antibody level she said they expect them to be high because of thyroid condition, I feel a bit defeated but will carry on trying to get a good result. I'll send for private testing in a few weeks and see if there are any changes.
Thank you all for your time, my eyes have been well and truly opened.
Edit * sorry , i realise this reply has turned into a rant because it makes me cross when Doctors keep having little jabs at peoples confidence ... *
"I feel a bit defeated.."
Don't let the appointment make you feel defeated.. you won . (a dose increase was required and you got one, which they wouldn't have done without you making it happen...) they just don't like admitting it. so they talk down to you .
How much did they increase dose by ?
You won't be surprised to learn that the GP is incorrect to say "it goes on weight" ..... it doesn't .
The guidelines for weight were designed to give them a rough idea of what a reasonable starting dose might be for a patient who need's starting on a full dose .. ie . after thyroidectomy. They were never designed to be used to adjust dose with.
NHS guidelines do not say adjust dose by weight.. they say adjust it by TSH .. and you pointed out your TSH was still too high.
But the Doctor wasn't able to admit you're right , so they give the weight reason to make them feel more in control again.
Probably , if you'd said "i need more according to my weight" , the same doctor would have said , "No, it goes on TSH, not weight" ... they just need to be more right than you.
It takes a strong character to admit a patient is right about something ,when you are the Doctor .
So whenever GP's make comments that make you feel like this in future , remind yourself it's a character flaw in THEM.
Same goes for some of the other little comment's, like ' there's a lot of over reaction to thyroid', 'your cholesterol wasn't slightly raised' etc ... all are just defence mechanism's for a GP who feels their authority is threatened.
There may well be a lot of 'over-reaction to thyroid' (and all sorts of other health conditions) in some quarters........ but unless she is saying YOU are over reacting . .( in which case she should have the guts to say so directly.. not imply it )....it's not relevant to her appointment with you ... you were trying to discuss published scientific papers from accepted medical sources giving good medical reasons for keeping TSH lower than yours was........Wanting to discuss your TSH in the light of known science, is NOT 'over reacting'
I let comment's like this from Gp's /chemists ( even receptionist's !) damage my belief in myself for years, before finding my way here and learning that there were good scientific reasons for the thing's i felt, and that it was not 'just a few people over reacting', but rather a significant % of the people treated for thyroid problems, all noticing the same things , independently of each other, who then eventually got to talk to each other having been told .. "oh, everyone else is fine, it's just you thinking 'x' is thyroid related" for years.
WE are the ones who are slowly defeating THEM .. with scientific evidence.. they just don't like admitting it.
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 again for the advice.I've had thyroid issues for 28 years firstly over active then it settled for a few years before going under active 23 years ago. I've always just done what the doc says but as I've got older (53) and discovered this forum it's lead me to a whole new level of looking after my health and for that I thank you all again for taking time to respond.
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