Help!!
I’m just a big angry mess. Feel okish otherwise managing to work 3 x 12 hour shifts and my home life, 3 kids etc but I’m a short tempered furious mess. My latest bloods marked normal by my gp were
T4 11.5 (10-25)
Tsh 0.29 (0.30-3.30)
T3 2.6 (2.0-6.0)
My dr only prescribes levo won’t refer me back to an endo as I’m “normal” I’ve one surgery in my town, so changing drs isn’t an option. All other stuff ferritin b12 etc all normal. What can I do! I’m also the biggest I’ve ever been 
FT4 and FT3 are very low which is very likely to cause symptomsWhat dose of hormone are you taking....if any?
"Normal " is meaningless your dose needs to be optimal i.e such that it makes you feel well.
Your doc is dosing by TSH which is rediculous.
FT3 refers to the active thyroid hormone T3 and is the significant reading. Yours is low and indicates hypothyroidism/undermedication, as do your symptoms.
Likewise are your nutrients optimal rather than 'normal'.
Yeah all others were fine, I’m on thyroxine 200mcg
On 200mcg thyroxine your FT4 is very lowIt looks as if it is not reaching the serum adequately from the stomach...see SlowDragon's response re Hashimotos and leaky gut.
Are you gluten free?
Your doctor should realise this and refer you to an endo.
You should not be left feeling like this
On levothyroxine the aim is to increase the dose slowly upwards in 25mcg steps until Ft3 is at least 50% through range, usually on just levothyroxine Ft4 will need to be a bit higher, around 60-80% through range
How much levothyroxine are you currently taking
Do you always get same brand levothyroxine at each prescription
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Assuming yes…..
Currently Ft4 is only 10% through range so you are extremely under medicated
Ft3 is only slightly better at 15% through range
Helpful calculator for working out percentage through range
How much do you weigh in kilo approx
Guidelines on dose by weight is 1.6mcg levothyroxine per kilo of your weight.
Can be useful ammunition to get dose levothyroxine increased
See GP for 25mcg dose increase in levothyroxine
If they refuse you will need to see thyroid specialist endocrinologist
ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12
Extremely common to have low vitamin levels, especially when under medicated
When were vitamin levels last tested
What vitamin supplements are you currently taking
I weigh about 12st 7 just now, I take vit d, selium and 200mcg of levo
So your weight is approx 79 kilo
So your dose is well over guidelines of 1.6mcg per kilo
This suggests poor absorption, possibly lactose intolerant, gluten intolerant, H Pylori or other malabsorption issues
Perhaps trying liquid levothyroxine is something to consider
GP unlikely to initiate. Would need to see endocrinologist
Research into dose by weight and malabsorption issues and possible advantages of liquid levothyroxine
frontiersin.org/articles/10...
Malabsorption issues
As you have Hashimoto’s are you on absolutely strictly gluten free diet or dairy free diet
Can see you have ongoing digestive and sinus issues
With Hashimoto’s we are frequently gluten intolerant, not coeliac
It’s ALWAYS worth trying strictly gluten free diet
Lactose intolerance is also EXTREMELY common…..
Especially if gluten intolerant
Sometimes lactose intolerance improves after year or two on strictly gluten free diet
Lactose intolerance frequently results in needing higher dose levothyroxine than typical
ncbi.nlm.nih.gov/pubmed/240...
Lactose intolerance was diagnosed in 75.9 % of the patients with HT
read.qxmd.com/read/24796930...
These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.
Poor gut function with Hashimoto’s 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
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
lloydspharmacy.com/products...
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
ncbi.nlm.nih.gov/pubmed/296...
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
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
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
restartmed.com/hashimotos-g...
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.
hypothyroidmom.com/how-to-l...
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.
Hello Carrie
Has your doctor actually seen this results or is s/he working from just a TSH blood test ?
Your T4 is just around 10% through with your T3 at around 15% slightly higher but T3 will be maintained over T4 when results are so low.
We generally feel at our best when our t4 is in the top quadrant of the range as this should give a good level of T3 but you are very undermedicated, though your TSH shows overmedication if looked at in isolation.
Obviously optimal vitamins and minerals are needed to convert the T4 into T3 but you are not on sufficient thyroid hormone replacement, or maybe , the T4 isn't be absorbed well and you could have stomach issues and there is liquid T4 if you have known stomach issues.
I see you are with Hashimoto's so presume you have removed the " usual suspects " from your food like gluten, wheat, and dairy, and have you been tested for celiac ?
Maybe a referral to an endocrinologist might help you get a better handle on this as you must be feeling awful and to be told you are normal is not acceptable, is there another doctor in this surgery who might be better able to interpret and read a blood test result.
So I did a econsult over the weekend and my dr emailed me back just saying he can increase my thyroxine. I’m already on 200mcg said he won’t refer me as the endo will just prescribe the same.
Hey there again ;
You are on quite a large dose of T4 and I think that you are likely having issues absorbing this medication.
This can happen especially with people who have Hashimoto's as there can be what's called " leaky gut " where the stomach lining isn't able to well absorb some medications and the essential key vitamins and minerals of ferritin, folate, B12 and vitamin D that are needed to be maintained at optimal levels to be able to convert the T4 into T3.
It would be useful to get these vitamins and minerals checked out and post these results and ranges back up on here for considered opinion.
Unfortunately some doctors are not knowledgeable on vitamins and minerals and the little understanding of the importance of keeping these at good high levels in the ranges to help the T4 work well and convert to T3.
Please read above SlowDragon's replies above :
I know it's a lot to take in but I do think it's worth asking to try liquid T4 and if that needs a referral to an endocrinologist, so what, do it, as s/he might also be more knowledgeable on how Hashimoto's AI disease damages the body and better informed on how to treat than your current doctor.
Yes dr seen the results and concluded satisfactory
optimal thyroid levels
Follow on from visit to hospital thread. 
T3 and cortisol issues? 
Hashimotos: Constant dizzy/ feint feeling
Graves rage
