Asking for my son who started levo 8 weeks ago tsh 1 t4 only 14

[Timetraveler67]

My son just got his results back after 8 weeks on 100mg of levo although his tsh has dropped to 1 his t4 at 14 Is only just in range - could this indicate a problem? Or will things balance out as he continues? He said he feels well but he is worried about the t4 please would you give him some advice really appreciate thank you

[SeasideSusie Remembering]

Timetraveler67

It's early days, only 8 weeks on Levo, hormone levels are probably still stabilising but it's a good start that he is feeling better.

His pituitary is responding to the Levo, ie it recognises that there is thyroid hormone so the signal - TSH - is no longer high, it has lowered, so the pituitary is quite satisfied. However; how low in range is his FT4 of 14? Is the range 12-22? His ultimate aim is for FT4 to be in the upper part of it's range, and once on Levo it doesn't matter if TSH goes low, it's the actual hormone levels that are important.

Has his GP arranged for further testing? If not your son could ask to be tested again in, say, a further 6 weeks, that will then give a good indication of where his FT4 has settled.

If GP isn't going to do any further testing then he could do a MonitorMyHealth fingerprick test for TSH, FT4 and FT3, this will give a very good overall picture as it will show how well he is converting the T4 to T3:

thyroiduk.org/help-and-supp...

How is he doing with his Vit D? Is he taking the supplements and is the GP going to retest?

How much D3 is he taking? Did he having loading doses totalling 300,000iu or was he given just 800iu or 1,600iu?

At some point he will have to buy his own. His GP may be satisfied just to get him into the adequate category which is >50; however, the Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L so this should be his aim.

There are important cofactors when taking D3 that the GP wont know about and we always suggest to take here - magnesium and Vit K2-MK7.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

Something to keep in mind and introduce maybe a little further down the line.

Is he keeping his Levo well away from his anti-depressants, and 4 hours away from the Vit D?

Did he sort out his exemption certificate for free prescriptions?

[Timetraveler67 in reply to SeasideSusie]

Thank you for replying to me, I will tell him everything when I next see him. He has a telephone appointment tomorrow (Thursday) I hope Dr Re tests him in 6 weeks again. He is taking his levo at 6am and takes everything else lunch time. He wants to know (last time we spoke) if his tsh will eventually come down to 0 ? If his T4 stays low after another 6 weeks does this indicate another problem? Anyway I will show him your reply tomorrow and I know he will be very grateful for the advice. I have told him already that I will pay to get him private T3 tests in a few weeks - I hope that’s not too early. Thank you for or helping

[SeasideSusie Remembering in reply to Timetraveler67]

Timetraveler67

He wants to know (last time we spoke) if his tsh will eventually come down to 0 ?

I've never seen a result of zero actually. Mine is suppressed (suppressed is <0.1) and depending on how low the machine measures mine comes back at 0.01 or 0.02 or <0.01 or <0.02 and even <0.005 depending on whether it's my GP or a private test. TSH is a signal from the pituitary. The pituitary checks to see if there is enough thyroid hormone, if there isn't it sends the signal - TSH (Thyroid Stimulating Hormone) to the thyroid to produce some and the TSH will be high. If the pituitary detects there's enough thyroid hormone the TSH will be low. Once on thyroid hormone replacement the TSH is practically irrelevant, it's the FT4 and FT3 that are the thyroid hormones and tell us what we need to know, so we're looking for both of those to be in the upper part of their ranges when optimally medicated.

If his T4 stays low after another 6 weeks does this indicate another problem?

It will mean that he is not yet on enough Levo and will need to continue increasing until FT4 is about 70% plus through it's range, so if the range is 12-22 then you'd be looking at 19 plus. You'd also be looking for FT3 to be over half way through range, possibly around 60% plus. Those levels are a generalisation, we all have our own particular sweet spot where we feel well.

I have told him already that I will pay to get him private T3 tests in a few weeks

Don't test FT3 on it's own, it needs to be done at the same time as TSH and FT4 from the same blood draw.

[Timetraveler67 in reply to SeasideSusie]

He told me the range is 9-23 for the T4 tests he had. His hair is falling out in clumps, is this the levo? If it is will it come back? He’s in a rock band and his long hair plays the part. Thanks seaside susie these are the questions he is asking and is grateful for your advice.

[SeasideSusie Remembering in reply to Timetraveler67]

Timetraveler67

He told me the range is 9-23 for the T4 tests he had

OK, so we have FT4: 14 (9-23) which is 35.71% through range

(calculator here: chorobytarczycy.eu/kalkulator )

He would be looking to aim for around 19 plus with that range so a fair way to go, he needs 25mcg increases every 6-8 weeks. Did he get an increase after this latest test? He is probably looking at 150mcg, 175mcg, maybe more before he is optimally medicated.

How much does he weigh?

One way of starting Levo is by weight - 1.6mcg Levo per 1 kg of weight. The end dose is not set in stone by weight, it's just a way of starting Levo and adjusting as necessary. This method doesn't suit everyone, some are better starting lower and building up gradually.

Sometimes doctors are satisfied when the results are in range, regardless of where in range, they seem to have no understanding of "optimal" but that's what we need to aim for. And, of course, most doctors are TSH obsessed and this is all they look at as as long as that's in range they are satisfied regardless of how the patient feels.

What brand of Levo is he on?

Levo can contribute to hairloss, but so can low ferritin and/or low iron. Has he had nutrients tested? If not maybe this will be a good step to take - Vit D, B12, Folate and Ferritin.

[Timetraveler67]

He is around 17 stone, he talks to his Dr this afternoon about the latest results which he got Sent to his phone by the app he has a few days ago. This is his first test since starting levo 8 weeks ago. I will ask him if he has been tested for the vitamins etc when he rings me later. I do know he takes multi vitamin tablets and has a fairly good diet. He’s on mercury pharma and has no side effects but does get hot flushes but I think that’s normal? Is there a point when the hair loss will stop when being on levo? Sorry all the questions, he’s ringing me later to tell me what his Dr says and I can tell him everything you’ve kindly said. Thank you again

[SeasideSusie Remembering]

Timetraveler67

17 stone is around 108 kilos, so if his GP had started him on dose by weight that would have been 173mcg Levo (175 is nearest). That would have been rather a shock to the system, which is why I think it's probably best to start low and increase gradually, but it does illustrate that this might be a target dose for him.

If he wants a reference for dose by weight it's here:

nice.org.uk/guidance/ng145/...

1.3.6 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.

1.3.7 Consider starting levothyroxine at a dosage of 25 to 50 micrograms per day with titration for adults aged 65 and over and adults with a history of cardiovascular disease.

I will ask him if he has been tested for the vitamins etc when he rings me later.

He probably wont have been, it's not standard, but he could say that he has been in touch with ThyroidUK - the charity recommended by the NHS regarding thyroid conditions - (but don't mention the internet or forum, they don't like that!) who suggest that it's important to test Vit D, B12, Folate and Ferritin.

I do know he takes multi vitamin tablets

Multivitamins aren't recommended here for a variety of reasons.

They do not contain enough of anything to help with low levels or deficiencies.

They tend to contain the cheapest, wrong form and least absorbably of active ingredients.

They usually contain things we must test for first before supplementing, eg iron, calcium, Vit D, iodine.

If it contains iron then that will affect the absorption of everything else as iron should be taken 2 hours away from any other supplement or medication.

If it contains Vit C and B12 then the Vit C may keep the body from absorbing B12.

Calcium should not be taken at the same time as iron, zinc or magnesium.

Fat soluble vitamins - A, D, E, K - taken together they compete for fat for absorption, best taken away from each other.

So it's best to ditch the Multivitamin and test the key nutrients then supplement where necessary at the appropriate dose.

He’s on mercury pharma and has no side effects but does get hot flushes but I think that’s normal?

I believe Mercury Pharma is well tolerated by members generally. The hot flushes I don't know, but I believe you can get hot flushes with low B12, particularly night sweats.

Is there a point when the hair loss will stop when being on levo?

I don't know, it's something I haven't experienced. I think we hear more about hair loss with low ferritin/iron so I think it's important to get these checked.

[Timetraveler67]

His Dr said she was happy with his results as he’s now in range, however she did give him the option to increase if he wanted to by 25mg so he said he would increase and will be on 125mg starting tomorrow. Even I didn’t really know about the multi vitamins- I will explain everything to him when we meet face to face over the weekend I really can’t thank you enough you’ve helped so much.