I have been feeling very unwell for about 3 weeks with dizziness, headaches, fatigue, weakness and in the last few days twitching muscles and blurry vision. Having hypothyroidism, I thought my levels must be out however my recent blood test (last week) suggests not:
TSH: 1.48 (0.30 - 4.20)
Ferritin: 19.9 (10-200)
Having researched my symptoms I wondered about a vitamin B12 deficiency? My Dr dismissed this possibility due to my Ferritin level being ok. Is she right? Does anyone have any idea what could be causing my symptoms and making me feel so unwell? Thanks so much.
(Currently taking 100mg of Teva Levothyroxine. Have been on this brand for over 12 months)
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ctw0410
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Do you have the laboratory reference ranges for your blood tests? Because if it’s the usual range for ferritin, that level is NOT ok. And ferritin and B12 aren’t related so your doctor said something really quite odd there!
Are you on levothyroxine? If so, how much? Did your doctor do any other thyroid tests, e.g., FT4 and FT3?
Guidelines on dose by weight is approx 1.6mcg Levo per kilo of your 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.
Ferritin looks extremely low. Any ferritin result under 30, GP should be doing full iron panel test for anaemia
Please add ranges on results
How much levothyroxine are you currently taking
Do you always get same brand levothyroxine at each prescription
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Iron and ferritin often low when hypothyroid, especially if under medicated
See/contact GP and request they do full iron panel test for anaemia
Meanwhile
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
hello i would ask your doctor to do some vitiman s test i had vitiman d3 leavel 15 i was so ill . i now take vitiman d3 every day 1000 iu per had . you need to have some vitiman test hope you feel better soon .
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Vitamin b12 deficiency 
Vitamin/mineral levels
Vitamin D Deficiency 
Vitamin deficiency 
