Alli Your low ft3 and low ft4 are causing your symptoms. T3 is what all the cells use and to have good levels of T3 you need to have good levels of T4 and convert well.Firstly consider absorption. Has something changed in your gut or have you had antibiotics that would have stopped the levo being absorbed so well?
Vitamin levels are crucial for the body to work efficiently. Have you had ferritin, folate, B12 and vit D checked recently? Levels should be over halfway throw the ranges as a general guide.
As your levels are low I would see if you could increase levo by 12.5mcg or 25mcg daily with monitoring of bloods every 12 weeks or so so that you don't overmedicate if things go back to normal.
Sex hormones do also play a part in this but I have no idea about them!!!!!!
Alli Your low ft3 and low ft4 are causing your symptoms. T3 is what all the cells use and to have good levels of T3 you need to have good levels of T4 and convert well.Firstly consider absorption. Has something changed in your gut or have you had antibiotics that would have stopped the levo being absorbed so well? Nothing i can think of.
Vitamin levels are crucial for the body to work efficiently. Have you had ferritin, folate, B12 and vit D checked recently? Levels should be over halfway throw the ranges as a general guide. Yeah thats what i thought... my GP seems to think differently
As your levels are low I would see if you could increase levo by 12.5mcg or 25mcg daily with monitoring of bloods every 12 weeks or so so that you don't overmedicate if things go back to normal.
Sex hormones do also play a part in this but I have no idea about them!!!! Me either....
Well, doctors do like to blame menopause for all sorts of things but it's pretty clear that those results show that you are undermedicated and if your GP can't see that there is a big problem with your FT3 then they know nothing about treating hypothyroidism.
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.
Look at your results:
TSH -1.11mu/L (0.35-3.5) - not too bad but TSH is not a thyroid hormone (it's a pituitary hormone) nor does it give us our thyroid status. FT4 and FT3 are the thyroid hormones.
T4 -11.6 pmol/L (7.5-21.1) = 30.15% through range
FT3 -3.5pmol/lL (3.8-6.0) = below range at minus 13.64%
Your FT4 is too low and your FT3 is below range. It's low T3 that causes symptoms.
Quite simply you need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks. You may need further increases.
Ask your GP for an increase and to support this use the following information:
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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing ThyroidUK at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
A couple of questions:
1) Have you ever had thyroid antibodies tested, if so were they raised? This would tell you if your hypothyroid is autoimmune (known to patients as Hashimoto's).
2) Have you had key nutrients tested:
Vit D
12
Folate
Ferritin
These need to be optimal for thyroid hormone to work properly.
If they haven't been tested, ask GP to do them. If GP can't or wont do them we have recommended private labs so you can get them privately.
Always advised here, when having thyroid tests:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, (if taking NDT or T3 then last dose should be 8-12 hours before blood draw). Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
(These are patient to patient tips which we don't discuss with phlebotomists or doctors. )
Is this how you did your test?
Also, to avoid any problems with absorption of levo, do you take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected.
Do you take any other medication or supplements? These should be taken at least 2 hours away from Levo, some need 4 hours.
1) Have you ever had thyroid antibodies tested, if so were they raised? This would tell you if your hypothyroid is autoimmune (known to patients as Hashimoto's). Yes I have Hashimotos last antibody test was around 200.
2) Have you had key nutrients tested:
Vit D Low but im not sure of the number around 86 i think
B12 is 236 (187-883)
Folate 6.2 (2.7-15.0)
Ferritin 53 (23-300)
These need to be optimal for thyroid hormone to work properly.
If they haven't been tested, ask GP to do them. If GP can't or wont do them we have recommended private labs so you can get them privately.
Always advised here, when having thyroid tests:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH Yes always
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH. No nothing for at least 4 hrs prior
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, (if taking NDT or T3 then last dose should be 8-12 hours before blood draw). Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin). No nothing apart from my shampoo has biotin?
(These are patient to patient tips which we don't discuss with phlebotomists or doctors. )
Is this how you did your test?
Also, to avoid any problems with absorption of levo, do you take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Yes i take at 4am when i get up for the bathroom.
Do you take any other medication or supplements? These should be taken at least 2 hours away from Levo, some need 4 hours. no nothing
Yes I have Hashimotos last antibody test was around 200.
Are you on a gluten free diet? Some Hashi's patients find this helps. Also supplementing with selenium is said to help.
Hashi's can cause gut/absorption problems leading to low nutrient levels.
**
Vit D Low but im not sure of the number around 86 i think
This isn't too bad although 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.
If you would like to improve your level then to reach the recommended level from your current level, you could supplement with 2,000-3,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
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.
This is very low. I think the unit of measurement for this test is either pg/ml or ng/L (they are both the same). Many people with a level in the 300s have been found to need B12 injections so before considering self supplementing you should check for signs of B12 deficiency:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results. Doctors are supposed to be guided by symptoms rather than numbers where B12 is concerned.
**
Folate 6.2 (2.7-15.0)
This is on the low side although it isn't folate deficiency. Folate is recommended to be at least half way through range, so that would be around 9+ with that range. Folate rich foods may help, as can a good quality, bioavailable B Complex such as Thorne Basic B. Do not start this until further testing of B12 and any injections or supplements started.
When taking a B Complex we should leave this off for 3-7 days before any blood tests because it contains biotin, and this can cause false results when biotin is used in the testing procedure (which most labs do).
**
Ferritin 53 (23-300)
This is low. Ferritin is recommended to be half way through range although some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Your low nutrient levels wont be helping, optimal levels are needed for conversion of T4 to T3 and as we can see your FT3 is dire. So besides seeking an increase in your dose of Levo, you should optimise these key nutrients as well. A bit further down the line we can see how well (or not) you convert T4 to T3.
Do you always get same brand levothyroxine at each prescription. Yes always Wockhardt, i don't do well on some others.
Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after A good 4 hours before getting up when i get up for the bathroom in the middle of the night
No other medications or supplements within 2 hours - no nothing.
Some like HRT, magnesium, vitamin D, calcium at least 4 hours away from levothyroxine
Hi Sorry for the delay in replying. Been feeling so rough, its as much as i can do to get through my work...
I was taking B12 and a separate folate from recommendations on this page. I have stopped for a week now and am hoping my GP will test for B12 deficiency.
Could i ask,
If my TSH is 1.11mu/L (0.35-3.5) - about usual range for me
T4 -11.6 pmol/L (7.5-21.1) Is usually areound 16/18
FT3 -3.5pmol/lL (3.8-6.0) usually around 4.8
Does this make a case for suggesting a T3 addition? Just can't understand why my TSH would stay the same as usual and the T4/T3 are both a lot lower than usual (for me). My T3 was never this low even before i was medicated. Even when eventually all were in range I was still symptomatic. Obviously I take on board the vitamin advice too. and will be working to improve these.
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