I've been on Levo for 12 months. I will be talking to my GP next week who will probably say my results are fine. My main problem is digestive and lower abdominal bloating with constipation a major factor.
GP test results(only tests TSH and T4, tested 20th Oct)
TSH1.29 range (0.27-4.2)
T4 18.1 range (10-21)
Medichecks tested 20th Octber
TSH 1.34 range (0.27-4.2)
T3 4.4 range (3.1-6.8)
T4 20.7 range (12-22)
Ferritin 143 range (30-400)
Folate 5.2 range (2.9-14.5)
Vit B12 active 136 range(25.1 -165)
Vitamins D 77 range (50-200)
TGA 282 (0 -115)
TPA 342 (0-34)
Test done at 8.30 am on a fasting test. B12 med stopped a week before test. Coeliac test done in March negative and been gluten free diet since March. One bonus now is I dont get tired but stomach bloating is an issue. Any advice appreciated. I do take Vit D and B12 supplement daily and just started magnesium supplement although latest test showed magnesium 0.83 (range 0.7-1.0) I've also been on low fat diet for 3 months as Cholesterol in July was 6. Now reduced by diet to 5.2 without medication. Hoping trend continues.
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Are you currently taking a daily vitamin B complex, or just B12?
Folate levels likely to need improving with daily Vitamin B complex (remember to stop vitamin B complex a week before all blood tests as contains biotin)
Vitamin D likely better at least around 80nmol and around 100nmol maybe better
High cholesterol is linked to being under medicated/poor converter of Ft4 to Ft3
Likely to need addition of T3 prescribed alongside levothyroxine especially if you have seen benefits of going strictly gluten free diet
Email Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3
...NHS and Private
tukadmin@thyroiduk.org
Most people when adequately treated will have Ft3 at least 50-60% through range
Hello. Yes I always get the same Accord Levothyroxine at every prescription. I am currently taking 125 mcg of Levo since May. My weight of 14st 12 ribs suggests I should be on 150 mcg but my GP may not Increase next week because she has stated previous concerns of it may lead to heart problems or osteoporosis (not that I suffer with either and never have done)Is this true or what ?I am currently taking just vit B 12 but have read you highly recommend Igneus Vit B 12 comes. Can you advise where i can obtain it please.
I take Vit D tablet Do you recommend the Vit D+K spray instead as I have seen some people use on this forum. Maybe the spray version would be better for my digestion which seems so much slower through gut since been hypothyroid ? I feel so cold in hands and feet . I just feel if I can get my gut metabolism sorted I would be on the right path!!
Should I try these things before trying to obtain T3 supplement?
When I mentioned to GP previously to try T3 she said she cant prescribe nor does she know of any Endocrinologist in our area that would prescribe it. I will be speaking to GP next week re results. Any advice you can give is most welcome as always.
So. After discussion GP was happy with test results. I explained symptoms and GP agreed to increase dosage by 25mcgs levo to 150 mcg per day and retest in January. I have held off on dosage increase until now as I was had my Covid booster jab last week and had adverse reaction on previous jabs and didnt want to confuse any effect with levo increase. This is the first time my dosage of levo will be the amount recommended to body weight. I'm pleased my GP treats symptoms not results. Should I have concerns about 'hyper' symptoms appearing taking into account my latest readings posted on here 21 days ago.
I could try the alternate day dosage 125/150 and see how it goes. Then what retest after 6 to 8 weeks. What do I think. ?I trust your advice because you have done so well for me previously! Thankyou. I had my first increase to 150 this morning.
Thanks once again. Just what I was thinking. Just needed a bit of reassuring and so good to liaise with yourself and others on here. My energy levels are good at the moment . It's just the other one ir two symptoms that as you say need 'fine tuning'I think better to go up in stages than go too much and then have to reduce. I'll see how I go and keep you posted 👍
the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
20% Patients with no thyroid can not regain full health on just Levothyroxine
My main problem is digestive and lower abdominal bloating with constipation a major factor.
I expect you have low stomach acid. Most hypos do. When stomach acid is low, food stays in the stomach for too long, and starts to ferment, which causes bloating.
Cholesterol levels have little to do with diet, and nothing to do with fat. Fat and cholesterol are two entirely different substances and fat does not magically turn into cholesterol when you eat it.
Cholesterol is made in the liver, and the liver tries to keep an even level by making less when you eat more (cholesterol, not fat) and more when you eat less. However, when T3 is low, as yours is, the body cannot process cholesterol properly, and it tends to build up in the blood.
I would imagine your FT3 has risen slightly since you started thyroid hormone replacement, and that is why your cholesterol has dropped, nothing to do with diet. And, by the way, low/no-fat diets are dangerous. The body needs fat and all sorts of problems can arise if deprived of it.
Hi Greygoose. Thankyou for your input. My Cholesterol was regularly 4.5. It has only recently hit 6. Strangely enough my FT 3 has actually reduced slightly from 4.6 to 4.4. As previously highlighted I am a poor converter of T4 to T3. I have been reading a post you brilliantly commented on 8 months ago to Sunshine. You said that poor converters can benefit from Selinium supplement. I havnt tried this. Is it worth a try?? How much dosage. I'm also thinking to try the Vit D +k spray instead of Vit D tablet. My TSH last week was above 1. Previous reading was 0.59 . I felt improved when TSH below 1.
Even at 4.6, your FT3 was a tad low. But, changes in cholesterol levels are instantaneous. It takes time to build up.
Selenium might help you, who knows. You can only try it and see. But, there are so very many causes of poor conversion.
TSH itself has no effect on how you feel. When TSH rises, it is because your thyroid hormone levels have dropped. And vice versa. It is T3 that causes symptoms when it is too low or too high.
Edit: make that 'changes in cholesterol levels aren't instantaneous'! Sorry for the typo.
n any given day, we have between 1,100 and 1,700 milligrams of cholesterol in our body. 25% of that comes from our diet, and 75% is produced inside of our bodies by the liver. Much of the cholesterol that’s found in food can’t be absorbed by our bodies, and most of the cholesterol in our gut was first synthesized in body cells and ended up in the gut via the liver and gall bladder. The body tightly regulates the amount of cholesterol in the blood by controlling internal production; when cholesterol intake in the diet goes down, the body makes more. When cholesterol intake in the diet goes up, the body makes less. (obviously a good healthy thyroid is needed here)
This explains why well-designed cholesterol feeding studies (where they feed volunteers 2-4 eggs a day and measure their cholesterol) show that dietary cholesterol has very little impact on blood cholesterol levels in about 75% of the population. The remaining 25% of the population are referred to as “hyper-responders”. In this group, dietary cholesterol does modestly increase both LDL (“bad cholesterol” and HDL (“good cholesterol”), but it does not affect the ratio of LDL to HDL or increase the risk of heart disease.
If you are a hyper-responder (this is something you’ll need to determine with the help of a very good doctor or o our own lipid tests), I recommend following a Mediterranean Paleo-style diet, an approach that is lower in fat and higher in Paleo-friendly carbohydrates, rather than a ketogenic diet.
I for one am quite happy on keto and Intermitting fasting but it is hard if you have a thyroid problem.
Why? Insulin helps T4 convert to T3, and the keto diet does increase glucose levels once steady as there is very little insulin produced.
Numerous studies have shown an association between metabolic abnormalities (such as insulin resistance and diabetes) and a reduction in T4 to T3 conversion. In addition, such conditions are associated with increased shunting of T4 down the reverse T3 pathway. When insulin is elevated, D2 activity in the brain increases, resulting in the increased intra-pituitary conversion of T4 to T3. Again, this may account for a normal TSH, despite low T3 levels in the blood. For example, when researchers compared T3 levels in diabetic versus non-diabetic individuals, they found that those with diabetes had significantly lower T3 levels, despite having similar TSH and T4 readings. This means that despite the reduction in T3, TSH levels had not responded appropriately, likely to due to the effect of elevated insulin on deiodinase activity in the brain.
From this perspective, irregularities with glucose metabolism may both contribute to thyroid dysfunction and arise as a result of thyroid dysfunction. For this reason, I work very closely with my patients to ensure healthy blood glucose and insulin metabolism, not only to optimise thyroid function but to support their energy levels and weight loss goals as well.
Your TPA and TAG are quite high too and Graves and IBS are usually caused by autoimmune diseases, but if it is boating it can be down to low stomach acid and/or the gut in your bacteria (bad bacteria mostly but not all) immediately feeding of the carbohydrates (they love them) causing gas bloated, making you carbohydrate intolerant. That's ok, it is your body giving you a sign it isn't right. It can be the cause of your thyroid, and with your antibodies raised, you can perhaps lower this with a keto/paleo diet???
But if untreated SIBO, and especially a leaky gut causes inflammation, and that will affect the thyroid further.
Grave's is an autoimmune disease. IBS is a syndrome - Irritable Bowel Syndrome - a bunch of symptoms. Can be caused by Hash's or Grave's, but people without either can also have IBS.
yes, Gut Dysbiosis, SIBO, Gut Permeability, Stress, Non-Celiac Gluten Sensitivity and Other Food Intolerances lots of reasons. Finding the root cause is key
There's no such thing as 'good' and 'bad' cholesterol. LDL and HDL are actually the protein carriers of the cholesterol - that is what is tested when you have a blood test, not the cholesterol itself - and they're neither good nor bad, just have different jobs. The idea of 'good' and 'bad' was invented by Big Pharma to scare people into taking statins.
Yes i agree with you 100% but hear me out. Triglycerides are a bad thing. for heart disease indicators, not HDL or LDL cholesterol.
LDL particle number (LDL-P) (which is never tested) is a much more accurate predictor of cardiovascular disease risk than either LDL or total cholesterol.
LDL particles don’t just carry cholesterol; they also carry triglycerides, fat-soluble vitamins, and antioxidants. You can think of LDL as a taxi service that delivers important nutrients to the cells and tissues of the body.
As you might expect, there’s a limit to how much “stuff” that each LDL particle can carry. Each LDL particle has a certain number of cholesterol molecules and a certain number of triglycerides. As the number of triglycerides increases, the amount of cholesterol it can carry decreases, and the liver will have to make more LDL particles to carry a given amount of cholesterol around the body. This person will end up with a higher number of LDL particles.
Consider two hypothetical people. Both have an LDL cholesterol level of 130 mg/dL, but one has high triglycerides and the other has low triglycerides. The one with the high triglyceride level will need more LDL particles to transport that same amount of cholesterol around the body than the one with a low triglyceride level.
Thyroid hormone has multiple effects on the regulation of lipid production, absorption, and metabolism. It stimulates the expression of HMG-CoA reductase, which is an enzyme in the liver involved in the production of cholesterol. (As a side note, one way that statins work is by inhibiting the HMG-CoA reductase enzyme.) Thyroid hormone also increases the expression of LDL receptors on the surface of cells in the liver and in other tissues. In hypothyroidism, the number of receptors for LDL on cells will be decreased. This leads to reduced clearance of LDL from the blood and thus higher LDL levels.
Studies show that LDL particle number is higher in hypothyroidism, and that LDL particle number will decrease after treatment with thyroid hormone.
In order for cholesterol to be transported around the body in the blood, it has to be carried by special proteins called lipoproteins. These lipoproteins are classified according to their density; two of the most important in heart health and cardiovascular disease are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
I know this can get confusing quickly, so let me use an analogy to make this more clear. Imagine your bloodstream is like a highway. The lipoproteins are like cars that carry the cholesterol and fats around your body, and the cholesterol and fats are like passengers in the cars. Scientists used to believe that the number of passengers in the car (i.e. concentration of cholesterol in the LDL particle) is the driving factor in the development of heart disease. More recent studies, however, suggest that it’s the number of cars on the road (i.e. LDL particles) that matters most.
Coronary arteries are essentially hollow tubes, and the endothelium (lining) of the artery is very thin—only one cell deep. The blood, which carries lipoproteins like LDL, is in constant contact with the endothelial lining. So why does the LDL particle leave the blood, penetrate the endothelium and enter the artery wall? The answer is that it’s a gradient-driven process. Going back to our analogy, the more cars there are on the road at one time, the more likely it is that some of them will “crash” into the fragile lining of the artery. It’s not the number of passengers (cholesterol) the cars are carrying that is the determining factor, but the number of cars on the highway.
The significance of this in terms of determining your risk of heart disease is profound. When you go to the doctor to get your cholesterol tested, chances are he or she will measure your total, LDL and HDL cholesterol. This tells you the concentration of cholesterol (passengers) inside of the lipoproteins (cars), which is not the driving factor behind plaque formation and heart disease. Instead, what should be measured is the number of LDL particles in your blood.
LDL cholesterol levels and LDL particle number are often concordant (i.e. when one is high, the other is high, and vice versa), and this is probably why there is an association between LDL cholesterol and heart disease in observational studies. The elevated LDL cholesterol was more of a proxy marker for elevated LDL particle number in these cases. But here’s the kicker: they can also be discordant. In layperson’s terms, it’s possible to have normal or even low cholesterol, but a high number of LDL particles. If this person only has their cholesterol measured, and not their particle number, they will be falsely led to believe they’re at low risk for heart disease. Even worse, the patients that are the most likely to present with this pattern are among the highest risk patients: those with metabolic syndrome or full-fledged type 2 diabetes.
The more components of the metabolic syndrome that are present—such as abdominal obesity, hypertension, insulin resistance, high triglycerides and low HDL—the more likely it is that LDL particle number will be elevated
On the other hand, patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease. In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P. (3) Yet they will often be treated with statin drugs or other cholesterol lowering medications, because the clinician only looked at LDL-C and failed to measure LDL particle number.
THAT IS A BIG PHARMA FALSE INFORMATION COMES FROM TO PRESCRIBE YOU STATINS)
The purpose of this reply is not to suggest that LDL-P is the only risk factor that matters, or that other risk factors shouldn’t be taken into consideration. It is simply to point out that existing evidence suggests that LDL-P is a much better predictor of heart disease risk than LDL or total cholesterol and that it appears to be the only markers available to us now.
The fact that doctors only measure LDL_C is as bad as Doctors only looking at TSH and if you are lucky Free T4
In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P. (3) Yet they will often be treated with statin drugs or other cholesterol lowering medications, because the clinician only looked at LDL-C and failed to measure LDL particle number.
I really don't think that doctors even care about the numbers! All they want to do is prescribe statins. I have known a number of people with low 'cholesterol' whose doctors gave them statins 'just in case'! Which is bordering on criminal behaviour! Nearly killed a good friend of mine.
I have had 7 years of akathisia, and had a deep brain stimulation (often given to people with Parkinson's) which was tardive dystonia, which was permanent from a few pills from an SSRI. That s why i got into functional medicine.
The point of this second factor is that what we measure is important. Usually, doctors are only measuring total and LDL cholesterol, but what we really should be measuring as clinicians are things like LDL particle number, HDL particle number, and lipoprotein(a). These give us a much better idea of the overall risk.
But to point-blank say LDL has no risk to heart disease is wrong. I am just saying LDL concentrations have no relation to heart disease (which is what i said at the beginning), but the LDL Particle number IS, and we never have that test.
Just like for diabetes, we never test HOMA_IR test, but that is the most sensitive test there is but we don't measure insulin only glucose if we are lucky, or usually the HA1C test which can be years too before you know.
The only thing that is useful is the ratio of total-to-HDL cholesterol as well as non-HDL cholesterol, which is similar, are better predictors than total cholesterol or LDL cholesterol, but they are nowhere near as predictive as some of the newer markers like LDL particle number.
But, even if these things were tested - and I agree they should be - the odds are that doctors wouldn't even understand the results. They've never really understood thyroid testing. They are, in general, very, very bad at interpreting blood test results. So, I doubt it would make much difference to anything.
Yes, they are, and even worse when you think of the ranges involved being in the main wrong and far too wide (I am a believer when you start NTD, TSH just doesn't matter at all, the symptoms are).
Conventional medicine waits until you are unwell anyway unless the new fashionable drug is in town, and takes a lot of time to recover, if at all. It is only then they want you to take medication and keep unwell. Like insulin for diabetes II. It should be detected well before that. There is nothing like metformin to make you sick and keep taking insulin. Then you are a customer, often for life.
I agree. My GP has not mentioned Statins and I would be reluctant to go on them after seeing the debilitating effect they had on my mother. She was on statins for 10 years and caused her considerable muscular pain. In the end a private specialist advised her GP to take her off them quoting that quality of life would be improved. It was and she lived another11 years pain free until age 86. I have seen 1st hand too many people put on statins on the pretext of "preventative medication" unnecessary.
I've also been on low fat diet for 3 months as Cholesterol in July was 6.
Sadly, you've been led astray by dodgy propaganda coming from food companies and pharma companies.
To reduce cholesterol and triglycerides you need to reduce sugar and carbs intake, NOT fat and oils intake.
Low fat diets aren't actually healthy.
There are three macronutrients in the human diet - protein, fats/oils, and carbohydrates. Carbs aren't essential for life. Protein and fats are essential for life.
If you want to lose weight while eating a healthy diet this website might be of interest - and note that all the recipes are gluten-free :
Well you say that and I appreciate your input but I have reduced my level from 6 to 5.2 in 3 months. I always have a "balanced diet" and have reduced the carb intake. Weight reduction is 9 pounds in a steady reduction. What I am interested in is if the progressive reduction will continue. Well only time will tell. If not I may have to tweak the menu. I do the cooking and dont buy in processed foods. The word diet is vastly misinterpreted in my opinion.
When optimally and appropriately medicated, your cholesterol levels will naturally fall, and a balanced healthy diet is good ~ you've had excellent advice about this. I would say as you've got gut issues, which is common when hypo (as explained by others), then the BetterYou vitamin D+K2 spray would be a good way of avoiding absorption issues, and it certainly worked very well for me.
For the constipation, I use magnesium citrate and found it to be a life saver...constipation is miserable and can cause many other problems. There are many products available, so you could look into that...I used viridian powder, but other makes of mg citrate have also worked well. When taking Vit D, we should also take magnesium as it's a cofactor (like K2)and most people are deficient in magnesium these days anyway, due to mineral soil depletion, etc.
Organic golden linseed also helps with constipation, as it goes slimy once ingested, and aids transit of food through the gut...also has the bonus of being high in omega 3. Apple cider vinegar with the mother diluted in water (use a straw to avoid teeth) before food is good for raising low stomach acid, and fermented stuff like kefir and kimchi is good for helping to restore good gut bacteria, as is ensuring all B vits are optimal.
Thankyou so much for your input. There is some things here I will try and some I already do. Can I ask you about the magnesium citrate. Do you take this as a tablet. What I'm afraid of here is if it makes the bowel lazy. I do take Apple Cider (mother) regularly. I have also just started supplementing with Magnesium. Someone else has recommended the Vit D us K spray. Any advice on Magnesium welcome. I have to be careful due to only one kidney.
I understand your concern re making the bowel lazy, and for that reason I avoided many standard over the counter solutions. It certainly hasn't had that effect on me, and prior to taking advice from here, I had life long constipation, despite a good diet. I had never in my life experienced the urge to go, or ever had diarrhoea when others had a bug (and still haven't)...I only ever got the sickness, which I often had anyway, due to the awful blockages. I always thought it was just 'how I was' as it had always been there. Nothing helped, and I was hospitalised twice with it...as a child I nearly erroneously had my appendix removed! I seemed to have very poorly functioning peristalsis, and often it was difficult to eat properly, which of course made it worse.
After being diagnosed with hashimotos in the 1990's, (and other things) everything became much worse, and even on a high dose of levothyroxine (300mcg) all my muscles remained in a weakened state, which slowed down my peristalsis further, and I was back in hospital.
It wasn't until I was almost 60 and I started taking magnesium citrate that I experienced the urge (and utter joy) of going to the loo normally each day! Things really improved from there. The other stuff I mentioned helped slightly, but that was the real difference. I then found that I needed to take T3 only to prevent me from being hypo, as I had a resistance to thyroid hormones, and T4 didn't work for me, and so now I can go even without the mg citrate, but I still take it regularly along with other essential minerals.
So the short answer is no, I don't think it will make your peristalsis lazy, as it didn't have that effect on me, quite the opposite, and I started on the magnesium quite a while before I began taking the T3. I think if our guts aren't functional and clearing out toxic waste, we can't absorb our thyroid hormones or nutrients properly, which causes more problems and malabsorption.
I started out with viridian powder mixed with water or juice, but there are capsules available, (BioCare do them) which are convenient. NB I would avoid all tablet versions, as they're huge, chalky, and impossible to swallow. I personally think powder is a better option when constipation is an issue. We're all different of course, but I hope it works for you. Most of us with dysfunctional thyroids are low in mg and it should be taken anyway, so you may as well take the version that's considered best for thyroid, and best for constipation😊
I also meant to say, that due to having one kidney and therefore reduced ability for the clearing of excess vitamins, perhaps the powder would would be easier for controlling dosage...you could begin with small amounts until you reached a helpful level. My knowledge of kidneys is not great, but I looked into mg for a hypo friend with CKD a while ago, and although there wasn't much actual info available, (I'm also a poor researcher) I believe a symptom of mg accumulation is muscle weakness, but also that it doesn't directly affect the kidney...you could note any muscle changes, and reduce accordingly, but that may be complicated by being hypo.
Very low mg levels can also bring problems though, and it's difficult to get tested for...hopefully your nephrologist/GP tests creatinine clearance levels, etc. and you could post results for advice, allowing more knowledgeable members to advise 😊
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.
For your current level I'd be taking 3,000iu D3 daily. Then I'd retest around March/April to check level and adjust dose if necessary.
Tablets are the least absorbable form of D3. The two best forms are oil based softgels (fat is needed for D3 to be absorbed) and oral sprays. My preference is for Doctor's Best softgels which contain only D3 and extra virgin olive oil, nothing else. I don't consider sprays because they contain a lot of excipients and work out a lot more expensive. However, some people prefer sprays and because it's absorbed through the mucous membranes in the oral cavity rather than through the gut it works better for some.
Then you need magnesium for the body to convert D3 into it's usable form. 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.
You might be able to find an oil based softgel containing D3 plus K2-MK7, and the amount of K2-MK7 needed is 90-100mcg for up to 10,000iu D3. If not then there are oil based K2-MK7 sublingual liquids but if you can't find an oil based K2-MK7 then make sure you take a tablet or capsule with some dietary fat as it needs fat to be absorbed.
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