So on 50 mg of levo.
Results from private test.
Vit d 80
ferritin 80
Active b15 150
Folate 8
Tsh 2.17
Ft3 5.2, 3.1- 6.8
Ft4 16.6, 12-22
Antibodies low (not above levels previously antibodies indicated hashimotos)
Still constipated still got hair loss still got some edema...any advice shud I supplement more levo. I know gp won't increase it so will have to source myself. They believe it's within range so all good.
Tested fasting 830am
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
Ft4 is only 46% through range
Clearly you need 25mcg dose increase in levothyroxine
Print out these guidelines
Make an appointment and request 25mcg dose increase from GP
(Make sure you stay on same brand levothyroxine at each prescription and especially during increasing dose)
guidelines on dose levothyroxine by 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
NICE guidelines on full replacement dose
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.
Also here
cks.nice.org.uk/topics/hypo...
gp-update.co.uk/Latest-Upda...
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.
BMJ also clear on dose required
No levo taken the morning of the test. Taken before drinking or eating anything at 830am.
I'm worried that the gp won't increase. She only treated me to begin with because I threatened to treat myself as I was subclinical. Said that she would remove the medication if no change in symptoms. Said if the numbers improved but not the symptoms she would stop it as not worth life long commitment.
I was looking to source my own medication. But I'm on Teva from gp. Can't source the same anywhere.
Are you lactose intolerant that you’re on Teva brand
Teva upsets many people
Take guidelines to GP….request 25mcg dose increase
If she refuses….then either try different GP……see thyroid specialist endocrinologist
No Teva is the brand they have given me. Haven't noticed anything bad with it at all. Not lactose intolerant.
I've changed drs so many times. She's the first that has listened to me to even give me a trial and recognise I have hashis. I've also seen two endos one private and they didn't listen either.
I just read the pdf from the gp link you sent. It says if subclinical 5-10 trial for ,3- 6 months. If symptoms improve continue treatment if not discontinue treatment. This is what my GP said. I would worry saying symptoms aren't improving and she discontinues as this advises.
I was just over 5 when she agreed and had positive antibodies. She only agreed because I threatened to self medicate
Well don’t say symptoms aren’t improving….say symptoms are and that (as per clear guidelines) you would like to increase the dose levothyroxine up by 25mcg and retest in 6-8 weeks
But it doesn't say for subclinical to increase by 25...does it???
I thought the guidelines was if you where primary hypothyroid, not sub clinical like me?...if I say they are improving will she not say there is no point increasing it then since she was reluctant to give it to begin with?
It does cover sub clinical
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.
What article is that in I see it in your original message
Jump1
Presumably Medichecks test? Always please include all reference ranges to enable all results to be interpreted properly.
Vit d 80
If this is nmol/L and not ng/ml then 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. You might want to consider improving this, particularly as it's now winter and we can't make Vit D naturally during the winter months.
Do you already supplement? If so what do you take and the dose?
ferritin 80
Presumably range is 13-150 if you're female. If so then not too bad, some experts say the optimal level for thyroid function is 90-110ug/L.
Active b15 150
Range is either 37.5-188 or 25.1-165. Whichever it is your level is good. If you are supplementing with a separate B12 supplement you no longer need to.
Folate 8
Range is either 3.89-19.45 or 2.9-14.5. Whichever it it your level is a bit low. Would be better in double figures. Do you take a B Complex?
Tsh 2.17
Ft3 5.2, 3.1- 6.8
Ft4 16.6, 12-22
Antibodies low (not above levels previously antibodies indicated hashimotos)
If you've previously had raised antibodies confirming Hashimoto's then you still have Hashi's no matter what future results for antibodies are, they fluctuate so sometimes will be lower or higher than others but the Hashi's doesn't go away.
The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges.
When did you take your last dose of Levo before the test? Last dose should be 24 hours before test.
Your FT4 is 46% through range and your FT3 is 56.76% through range.
You could do with an increase in your Levo to reduce your TSH and increase your FT4. Your conversion, according to those results, looks good so your FT3 should increase as well as your FT4. You need an extra 25mcg now and retest in about 8 weeks.
Thank you. Sorry, yes I supplement everything but periodically. So I know from this to increase iron and vit d andnk again. I have folate tablets so will take some them again.
Test was done according to advice of this board, no medication 25 hrs before and no eating or drinking. At 830 in morning.
I'm worried the gp won't give me an increase and will take me off it.
So I was looking to purchase my own, but problem is none do the same brand.
yes I supplement everything but periodically.
It would be best to get all nutrients to optimal levels then reduce to a maintenance dose rather than stop and start again at some point.
So I know from this to increase iron
Have you done an iron panel? If not then I would suggest you do one before taking iron tablets. You have a fairly decent level of ferritin at 80, it's almost half way through range. If you take iron tablets without knowing your serum iron and saturation then your risk taking these far too high and too much iron is as bad as too little. If your serum iron is 55% through range and your saturation % is 35% through range you don't need iron tablets.
You can probably nudge up your ferritin level by eating iron rich foods, eg liver (maximum 200g per week due to it's high Vit A content) also liver pate, black pudding.
bda.uk.com/resource/iron-ri...
everydayhealth.com/pictures...
and vit d andnk again.
2,000-3,000iu should be about right through the winter. Test again at the end of March to check your level, you may be able to reduce as we start to make Vit D again naturally around April onwards. Don't forget that we need magnesium so that the body can convert D3 into it's active form.
I have folate tablets so will take some them again.
It would be better to take a B Complex to keep all the B vitamins in balance. My preference is Thorne Basic B, this contains 400mcg methylfolate which should improve your folate level (it raised mine from bottom of range to top of range in 2.5 months), the B12 it contains will maintain your B12 level and the other Bs will keep them all nicely in balance. If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.
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