Hi, I’ve been on 50 mcg of Levo for 8 weeks. I’ve added photos of my last results and today’s result. I did not take Levo for two days and had fasted. Test done at 7am. I’ve just found out I have the faulty MTHFR gene but my thyroid antibodies are fine. I’d be grateful to know if my T3 and T4 are in the correct range. My TSH has gone down by quite a lot and I’m definitely feeling more energetic and less cold etc.
New Thyroid Results : Hi, I’ve been on 50 mcg of... - Thyroid UK
New Thyroid Results
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Surrey17
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SeasideSusieRemembering
Surrey17
Why did you not take our Levo for 2 days? We should take last dose of Levo 24 hours before the test. Your results show a false low FT4 and possibly low FT3 due to leaving so long.
Your TSH is unexpectedly high for your FT4/FT3 results but it is still early days. Your TSH shows you need a dose increase which is normal about 6 weeks after initiating Levo.
Is your Levo prescribed? Your GP should do his own test and increase your Levo by 25mcg at this stage.
Vit D is recommended too be 100-150nmol/L.
B12 of 365pmol/L = 495pg/ml, this is on the low side, should be a minimum of 550pg/ml and would be better around 900-1000.
Folate would be better at least half way through range, ie 35 plus
Do you take any supplements.
No ferritin result?
So sorry, my photo was misleading. I didn’t realise the new one didn’t show. The TSH of 6.02 was 8 weeks ago. Today’s TSH was 2.97. Does that change things in terms of needing a greater dose? I’m confused by the T3 and T4. Thanks so much.
New results
OK, so your TSH is going in the right direction. The aim of a treated hypo patient on Levo only is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. So you need an increase in dose which should lower your TSH and increase your FT4 and your FT3 may increase too.
Am I right in thinking that you are self medicating?
Thanks so much. No, I’m under the care of my GP. I was delighted they agreed to treat me as I had hypo symptoms but I know many GPS don’t treat if TSH is under 10. As I’ve only been on Levo 8 weeks, will they suggest I remain on 50 mcg as it’s going in the right direction? May I ask what my t3 and t4 results need to be in terms of numbers? I seem to find these levels (as in what is considered upper range) the most confusing. I really appreciate your help.
OK, I just wondered why you only have private tests. Have you had a GP test, it's normal for GP to retest a couple of months after starting Levo then increase dose.
TSH should be below 2, and can be lower, according to GP online:
gponline.com/endocrinology-...
Cardiovascular changes in hypothyroidism
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Upper part of range would be around 60% plus, wherever you need the levels to be to feel well, so with FT4 range of 12-22 that would be 18 or more and with FT3 range of 3.1-6.8 that would maybe be around 5.5, but everyone has their own sweet spot.
You do need optimal nutrient levels for thyroid hormone to work properly though.
Great, thank you. My GP test came back with TSH of 4.73 and they didn’t want to prescribe. I did my own test as seeing a functional nutritionist and it came back as 6.03. I just did my own test out of interest but I’ll ask for another test. I’m trying to increase all my nutrient levels and I’m definitely feeling better. I’ve recently had a hysterectomy due to several things, including chronically low ferritin so I think things are improving. Thank you so much.
SlowDragonAdministrator
Which brand of levothyroxine are you currently taking
Many people find different brands are not interchangeable
Watch out for brand change with increasing dose
Teva is only brand that makes 75mcg tablets…..best avoided unless lactose intolerant
Thank you. I don’t think my gp is going to want to increase? Not sure how they view it if my TSH has responded so well in two months?
TSH is far too high for someone on levothyroxine
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
Graph showing TSH in healthy population
web.archive.org/web/2004060...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"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)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
please email Dionne at
tukadmin@thyroiduk.org
Thank you. Will have a look at all of this.
Ft4 is only 33% through range Ft3 43% through range
Helpful calculator for working out percentage through range
Most people when adequately treated will have Ft4 at least 60% through range and Ft3 similar
ALWAYS test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Thanks so much. Do you think I should be upping my dose then from the results? Or is that a question you’re not able to answer. Apologies if so.
Yes, definitely
Perhaps initially 50mcg an£ 75mcg alternate days for few weeks before going to 75mcg daily
Which brand of levothyroxine are you currently taking
I’m on Accord?
Ok
Accord only make 50mcg and 100mcg tablets
So to increase to 75mcg request GP prescribe extra 50mcg tablets and then cut them in half
Get weekly pill dispenser
Accord is also boxed as Almus via Boots and Northstar via Lloyds
BEWARE Northstar 25mcg is Teva
Great, thanks so much. Are gps normally amenable to increases if I provide information?
Under line that levothyroxine is helping and that “as per guidelines “ can you now increase dose levothyroxine to 75mcg and repeat blood test in 2-4 months
SlowDragonAdministrator
Approx how much do you weigh in kilo
Dose levothyroxine should be increased SLOWLY upwards in 25mcg steps until TSH is ALWAYS under 2
Most people when adequately treated will have TSH around or under one
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
I have lipoedema so am heavier than I look due to density of tissue. I have EDS and just found out I have the faulty MTHFR gene and SIBO. Everything seems to be related.
EDS and autoimmune thyroid disease frequently linked
Getting coeliac blood test done BEFORE considering trial on strictly gluten free diet
Many other EDS members find strictly gluten free diet is astonishing improvement
You don’t need to be coeliac
But best to test and rule out coeliac FIRST before trialing GF
That’s interesting, I’m definitely not coeliac as have had endoscopy and blood tests. My thyroid antibodies seem fine as I thought it might be hashimotos? Might have to trial!
Have you had ultrasound scan of thyroid?
20% of Hashimoto's patients never have raised antibodies
healthunlocked.com/thyroidu...
Paul Robson on atrophied thyroid - especially if no TPO antibodies
SIBO and low vitamin levels are directly linked to low stomach was result of being hypothyroid
Essential to improve and maintain OPTIMAL vitamin levels as this helps tolerate increasing Levothyroxine quicker
Optimal vitamin D at least around 80nmol and around 100nmol may be better
Folate and ferritin at least half way through range
Serum B12 at least over 500
What vitamin supplements are you currently taking
What was ferritin result?
Low stomach acid can be a very common hypothyroid issue especially with autoimmune thyroid disease
Thousands of posts on here about low stomach acid
healthunlocked.com/search/p...
Web links re low stomach acid and reflux and hypothyroidism
nutritionjersey.com/high-or...
articles.mercola.com/sites/...
thyroidpharmacist.com/artic...
stopthethyroidmadness.com/s...
How to test stomach acid
healthygut.com/articles/3-t...
naturalendocrinesolutions.c...
meraki-nutrition.co.uk/indi...
huffingtonpost.co.uk/laura-...
lispine.com/blog/10-telling...
Protect your teeth if using ACV with mother
SIBO and hypothyroidism
thyroiduk.org/related-condi...
kresserinstitute.com/hypoth...
Lipoedema linked to being hypothyroid
pubmed.ncbi.nlm.nih.gov/317...
Thank you so much for finding all this information. I need to digest it all but clearly it’s all linked. I’m taking pure encapsulations ONE vitamin with iron as well as using patch MD iron. Also high dose of omega 3 as I’m rock bottom and vitamin D drops high strength, 5 drops a day. Also started taking digestive enzymes before each meal. Haven’t had my thyroid scanned. Wonder if my GP will agree to have it done.
Ultrasound £150 privately if GP won’t
Iron supplements should only be taken if FULL iron panel shows low iron
When were iron and ferritin levels tested
Medichecks do full iron panel test
medichecks.com/products/iro...
I can’t seem to add photos. It was late august, so three months ago.
August
So yes low
Read many posts and replies by humanbean on iron and ferritin
Important to retest 3-4 times year when supplementing iron
Will do that, thank you.
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