My serum TSH is 0.29 - it says normal range is 0.35-4.94. The doctor says adequate thyroxine dose. I take 100 micrograms of Levothyroxine alternating with 125 every other day. I tried 125 every day and got palpatations.
I suffer from constipation and was wondering if it could be caused by low TSH or is just age related (I am writing this on behalf of my mum who is 86).
Thank you
Electricbrain
Low TSH doesn't cause constipation. If she is undermedicated then one of the symptoms of hypothyroidism is constipation but just testing TSH alone isn't adequate, it's a pituitary hormone not a thyroid hormone. The thyroid hormones are FT4 and FT3 and it's the FT3 result that tells us if we are adequately medicated, along with whether or not we have any symptoms. Unfortunately FT3 is rarely tested.
Was just TSH done or did they include FT4 and/or FT3?
Her GP should be able to help with something for the constipation although some members may have some suggestions that don't include prescription medication.
Thanks very much for your reply.
There is a reading for T4 - is that the same as FT4? It was at 16.90 pmol/L. (normal range 9.01-19.05) - so looks ok.
Thanks again.
Just testing TSH and Ft4 is inadequate
She needs TSH, Ft4 and Ft3 tested together
Frequently that means testing privately these days
Suggest you get FULL thyroid and vitamin testing done in 2-3 months after she starts on improving low vitamin levels
Low vitamin levels suggests either under or poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone)
For good conversion of Ft4 to Ft3 we need GOOD vitamin levels
Low vitamin levels common on levothyroxine
Low vitamin levels are more common as we get older too
Folate and Ferritin at least half way through range
Serum B12 at least over 500
Vitamin D at least around 80nmol and around 100nmol maybe better
Just testing TSH is completely inadequate
Low vitamin levels are very common on just levothyroxine
Low vitamin levels are also EXTREMELY common as we get older
When did your Mum last have vitamin D, folate, B12 and ferritin levels tested
Is she currently taking any vitamin supplements
In levothyroxine we need optimal vitamin levels
Request GP test vitamin levels ….or get FULL Thyroid and vitamin testing done privately
Does she always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
No other medications or supplements within 2 hours
Definitely taking levothyroxine everyday?
Weekly pill dispenser helps
Does she always get same brand levothyroxine at each prescription
Many people find different brands are not interchangeable
Only test after minimum 6-8 weeks on constant unchanging dose and brand of levothyroxine
Always test early morning and last dose levothyroxine 24 hours before test
Thanks very much for your detailed reply.
T4 was also listed as 16.90
Yes she is careful to take every day and wait an hour. I check her pills in a weekly dispenser so should be ok.
Good idea about getting vitamin levels test - a full blood count was done and was normal.
I will ask if can have a B12 test and the others. Although she does take a multivitamin with minerals - so in theory levels should be ok. Or if not get a private test done.
Remember to stop taking any supplements that contain biotin a week before ALL blood tests
Multivitamins never recommended on here. Usually contain too little to rectify any deficiencies.
Most contain iodine not recommended for anyone on levothyroxine, unless tested and found deficient
Typically better to supplement separate vitamins. Usually vitamin D and vitamin B complex. Sometimes need B12 as well. If anaemic might need iron supplements
Always test early morning (9am latest ideally) and last dose levothyroxine 24 hours before test. If testing iron/ferritin it should be a fasting test …..so nothing apart from water before test
Usual advice is test first, and then only supplement what’s necessary
She has had an iron blood test - and all ok B12, vitamin D, apart from Ferritin which is 11. She has got to talk to the doctors.
Please add actual vitamin D, B12 and folate results and ranges ….within range is not necessarily adequate
Ferritin is extremely low and deficient and she needs full iron panel test for anaemia
Does she eat red meat and liver?
cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
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
List of iron rich foods
Links about iron and ferritin
An article that explains why Low ferritin and low thyroid levels are often linked
preventmiscarriage.com/iron...
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
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
healthunlocked.com/thyroidu...
restartmed.com/hypothyroidi...
Post discussing just how long it can take to raise low ferritin
healthunlocked.com/thyroidu...
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Medichecks iron panel test
medichecks.com/products/iro...
Low Iron and thyroid link
healthunlocked.com/thyroidu...
Posts discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Chicken livers if iron is good, but ferritin low
healthunlocked.com/thyroidu...
Test results B12 377 pg/mL (normal range 187-883)Serum Folate 18.8 ng/mL (normal range 3.1-20.5)
25 Hydroxy Vitamin D (total) 90.4 nmol/L (normal range 50-150)
Regarding iron - no she is vegetarian.
A full blood count was done which they say is normal.
I will have a look through the links when I have time.
Thanks
B12 is too low
As a vegetarian she will need to supplement B12 continuously
academic.oup.com/nutritionr...
The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency. Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3
As vegetarian highly Likely to need iron supplements too
Just testing ferritin is totally inadequate
Essential to do a full iron panel test before starting any iron supplements
If supplementing iron retest full iron panel 2-4 times a year
It’s possible to have high iron and low ferritin
Ferritin needs improving to at least half way through range
Thanks for your latest reply. I have asked the doctors to start her on iron tablets again. Also I will get some B12 pills to supplement as well.
There were some other results IRON STUDIES:
serum iron level 29.1 umol/L (normal range 4.4 - 27.9)
serum transferrin 3.74 g/L (normal range 2.0 - 3.2)
Transferrin saturation index 30% (normal range 0-55).
Thank you
apart from Ferritin which is 11.
There were some other results IRON STUDIES:
serum iron level 29.1 umol/L (normal range 4.4 - 27.9)
serum transferrin 3.74 g/L (normal range 2.0 - 3.2)
Transferrin saturation index 30% (normal range 0-55).
Her results suggest she probably does NOT need iron supplements
Will flag up to SeasideSusie and humanbean
Can I ask when your mum takes her thyroxine medication? Reason I ask is that i was advised to take mine first thing in the morning and an hour before I had my breakfast or anything with milk. I also take the rest of my medication at this time too, some say to wait at least 3 hours before taking other medications but for me I need to wait a minimum of an hour. I've not experienced constipation from thyroxine. I find adding prunes to my porridge or cereal works for me.
I wish you well.
Thanks for your message. Yes she takes her thyroxine first thing and waits an hour before having breakfast. She is taking senna to help with constipation. Also does have prunes.
She could try taking levothyroxine at bedtime
Get a weekly pill dispenser for levothyroxine on its own ….easy to see then if missed a dose
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
Thyroid level dangerously low?
Low Thyroid Results but Vits OK
Low ferritin and Thyroid levels 
On LDN - Are my thyroid levels too low as I'm so sleepy and spaced out
tsh too low on levo dose
