Please could I have help with my latest blood test results (done first thing in the morning before levo dose). I think I need increase in levo (currently on 75mcg) as showing just out of range but dr says “tsh borderline but free thyroid levels normal and it is also possible this is being affected by low vitamin d levels so I wouldn’t suggest a change to your dose just check again in 3-6 months”.
I explained that my hypo symptoms seem to be getting worse. I’m still putting on weight despite exercising and not eating much (I’ve put on 2 stone since being diagnosed 2.5 years ago). My biggest concern is my brain fog which is awful at best and sometimes total confusion for moments, I feel like I have early onset dementia to describe it better. I find it really hard to comprehend things sometimes and forgetfulness is ridiculous. Lack of energy and motivation are with me daily, some days worse than others, this gets me down as I used to be very enthusiastic and motivated in everything I did, now I’m like a sloth!
I think I may be going through peri menopause so perhaps the symptoms are from that and not thyroid related.
I asked gp for a further B12 test (as recommended by Medichecks) but he refused and said the level is fine and just supplement with over the counter medication which I will do. Any recommendation for a decent brand would be helpful as I known it all supplements are equal! He is prescribing me vitamin d to get level up so perhaps that will help with symptoms.
Any help/guidance/reassurance from those more learned than I gratefully received 🙏
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Moop-kf
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That’s a total of 300,000iu of vitamin D over 6-8 weeks
Active B12 under 70 is too low and you need testing for Pernicious Anaemia before starting any B12 and vitamin B complex
Thyroid
TSH is far too high for someone on levothyroxine. You need immediate 25mcg dose increase in levothyroxine to 100mcg daily and retest levels again in 6-8 weeks
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
If you haven’t had coeliac blood test done yet, this also needs testing
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
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.
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.
Have to say your GP is an imbecile. How he can read results and not see you are under medicated and severely vitamin deficient is beyond me especially as you are presenting with the symptoms if being hypo.
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
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
HiYou seem quite new to this and I remember feeling just like you when I was under medicated. Please read the advice from SlowDragon. Very clever people here who will change you life………
Thanks SarahJane1471! I’m ashamed to say I’ve been diagnosed for 2.5 years but I’ve been burying my head in the sand until my symptoms are too invasive to ignore. Planning on trying to learn (and retain which is a problem) from the experts here and get myself feeling better.
Do get genned up - read my profile- I’ve mapped my journey to full replacement dose. Once you get a dose increase you will get a bit of a boost. I found a week or so after a dose increase my brain worked for a few few weeks until I needed another dose increase. I used this period when I felt better to read and absorb information and you may need further dose increases.
Both are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)
Available online
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Well done SlowDragon 👏as always great detailed info. Moop-kf it seems like a lot of information to take in all at once but it will all eventually make sense to you. You really will have to be your own advocate when it comes to treatment as most GP s are pretty useless ( unless you are lucky).
Love the analogy 😂 GP is going to be ditched and I’ll find another that is willing to at least try and help. Armed with the info I’ve been given here I feel more empowered to get the meds I need to feel better. It’s so hard when the drs make you feel like you’re making things up and making a fuss. So very grateful for this forum and those that give their time to helping us 🥰
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