Would like some advice

[TurkeY787]

New blood test and my doctor well not put my medication up i’m not sleeping being diagnosed Hashimoto’s and always sweating has fallen out either very sticky Face is very puffy go to see my private consultant in two weeks hopefully he can up my medication gPs are rubbish

[SlowDragon Administrator]

Looking at previous posts

Are you still only on 75mcg levothyroxine

Approx how much do you weigh in kilo

Ferritin is extremely low, almost deficient

Are you vegetarian or vegan?

Request GP do full iron panel test for anaemia

Looking at previous posts

You have Hashimoto’s, are on strictly gluten free diet

B12 and folate were ok, but could be higher

Are you currently taking vitamin D supplements and vitamin B complex too ?

[TurkeY787 in reply to SlowDragon]

Yes I’m on still on 75 mcg and taking vitamin D going to ring doctor again tomorrow but they are so right thank u x

[TurkeY787 in reply to TurkeY787]

I weigh nearly 9 stone

[TurkeY787 in reply to SlowDragon]

Yes I’m also taking B complex to only for a week x

[SlowDragon Administrator]

Low ferritin

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

dailyiron.net

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...

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...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

[TurkeY787 in reply to SlowDragon]

Thank u so much i’m going to ring the doctor tomorrow and ask him if up my medication and check my iron and a ferritin again what else should I ask thank you so much for your help

[SlowDragon Administrator]

Do you do your tests early morning, ideally before 9am and last dose levothyroxine 24 hours before test

FT4: 14.5 pmol/l (Range 11 - 21.2)

Ft4 is only 34.31% through range

FT3: 4.1 pmol/l (Range 3.1 - 6.8)

Ft3 only 27.03% through range

Most people when adequately treated will have Ft4 and Ft3 at least 50% through range

[TurkeY787 in reply to SlowDragon]

Yes I always test in the morning don’t take my medication stop my vitamin a week before b complex a week before to x

[TurkeY787]

On my previous post I was advised to go to 100 but my doctor wouldn’t do it but I do have some 25s in the cupboard so I might start taking them

[SlowDragon Administrator in reply to TurkeY787]

You need to get GP to increase dose…..otherwise you’ll run out of extra tablets to maintain at 100mcg

Ask for increase as a trial

How much do you weigh in kilo

Use guidelines on dose levothyroxine by weight to push for next dose increase

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

bmj.com/content/368/bmj.m41

[TurkeY787]

My weight is in kilos57.1526

[SlowDragon Administrator]

FT4: 14.5 pmol/l (Range 11 - 21.2) 34.31%

FT3: 4.1 pmol/l (Range 3.1 - 6.8) 27.03%

thyroid.dopiaza.org

Helpful calculator for working out percentage through range

Results show you are under medicated and in need of dose increase in levothyroxine

Obviously you need to retest again see where levels are now

Ferritin likely to still need improving

Endocrinologist should increase levothyroxine at this stage

Not add T3

[TurkeY787 in reply to SlowDragon]

Thank you so much I’ve asked them to increase it and the doctor is going to get back to me x

[TurkeY787 in reply to TurkeY787]

What’s good to increase my ferritin they said it doesn’t need increasing but everyone says below 50 with Hashimoto’s you should be more like in the 80s if that’s right.

[SlowDragon Administrator in reply to TurkeY787]

Increasing iron rich foods in your diet

Red meat most days, liver or liver pate once a week, black pudding…..etc etc

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

dailyiron.net

Links about iron and ferritin

An excellent 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...

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...

[SlowDragon Administrator]

So few endocrinologist seem to grasp it’s important we get all four vitamins tested and at GOOD levels

Please add any new thyroid and vitamin test results and ranges

Approx how old are you

Pre or post menopause

[TurkeY787]

I am 42 @

It ok.