TSH and cholestrol high, despite taking 150mg L... - Thyroid UK

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TSH and cholestrol high, despite taking 150mg Levothyroxine.

Littleshopofhorrors profile image

My latest blood tests were:

THS 6.91 ml U/L (normal 0.3 - 4.80)

Serum Free T4 8.7 pmo/l (normal 7.7 - 20.6)

Serum Free T3 4.2 pmo/l (normal 4.2 - 6.9)

Serum Cholestrol 6.9 mmol/l (normal -5)

As I'm taking 150mg Levothyroxine, and have been for a few years, this seems wrong. I am putting on weight and can't lose it, feel depressed (despite 40mg Fluoxetine) constantly tired and actually feel like giving up.

I'm 61 this month and feel as if I'm 80.

GP is useless....whole surgery was rated inadequate last month, so have little faith in the system.

Any advice will be really welcome.

14 Replies

Your blood test results clearly show you are undermedicated and need your meds increasing. This is supported by the symptoms you describe. I ended up on nearly 300mcg of levothyroxine to address my hypothyroidism. Everyone is different. In my case I end up on a combination treatment as I still wasnt well even on that high dose. You also need to ensure the following are optimal to utilise the levothyroxine properly. Vit D, B12, Ferritin, folate. Ask your doctor to do a blood test to check these and increase your levothyroxine dose.

Also your high chloesterol is another sign you are undermedicated. This should drop once you are optimally treated.

Thank you for your reply. My B12 was 273 ng/l (normal 145 - 914)Serum folate was 15.43 ug/l (normal 3 - 20)

Serum ferratin 11.6 ug/l (normal 11 - 20)

Vit D wasn't tested, but is normally low.

I've requested that the GP contact me to discuss the results, via the NHS app. I tried 113 phone calls starting at 8am this morning (not unusual) without getting through, so I'm unlikely to get through today.

Your B12 is too low but your GP will argue its in range. The Pernicious anemia Society state that everyone's (not just PA ) should be over 500. If you eat a healthy diet with meat in it (main source of b12) and are not vegetarian your GP should investigate why its low. Look up b12d.org at their symptom checker. We need b12 for uptake of thyroid hormones & conversion. It is commonly low in hypothyroidism when under treated. And some people need to supplement or have injections even when on optimal thyroid dose.

Recommend reading Your Thyroid & how to keep healthy by Barry Peatfield-Durrant. Knowledge is power. 😊

Fluoxetine works by altering serotonin levels. Much of our serotonin is in the gut so gut function changes. This in turn can affect how we absorb levo. For some on SSRI medication such as fluoxetine it means that we may need a higher dose o levo to compensate for the reduced absorption. I say this so you may realise that maybe 150mcg is not necessarily a big dose partic if it is not being absorbed.Do you take your fluoxetine well away from your levo?

You have had previous problems with anemia and low vitamin levels. If levels remain low then they compromise how efficiently your body can use the levo.

I would suggest that you need an increase in levo and that you revisit your vitamin levels and supplements to see if there's anything you can do to improve them

Thank you for your reply. I take my levo first thing in the morning and the fluoxetine with lunch. Last month's iron was 9.3 umo/l (normal 11 - 32) so I am still anaemic and can't tolerate iron supplements. GP appears unconcerned! I also have Coeliac Disease and have followed a strict gluten free diet for 3 years, so absorbtion should have improved. GP tells me I should eat red meat...I'm a vegetarian, and really can't go back to eating meat.

Ahhh see you're a vegetarian & coeliac. You definately need b12 supplement and would advise a low complex b like Thornes Basic as the bs work together. I'm gluten free but still need b12 jabs etc....

Just to check, :) you do take your levo on an empty stomach and leave one hour before eating or drinking anything other than water, and at least two hours away from other medication and supplements?

Thank you for your reply. Yes, I do. I have it first thing in the morning, before I get out of bed.

SlowDragon profile image

My B12 was 273 ng/l (normal 145 - 914)

Serum folate was 15.43 ug/l (normal 3 - 20)

Serum ferratin 11.6 ug/l (normal 11 - 20)

Vit D wasn't tested, but is normally low.

Your B12 is extremely low

Ferritin deficient

What vitamin supplements are you currently taking

GP must do full iron panel test for anaemia….you almost certainly need iron supplements, possibly iron infusion

Are you vegetarian or vegan?

Test vitamin D yourself

Aim to maintain at least around 80nmol and around 100nmol maybe better

Test twice yearly via NHS private testing service when supplementing


Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. One spray = 1000iu


It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Vitamin D and thyroid disease


SlowDragon profile image

THS 6.91 ml U/L (normal 0.3 - 4.80)

Serum Free T4 8.7 pmo/l (normal 7.7 - 20.6)

Serum Free T3 4.2 pmo/l (normal 4.2 - 6.9)

These results show you are under medicated

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

GP needs to increase dose levothyroxine to 175mcg per day

Retest in 6-8 weeks

Meanwhile essential to work on improving low vitamin levels

Your not taking levothyroxine at same time as your antidepressant are you?

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo per day

If you need substantially more than guidelines suggests poor gut absorption, often lactose intolerance and/or gluten intolerance

Are you on dairy free or gluten free diet?

If not request Coeliac blood test via GP

Absolutely essential to maintain OPTIMAL vitamin levels

Vitamin D at least around 80nmol

B12 at least over 500

Folate and ferritin at least half way through range

SlowDragon profile image

Just read you’re vegetarian and not found any iron supplements you can tolerate

Obviously as a vegetarian it’s your responsibility to maintain good vitamin levels by supplementing

Do you currently take daily B12 and vitamin B complex?

If not, need to start

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid


Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.


B vitamins best taken after breakfast

Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)

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



Low B12 symptoms


If 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.

As vegetarian and coeliac and hypothyroid may need ongoing daily B12 as well as vitamin B complex indefinitely

B12 sublingual lozenges




How other member saw how effective improving low B vitamins has been



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

What iron supplements have you tried

There’s a wide variety of different ones

humanbean may be able to suggest some

Please add which ones you have tried.

If you can’t find any supplements that help you may need to consider private iron infusion

Are you near London



SlowDragon profile image

Come back with new post once you get vitamin D results

How much vitamin D are you currently taking and is it tablets or mouth spray

As coeliac and autoimmune thyroid disease Likely to need high dose vitamin D daily ….typically 4000iu …possibly higher

Vitamin D tablets you swallow should be at least 4 hours away from levothyroxine

Vitamin D mouth spray, often more effective as avoids poor gut absorption and only need be an hour away from levothyroxine

Are you currently taking any magnesium supplements

Calm vitality magnesium powder is cheap and easy to use and extremely effective at improving constipation. Best to start on low dose and increase until get desired effect…..too much can cause diarrhoea

All magnesium supplements best taken afternoon or evening and must be minimum of 4 hours away from levothyroxine

Gluten free diet is low in magnesium

Web links about taking important cofactors - magnesium and Vit K2-MK7





Great article by Dr Malcolm Kendrick on magnesium


Vitamin K2 mk7



2 good videos on magnesium


Last month's iron was 9.3 umo/l (normal 11 - 32)

Serum ferratin 11.6 ug/l (normal 11 - 20)

If you could tell us which brands and forms of iron supplement you have tried, at what dose, time of day, whether with or without food and anything else that seems relevant, we might be able to make some suggestions that will raise your iron and ferritin.

There are several different iron supplements that people can try. It isn't necessary to struggle on with one that you can't tolerate. And doctors almost always prescribe the cheapest possible supplement which many, many people can't tolerate.

Thank you all for your very detailed replies, which I am working my way through.I am voluntarily lactose free, as I find lactose causes bloating. Since my Coeliac diagnosis, I also eat tuna and white fish. I currently take a multivitamin, Centrum Women, which includes iron, B12 and Vit D. I take this last thing at night, so it is well away from any other food, drink or medication.

I have been prescribed ferrous sulphate, ferrous fumerate and an expensive sort, via a private hospital, called Ferric Maltol. I either vomit or get such serious constipation that I have to take 4 Dulcolax tablets, or a combination of the 2. My GP has told me that the NHS won't give me an iron infusion, as my levels are not low enough, and my referral has been bounced back twice.

I don't think my digestive system works properly, despite a completely gluten and lactose free diet. I have tried dairy free too, and that made only as much difference as cutting out lactose. My diet is so restricted, that I need to keep dairy, if at all possible.

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