Hi
my daughter is taking 200mcg. of levothyroxine and her recent results show
TSH 0.03 range 0.35 - 4.8
Free T4 12 range 9.8 - 21.0
Free T3 not done
Obviously her Free T4 is low in range for the amount of levothyroxine she is taking, all vitamins are at a good level, so what could be causing the low FT4 level.
Any advice would be appreciated.
Thank you.
How long has she been on 200mcg levothyroxine
Which brand
Does she always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
No vitamin supplements or other medications within 2 hours minimum …some like iron, magnesium, vitamin D tablets, minimum 4 hours away
What vitamin supplements is she currently taking
Presumably she has Hashimoto’s
Is she lactose intolerant or gluten intolerant
Thank you for your reply. She has been on 200mcg for 3 months. She does not always get the same brand.She takes her levo during night with water and takes her vitamins and iron after breakfast. She takes vit D, B12, B complex, magnesium and iron.
She is not lactose intolerant but years ago she had an endoscopy and was told it looked though she could have celiac but the specialist said she was not 100% sure. She stopped eating gluten but when she had another endoscopy a few years later a different consultant said he didn’t think she had celiac so she started eating gluten again.
In the past she has tried adding T3 to her levo and also tried NDT but nothing seems to make feel well.
She is constantly hungry and has read about Leptin resistance been associated with hypothyroidism so wonder if this is why she is not well.
takes her vitamins and iron after breakfast. She takes vit D, B12, B complex, magnesium and iron.
She should take her iron at least 2 hours away from these other supplements. Iron affects their absorption and should be taken on it's own.
Thank you I will tell her this.
Only 5% of autoimmune thyroid patients are diagnosed as coeliac, but further 89% find strictly gluten free diet helps, often significantly or is absolutely essential
Approx how much does she weigh in kilo
If on substantially higher dose than guidelines of 1.6mcg per kilo …..this suggests malabsorption issues
First steps
Try gluten free diet again
Work out which brand levothyroxine suits her best than always get that brand.
If sticking with one brand doesn’t help, endocrinologist can prescribe liquid levothyroxine. This has remarkable positive results for many who try it. It’s expensive…..so they are reluctant to offer it. Dose is usually split as 2 smaller doses waking and bedtime
gov.uk/drug-safety-update/l...
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.
Thank you ,she weighs 88.9 kilograms, so multiply this by 1.6 equal 142.24 kilos, so this proves it’s an absorption issue.She is just piling the weight on, and feels not very well.
I will tell her to ask pharmacist to prescribe the same brand and go gluten free, then if no better ask about the liquid levo.
Thank you for the link, very helpful to show to the doctor.
How long has she been on levothyroxine? Was her TSH ever high in the past?
Her TSH is very low, so something else could be going on.
HiShe has been on levothyroxine for four years now. She was self treating before this with NDT at first, then T3.
Her doctor would not treat because her TSH was 4.2 and top of range 4.5 . She had all the symptoms of hypothyroidism but doctor kept saying she had CFS.
It was when she needed to go in for a small operation they told her to stop self treating for six weeks so they could see what her levels were, it was then her TSH went above range so they decided to give her levothyroxine.
Do you have her previous blood test results, on levothyroxine alone, that show her FT3 levels?
If her TSH was not very high, the test results make more sense. Let's suppose that she just absorbing 50% of her levothyroxine. That would be enough to nearly suppress her TSH, but not high enough to increase considerably her T4. A FT3 test should say more about her thyroid status. If her FT3 is on par with her FT4 or lower, this would confirm the malabsorption hypothesis.
If her FT3 is at a good level, I am not so sure about the malabsorption. Perhaps she is just converting very efficiently.
Out of curiosity, did she ever had a positive antibody test?
She did have T3 tested on a previous test. I can’t quite remember the level but I think both T3 and T4 were around mid range.
She has not had a positive result for antibodies but the only time they did test them was when she was on a gluten free diet and they came back very low.
Please help- thyroid results- normal TSH low free T3 and free T4
normal TSH, borderline low T4 free
Very Low TSH With Low T4
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