I wonder I if you could all help me like you did last year with some recent blood results I have had taken by Medichecks.
Since my post last May 2021, my GP has reduced my thyroxine medication twice, due to stating my tsh levels were too low, and I am now on 112 per day. I am just very concerned as still have thyroid symptoms of being tired, really bad constipation, brain fog, and I have put a stone on in weight, which is so upsetting.
I am going through the peri menopause too so not sure if some of my symptoms are because of this or both that and my thyroid.
Thank you for all your help, please see the results below.
Inflammation - CRP HS 2.43 mg/L (Range: 0 - 5)
Iron Status - Ferritin 128.0 ug/L (Range: 13 - 150)
Fiona Your vit D is at the bottom of the optimal range. It is suggested that 100 is the minimum to aim for so maybe a wee bit of supplementation would be called for. Don't forget you need magnesium as well to aid the action of vit D.Your doctor is unfortunately dosing by TSH. Your thyroid hormones are low in range and you really need an increase in levo. I would in your position be trying to get ft4 into the top third of its range first and once its there see how ft3 level is then. Most normal folks on average would have ft4 50% through range but hypos need it higher as our body does not use it as efficiently.
Thank you for your advice, I was very low with vitamin d last year, so supplemented, but my gp told me to stop as it was getting too high. It is so confusing isn't it when they say these things. I will start again and try and get my levels up a bit.I find it so frustrating like everyone else on this forum that the GP's go by the TSH levels, mine will not look at anything else, and even though I told her a felt I needed mine to be quite low she still insisted in reducing my medication twice, hence the weight gain I feel. Just not sure how I can get it increased again with the way she is.
I find it so frustrating like everyone else on this forum that the GP's go by the TSH levels, mine will not look at anything else
TSH 0.30 mU/L (Range: 0.27 - 4.2),
Free T3 3.83 pmol/L(Range: 3.1 - 6.8), = 19.73% through range
Free Thyroxine 14.8 pmol/L (Range: 12 - 22) = 28% through range
Provide her with evidence that TSH can be low/suppressed.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of the article which contains this quote from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
So your GP is not bound to the guidelines she can use her own judgement by taking your symptoms into account and as long as FT4/FT3 are within range there is no problem with a low TSH.
Are you taking any supplements? Your Active B12 is too high to be measured yet your folate level is rather low.
Thank you for all the information, I will have a listen to the talk and read all the articles. I take selenium, iron supplements, vitamin c and use a magnesium spray as I have awful restless legs. My B12 has been high for ages, but and was last year but the GP doesn't want to do anything about it and I have no idea why it is high as I have never supplemented that.So do you think the reduction in the thyroxine could have caused the weight gain and other symptoms. I feel like everything is an effort again and keep falling asleep like I used to.
I doubt my GP would increase my medication as she has reduced it twice now, even though I said I didn't want to, but felt I had no option.
My B12 has been high for ages, but and was last year but the GP doesn't want to do anything about it and I have no idea why it is high as I have never supplemented that.
When B12 is high due to supplementation that's not really a problem, it's the supplement that causes the high level and any excess is excreted. However, high B12 without supplementation should be investigated:
There is no upper limit for vitamin B-12 intake because consuming high levels does not cause problems. However, having naturally high levels of vitamin B-12 in the body may be a cause for concern, as it suggests a severe underlying condition. Doctors will aim to treat the underlying medical condition, rather than the elevated levels of vitamin B-12.
So do you think the reduction in the thyroxine could have caused the weight gain and other symptoms. I feel like everything is an effort again and keep falling asleep like I used to.
Yes. Those are hypothyroid symptoms. You are undermedicated, simple as.
Last year on 125mcg Levo and my comments:
TSH X 0.23 mIU/L (Range: 0.27 - 4.2)
Free T3 4.5 pmol/L (Range: 3.1 - 6.8)= 37.84% through range
Free Thyroxine 20.1 pmol/l (Range: 12 - 22) = 81% through range
Your 125mcg Levo is giving you a good level of FT4 at 81% through it's range. However, your FT3 is only 37.84% through it's range and this shows you are not converting T4 to T3 very well.
Currently on 112mcg Levo daily
TSH 0.30 mU/L (Range: 0.27 - 4.2),
Free T3 3.83 pmol/L(Range: 3.1 - 6.8), = 19.73% through range
Free Thyroxine 14.8 pmol/L (Range: 12 - 22) = 28% through range
So all your reduction has achieved is a tiny increase in your TSH but your FT3 level has halved and there is a massive reduction in your FT4 level, all of which means you are undermedicated with hypothyroid symptoms returned.
I take selenium, iron supplements, vitamin c and use a magnesium spray as I have awful restless legs.
Ferritin 128.0 ug/L (Range: 13 - 150)
Why the iron supplement? You have a very good ferritin level. You need to do an iron panel to include serum iron, transferrin saturation percentage, total iron binding capacity plus ferritin. If yur serum iron and saturation are high then taking iron is going to take it to toxicity level. You should be able to maintain your ferritin level by eating iron rich foods regularly, eg liver, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and other iron rich foods:
I have asked numerous times about my high B12 but they never want to do anything, I will mention it again, thank you for the information.Thank you for explaining the ranges and levels for my TSH, FTs and FT4, I will try and have a chat with my gp and see what she says, but I do not hold much hope there, I am just worried if I stay on this dose I am going to start feeling really not well again, feels like I am going back years to the beginning of being diagnosed, and the weight carries on increasing.
I just take one tablet a day for my iron as whenever I stop it my levels go dire and I feel dreadful, I am not sure if I have ever had a full iron panel done, so could ask about that too, thank you.
I am just worried if I stay on this dose I am going to start feeling really not well again, feels like I am going back years to the beginning of being diagnosed, and the weight carries on increasing.
That's what will probably happen. Use the information from Dr Toft and the guidelines to support your request for an increase. To be honest, you didn't have to agree to the reduction in the first place, a GP can only suggest what you do, it has to be a joint decision.
I would do your own iron panel if GP wont do one, Medichecks does one - Home Iron Test - £39 less our usual discount here:
Hi Kay, I know this post is a while ago and you may have found help for your RLS. There is a forum on health unlocked which could help you. In the meantime a great article was published about treatment of RLS (The Management of Restless Legs Syndrome) it also covers PLMD (Periodic Limb Movement Disorder (the one that wakes you or keeps you awake in the night ) in July 21 by the Mayo Clinic which you can search online - I couldn't find a way to upload it to this post
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
Approx 86% of Hashimoto’s patients find strictly gluten free diet helps or is essential. Get coeliac blood test done BEFORE cutting gluten out
Your under medicated and very poor conversion of Ft4 to Ft3
Ft3 is far too low
Retest thyroid and vitamin levels 2-3 months after getting 25mcg dose increase in levothyroxine…….working on improving low vitamin levels and trialing strictly gluten free diet
If Ft3 remains low………Likely to need addition of small doses of T3 prescribed alongside levothyroxine
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
Thank you SlowDragon for all you help, I shall look into everything you have said. No I am not gluten or dairy free. I will try and get my medication increased by my GP and see if I start to feel a bit better, whether they will, who knows, thanks again
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