I’ve just had some test results back, a re test after upping my Levothyroxine from 75mcg 4 days per week and 75mcg 3 days to 100mcg daily.
My results in May were -
Vitamin D3 90 51-25
B12 412 160-925
Ferritin 20 30-200
Free T3 3.9 3.10-6.80
TSH 0.74 0.30-4.20
Free T4 16.5 12-22
Results from end of July -
TSH 0.43 0.30-4.20
T3 4.5 3.10-6.80
T4 16.7 12-22
I’m finding I do have more energy but that’s the only thing that’s improved in terms of symptoms.
Weight gain is my main issue and if anything I find that I’ve gained MORE weight after upping the dose… also to me it seems the dose adjustment didn’t have much effect, looking at the numbers.
I’ve also had a full iron panel and have been informed that my iron is indeed low and I have a follow up discussion with my GP on the 15th of August. They won’t give me the results prior to that. Do I need to request combination therapy? So fed up with not feeling any better 😥😩. Any advise would be very much appreciated!
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Northlondonmummy
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Request 25mcg dose increase in levothyroxine……or at least 25mcg extra 4 days a week
Retest in 6-8 weeks
Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
Which brand of levothyroxine are you currently taking
Do you always get same brand levothyroxine at each prescription
Approx how much do you weigh in kilo
ESSENTIAL to get all four vitamins at GOOD levels
No folate result in May
B12 too low
What vitamin supplements are you currently taking
Ferritin obviously terrible
Are you vegetarian or vegan
Aiming for ferritin at least over 70 minimum
Iron supplements must be taken at least 4=hours away from levothyroxine
Can take many months to improve low ferritin
Meanwhile increasing iron rich foods in your diet. Red meat every day. Liver or liver pate once a week. Orange juice or vitamin C at same time as meat to improve absorption
Yes the last one is on 100mcg daily. I’ve been on the same brand since the upping and before then TEVA. The last test was done at 8:30 in the morning. I do think the iron is a big part of my issues. It just seems like I’m unable to get it up. Tried for years and the GP suggests taking more Ferrous Fumerate or to get a mirena coil… I weigh around 85kg which is lot more than I used to. Not veggie or vegan. I avoid gluten and dairy but not completely.
Thanks for the link, very useful info! I haven’t noticed any difference in brands to be honest. Currently on Mercury Pharma and feel the same as on TEVA.
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.
I’ve also had a full iron panel and have been informed that my iron is indeed low and I have a follow up discussion with my GP on the 15th of August. They won’t give me the results prior to that.
So with that ferritin level and low iron you very likely have iron deficiency. Hopefully your GP will have also done a full blood count to see if you have anaemia, you can have iron deficiency with or without anaemia.
Low iron and low ferritin bring lots of symptoms which can overlap with symptoms of hypothyroidism:
Symptoms of low ferritin include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
Symptoms of iron deficiency include:
◾Persistent fatigue
◾Pale skin
◾Shortness of breath
◾Headaches
◾Dizziness
◾Heart palpitations
◾Dry skin
◾Brittle hair and hair loss
◾Swelling or soreness of the tongue or mouth
◾Restless legs
◾Brittle or ridged nails
Also, ferritin that low means that thyroid hormone can't work properly, some experts say that the optimal level for thyroid function is 90-110ug/L.
B12 412 160-925
This could be a lot better. Is the unit of measurement pg/ml or ng/L (which are both the same, and I'm guessing it is because it's the same as my GP's.
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
So you should be aiming to improve this level.
Was folate tested, folate and B12 work together.
Results from end of July -
TSH 0.43 0.30-4.20
T3 4.5 3.10-6.80 = 37.84% through range
T4 16.7 12-22 = 47% through range
Weight gain is my main issue and if anything I find that I’ve gained MORE weight after upping the dose… also to me it seems the dose adjustment didn’t have much effect, looking at the numbers.
Did you both tests as we advise, i.e. no later than 9am, water only before test, last dose of Levo 24 hours before test, no biotin/B Complex for 3-7 days before test?
Do I need to request combination therapy?
No, not at this stage, you need an increase in Levo. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well. Increasing Levo will increase your FT4 and will also increase FT3 because your conversion rate is pretty good. Good conversion is said to take place when FT4:FT3 ratio is 4:1 or less, yours is 16.7 : 4.5 which is 3.7 : 1
You really need to optimise your nutrient levels - sort out your iron, improve B12 (and possibly folate) and at least maintain your Vit D although you might want to aim for the level recommended by the Vit D Council, Vit D Society and Grassroots Health which is 100-150nmol/L with a recent blog post on Grassroots Health quoting a study recommending at least 125nmol/L. Once you've done this symptoms should improve (re low ferritin/iron) and thyroid hormone should work better. But I would also push for a 25mcg increase in your dose of Levo and retest in 8 weeks.
This is all very helpful, thank you for responding. I have more than half of those symptoms… I shall try and push for an increase in Levo and work a bit more on the nutrients. The iron is by far the most difficult one for me. The test sheet stated ‘iron works’ but no idea what that actually entails. No FBC this test but I do believe they did one in May. Again thanks for taking the time to read and respond.
My daughter struggles to absorb iron from ferrous fumarate and instead takes ferrous bisglycinate. It's a fairly new form of iron supplement. It might work better for you.
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