Bad episode of Vertigo and blood tests

[Gal_Ka]

Hello everyone,

I used to have subclinical Hashimoto for more than 10 years and was on 25 or 50 mcg of Levothyroxine. Several months ago I started to take Tirosint gel capsules 50 mcg. I did not feel the difference, just maybe my tinnitus became a bit louder and started effecting my hearing. Recently I had a bad incident of Vertigo and decided to get a quick blood test. The first time it showed higher TgAb

Free T3 3.5 (3.0 - 5.6)

Free T4 14.69 (9.0 - 19.05)

TSH. 2.33 ( 0.4 - 4.0 )

Tg Ab 4.5 ( <4.11 )

TPO Ab 241.0 ( <5.6 )

Please comment on my blood results and should I be worried that some changes in my blood test results started to show up and was this recent Vertigo a sign of some decline.

[SlowDragon Administrator]

50mcg is only a starter dose of levothyroxine

FT4: 14.69 pmol/l (Range 9 - 19.05)

Ft4 only 56.62% through range

FT3: 3.5 pmol/l (Range 3 - 5.6)

Ft3 only 19.23% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org/

your results show you are not on high enough dose levothyroxine and very poor conversion rate of Ft4 to Ft3

Very likely low vitamin levels directly linked to being on inadequate dose levothyroxine

Most people when adequately treated will have TSH around one or less. Ft4 at least 70% through range and Ft3 at least 50-60% through range minimum

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Have you had coeliac blood test done

Are you on strictly gluten free diet and/or dairy free diet

ESSENTIAL to test vitamin D, folate, ferritin and B12

That’s next step plus getting next dose increase in levothyroxine

Optimal vitamin levels are essential for good conversion of Ft4 to Ft3

[SlowDragon Administrator]

Tinnitus and Vertigo is frequently linked to low B12

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Gal_Ka in reply to SlowDragon]

Thank you very much for your reply.

I was thinking about B12. I did not do a coeliac blood test so far but most of the times I am on a gluten and diary free diet unfortunately not very strict recently. For all these years with Hashimoto I did not manage to get a referral to the NHS endocrinologist. I did this blood test privately and just wonder if you can recommend a private doctor in London, maybe the holistic one.

[SlowDragon Administrator in reply to Gal_Ka]

Before considering booking any consultation, especially private…get vitamin levels tested

Likely to need to supplement vitamin D and vitamin B complex continuously….perhaps separate B12 as well especially initially

Meanwhile request/insist on next dose increase in levothyroxine to 75mcg

come back with new post once you get results

Members can advise on what vitamin supplements needed

Meanwhile

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors 

[e-mail]

[Gal_Ka]

Thank you very much for your comments once again. Yes, it makes sense to start with vitamin blood tests.