I’ve been taking levothyroxine for 2.5yrs now for Hashimotos hypothyroidism. Currently taking 100. I’ve just had the below results through which my doctor wants to discuss in a couple of weeks. She doesn’t seem to understand and I don’t have confidence in what I’m being told. Can you help me understand them please before I go and see her. I’m struggling with excessive weight gain, my hair is starting to recede and I have no hair on my arms, legs or eyebrows. I’m trying so hard to find out why but not getting very far. Anyway my results are below so any help you can give would be appreciated.
Many thanks in advance
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efm2022
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With 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.
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.
In week before blood test, when you have to stop vitamin B complex, you want to consider taking a separate methyl folate supplement during that week and continue separate B12
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.
I realised I put my question as a reply to myself…oops!
So my endocrinologist has replied to my doctor about my request for T3 medication and to address the weight gain. Their response is that my TSH is suppressed so I am on more than adequate levo. They are not attributing my huge weight gain to my thyroid/Hashimotos. They suggested a dietetic referral and don’t think liothyronine is of any benefit. They said it was associated with a higher risk of adverse effects.
I have been looking at all the information you all kindly gave me links to, but I wondered if you could help me have answers ready when I have my doctors appt in a weeks time when I’m confident they will want to reduce my levo and refuse t3 medication. Thanks in advance x
Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron
See page 13
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)
Are you taking HRT at least 4 hours away from levothyroxine
Suggest you experiment with splitting your dose levothyroxine. Try taking half dose waking and half at bedtime. Plus improving low vitamin levels…..you may see TSH increase at next test
Refuse to reduce dose levothyroxine and request another test in 6-8 weeks
Book test for early morning, ideally before 9am and last dose levothyroxine 24 hours before test
If Ft3 remains low at next test look at seeing recommended thyroid specialist endocrinologist from the list who will prescribe T3
I had my phone appt with my doctor today and I actually cried when the call ended. She had no interest in anything I had to say. She told me everything is in range and fine. When I discussed my (your) findings regarding t4 to t3 conversion she said it was nonsense and where was I getting this information from. She has agreed reluctantly to do a blood test in 6wks just to get me off the phone. She would not discuss my weight gain or other symptoms as all look fine. She was truly horrible.
Anyway I’ve got the blood test and hopefully a referral back to the endocrinologist but I feel totally deflated after finally feeling I had some useful information that would help. I know the endo will do the same thing😔
Hi efm2022, you need to be prepared for the possibility that your GP most likely wants to see you to discuss reducing your dose of levo. and is very unlikely to agree willingly to increase your dose .
This is due to your TSH being below range (and lower than it was at your previous test).
Thyroid Stimulating Hormone (TSH) is the message from the pituitary to the thyroid asking for more or less thyroid hormone to be produced) and TSH is often all GP's look at or have an interest in , so they may ignore your fT4 / fT3 results and just say ,, " but your TSH say's you are overmedicated, which is bad for your heart and bones , so i need to reduce your dose "
To prepare for this conversation , spend some time reading through the list of posts about low TSH /quality of life /risks:
So my endocrinologist has replied to my doctor about my request for T3 medication and to address the weight gain. Their response is that my TSH is suppressed so I am on more than adequate levo. They are not attributing my huge weight gain to my thyroid/Hashimotos. They suggested a dietetic referral and don’t think liothyronine is of any benefit. They said it was associated with a higher risk of adverse effects.
I have been looking at all the information you all kindly gave me links to but I wondered if you could help me have answers ready when I have my doctors appt in a weeks time when I’m confident they will want to reduce my levo and refuse t3 medication. Thanks in advance x
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