Further to advice on here a week or so ago I have had the MediChecks advanced Thyroid Check.
I don't supplement anything, eat a normal varied diet, but have been piling on weight since being changed from 150mg to 125mg Levo. I have joined a Gym to boost what I would say was an already pretty active lifestyle and have not alerted my diet or intake of calories (although I don't count them).
I am most worried about my blood pressure and thought the reason it was so high might be lack of T4. Seems its not that?
Any help and suggestions greatly appreciated. I can't carry on putting weight on like this.
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Scopas
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125mcgs Levo is a low dose for a male. Looks like your vitamin levels are low which you need to work on to get OPTIMAL which would help all round and help your conversion rate.
Free T4 (fT4) 18 pmol/L (12 - 22) 60.0%
Free T3 (fT3) 4.56 pmol/L (3.1 - 6.8) 39.5%
So the drop in Levo has reduced your FT3 too much, coupled with low vitamin levels has you piling on weight.
Folate and B12 are too low. You would benefit from a good methylated B complex. This one on Amazon has all you require there. amazon.co.uk/Yipmai-Liposom...
Thanks - I wish that telling the GP what dose I want to be on was an option. They have their "guidelines" to follow apparently. I'll try B12 supplementation and see what happens. Thanks for taking the time to reply.
That's just it, they are GUIDELINES and not written in stone. You can accept responsibility for keeping your TSH lower. See this thread for links to getting TSH lower. If one GP is a stickler then try another at the same practice. You need to be persistent - nicely. healthunlocked.com/thyroidu....
It's not just B12 you need but folate too so try the B complex that has both.
Hi Scopas , I suggest you ask GP to try putting it back halfway between the two doses for 6 months (to 137.5mcg) to observe what effect that has on symptoms and TSH ( they are usually only interested on TSH, because they are usually muppets~ so sometimes you have to play them at their own game)
get your GP to have a look at this list of references recommending GP's keep TSH between 0.4/0.5 and 2/ 2.5 in patients on Levo : healthunlocked.com/thyroidu... my-list-of-references-recommending-gp-s-keep-tsh-lower-
some are taken straight from GP's 'update' sources , one is written specifically for GP's by NHS Specialist Registrars in Cardiology and Endocrinology .
That should reassure them of the safety of a small 12.5mcg increase since your TSH is currently 2.7
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Assuming a dose of 137.5mcg does not lower your TSH below 0.04 , you can then use this paper to show that TSH between 0.04 and 0.4 on Levo did NOT increase risks for heart or bones or anything else. ( this study formed part of the evidence base used to make the current NHS thyroid guidelines relating to "overtreatment/ low TSH / risk" so there should be no argument whatsoever about it's validity as evidence of risk )
Serum Thyroid-Stimulating Hormone Concentration and Morbidity from Cardiovascular Disease and Fractures in Patients on Long-Term Thyroxine Therapy
Robert W. Flynn, Sandra R. Bonellie, Roland T. Jung, Thomas M. MacDonald, Andrew D. Morris, Graham P. Leese
The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 1, 1 January 2010,
"Abstract
Context: For patients on T4 replacement, the dose is guided by serum TSH concentrations, but some patients request higher doses due to adverse symptoms.
Objective: The aim of the study was to determine the safety of patients having a low but not suppressed serum TSH when receiving long-term T4 replacement.
Design: We conducted an observational cohort study, using data linkage from regional datasets between 1993 and 2001.
Setting: A population-based study of all patients in Tayside, Scotland, was performed.
Patients: All patients taking T4 replacement therapy (n = 17,684) were included.
Main Outcome Measures: Fatal and nonfatal endpoints were considered for cardiovascular disease, dysrhythmias, and fractures. Patients were categorized as having a suppressed TSH (≤0.03 mU/liter), low TSH (0.04–0.4 mU/liter), normal TSH (0.4–4.0 mU/liter), or raised TSH (>4.0 mU/liter).
Results: Cardiovascular disease, dysrhythmias, and fractures were increased in patients with a high TSH: adjusted hazards ratio, 1.95 (1.73–2.21), 1.80 (1.33–2.44), and 1.83 (1.41–2.37), respectively; and patients with a suppressed TSH: 1.37 (1.17–1.60), 1.6 (1.10–2.33), and 2.02 (1.55–2.62), respectively, when compared to patients with a TSH in the laboratory reference range. Patients with a low TSH did not have an increased risk of any of these outcomes [hazards ratio: 1.1 (0.99–1.123), 1.13 (0.88–1.47), and 1.13 (0.92–1.39), respectively].
Conclusions: Patients with a high or suppressed TSH had an increased risk of cardiovascular disease, dysrhythmias, and fractures, but patients with a low but unsuppressed TSH did not. It may be safe for patients treated with T4 to have a low but not suppressed serum TSH concentration."
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The risk to bones from low TSH (in patients on Levo) is also largely bunkum as long as fT4/ fT3 are kept in range , (the research supporting it usually came from patients who were NOT taking levo and had low TSH due to high T4/T3 levels) ,
See this recently published long term study of patients whose TSH was kept deliberately supressed with Levo (as part of their treatment following thyroid cancer) but whose fT4 was in range :
Longterm "subclinical hyperthyroidism" does not affect bone density in patients having had thyroid ablation for cancer"
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Then .. once you've persuaded them to let you try 137.5mcg for 6 months , if you still feel undermedicated and want to go back to 150mcg, point out that when on 150mcg previously your TSH was 0.09 which is over 0.04 , reassure them that you fully understand and accept the risks to heart and bones ( as they see them ) but that you are balancing those risks against your quality of life and point them to this bit at the beginning of the guidelines.
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. "
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and then try asking them to put it back to 150mcg of you didn't feel better on 137.5mcg
(make sure you let them know you are fully aware of the signs of overmedication ~ faster heart rate / increase frequency of bowel movements / sweating / feeling hotter than usual / a fine tremor in outstretched fingers when arms are held out in front palms facing down ~ and would of course want to reduce dose yourself if any of those happened )
Hopefully your doctor will cave in at that point and write "patient understands risks" on your notes to cover his back, and let you take more or less what you want as long as you're not appearing to be reckless.
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if the GP is such a muppet that they say "they don't make 12.5mcg tablets " then point out that it is common practice for NHS GP's to prescribe 12.5mcg increments of Levo by 'alternate dosing' eg 125mcg one day /150mcg the next /125/ 150 etc ... and those of us who find the different doses unsettling can easily cut the 12,5mcg tablet in half to get the same dose each day .
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Hope some of that comes in useful,....... If all of that still fails to get the GP to increase dose .... try dropping it into the conversation that you are so concerned about your current symptoms that you are considering asking them to refer you to an endo to see if they will offer you a trial of T3 combination therapy (which is expensive and will end up coming out of your surgery's budget if it's allowed) that often brings about a sudden change of mind re. trying a small dose increase.
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