Hi,
Wondered if anyone can answer this question. If I am on Levothyroxine 75mg (increased late last year) which I take circa 6.30 a.m. when is my tsh likely to be at it's lowest in a 24 hrs period (if known)
I am wondering whether low mood and lack of energy mid morning/middle of the day but improving 5-6pm is in any way connected.
Thanks for your input.
Unless very petite you are perhaps not on high enough dose levothyroxine
75mcg is only one step up from starter dose
Typically most people are eventually on approx 1.6mcg levothyroxine per kilo of your weight per day
Approx how much do you weigh in kilo
When not on adequate dose levothyroxine adrenals try to compensate for lack of thyroid hormones
Adrenals (cortisol) has pronounced circadian rhythm…..needing to be higher in morning
Feeling better by afternoon/evening suggests could be adrenals
Which brand of levothyroxine are you taking.
Teva is only brand of levothyroxine that makes 75mcg tablet
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
plus both TPO and TG thyroid antibodies tested at least once
have you had thyroid antibodies tested?
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
(Doesn’t include thyroid antibodies)
monitormyhealth.org.uk/full...
10% off code here
thyroiduk.org/getting-a-dia...
Only do private testing early Monday or Tuesday morning.
Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
HRH8591
I have only ever seen a graph of circadian rhythm of TSH levels in normal healthy people. I assume that a hypo patient who is optimally medicated with Levo would be as near as that as it's possible to be so that graph may be indicative of their TSH levels too.
Research indicates that TSH serum levels peak at between 2 am and 4 am and decrease to their lowest levels at between 4 pm and 8 pm.
thyroidpatients.ca/2020/07/...
However, I suggest you need to look beyond TSH which science proves is not a reliable marker for monitoring.
TSH is a pituitary, not a thyroid,hormone and reflects the overall hormone level... not the individual levels of FT4 and FT3...and there lies the important difference!
FT3 is the most important reading followed by FT4
thyroidpatients.ca/2021/07/...
Your symptoms suggest that you are undermedicated...do you have any recent labs?
75mcg ( not mg!) Is not a particularly large dose...and has only been raised recently
Testing needs to be done after at least 6 weeks on a steady dose to allow the hormones to first settle in the body
For full thyroid evaluation test...
TSH, FT4, FT3, vit D, vit B12, folate, ferritin and thyroid antibodies TPO and Tg
Medics are often reluctant to test everything so many of us test privately
thyroiduk.org/help-and-supp...
Your fluctuating symptoms may be the result of different factors eg vigourous exercise, stress, hunger which in turn affect hormone levels.
The best starting place is a full thyroid test, this enables evaluation of your thyroid function.
How late last year was dose increased ?
Probably ready for full thyroid and vitamin retest
What vitamin supplements are you currently taking
What were thyroid results before increasing to 75mcg
This graph shows the variation in TSH levels throught the day. It wouldn't surprise me if being hypo or slightly depressed affected circadian rhythm somewhat though.
Variations in energy levels are common if you're undre replaced. Do you have recent test results? Have you got your key vitamins to optimal- ferritin, folate, B12 & d3?
Things to try: eat eggs for breakfast instead of cereal or toast. Replace lunch time sandwich with a salad.
Have you tried removing gluten, dairy and soy from your diet?
have you had your T3 tested to check if you’re converting enough levo T4 to the most important hormone T3. T3 gives us all the energy needed to move and be energised. Without enough T3 you will struggle with your energy levels amongst several other symptoms. Weight gain, blurred vision, brain fog, low mood, just to mention a few. T3 also help’s cortisol production which gives you strength and helps fight infections. Cortisol runs on a circadian rhythm every 24hrs You can get your cortisol checked with a simple blood test at 9am by your GP There are saliva tests available privately too I’d request thyroid test and include TSH, T3 and T4 privately or through your GP
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