Fatigue

[tamari]

Hi all, still struggling with chronic fatigue. I have been on Levothyroxine 100mg for about 27 years always felt tired. I decided to take a Medicheck advanced Thyroid function blood test. As my gp only tests my TSH yearly!!! Which was on 12/12/ 22 TSH 4.4 GP added 25mg of Teva still feeling breathless ,muscle aches, and exhaustion!!! I wonder if one of you knowledgeable ladies could check out my blood results. Ferritin 64.2ug/L (range 13 - 150

Folate -serum 17.95ug/L (range >3.89

B12 - Active 63.1 pmol/L (range 37.5 - 150)

Vitamin D 49 nmol (range 50-200)

TSH 0.72 mU/L (range 0.27 - 4.2)

Free T3 4.09 (range 3.1 -6.8)

Free Thyroxine - 18.7 pmol (range 12 -22

Any help would be much appreciated, i can't thank you enough for all the work and time you devote to helping fellow sufferers.

[Jaydee1507 Administrator]

Have you been supplementing anything since your similar post 2 years go?

Well done on the 25mcg dose increase. If we can keep on top of vitamins and keep them optimal it often helps with raising TSH and also conversion of T4 to T3 the active hormone. Your less than 50% FT3 will be causing you symptoms along with less than optimal vitamins.

Free T4 (fT4) 18.7 pmol/L (12 - 22) 67.0%

Free T3 (fT3) 4.09 pmol/L (3.1 - 6.8) 26.8%

So as far as Levo goes you have plenty of room for an increase of 25mcgs but would have to be careful in case this pushes TSH over and your GP won't like that. It may be that you have a conversion issue but would need to see optimal vitamins and another raise in Levo to know that for sure.

Ferritin ideally should be 100 - eat chicken livers and pate a few times a week.

B12 could be higher. A good active/methyl B complex would help keep all the B's in balance and raise B12 & folate. This one is good. amazon.co.uk/Yipmai-Liposom...

Vit D, buy some D3 with K2 to help it go to the bones. Use thsi calculator to work out how much to take to get it to 100. grassrootshealth.net/projec...

[tamari in reply to Jaydee1507]

Hi Jaydee, i must admit i am not consistent with vitamins. I didn't realise they need to be optimal for conversion! How long would i need to take them to have the desired effect and increase T3. I don't eat meat i eat dairy and fish, and also have been treated for SIBO by Gastroenterologist, i do wonder if i absorb nutrients now that i am in my 60s 😊! Thank you for your help.

[Jaydee1507 Administrator in reply to tamari]

Low vitamin levels also contribute to fatigue. Its really hard when you're struggling, but worth while focussing on taking the supplements regularly. As a pescetarian its all the more important as only certain vitamins can be got from meats etc.

Being hypo alone means we don't absorb vitamins due to the low stomach acid. Ageing is another factor for reduced absorption + you have the diet issue.

Work on the vitamins for3-4 months then retest and see where your FT3 is. If it's not up to much then perhaps consider adding some T3. A Levo increase would also help.

[SlowDragon Administrator]

Are you lactose intolerant that you are on Teva levothyroxine

Teva brand levothyroxine upsets many people

Have you ever tried different brands?

B12, vitamin D are both too low

What vitamin supplements are you currently taking

Ferritin too low.

Look at increasing iron rich foods in your diet

[tamari in reply to SlowDragon]

Hi SlowDragon thank you for your reply, i have been taking Accord brand for years but they don't do a 25mg so gp put me on teva? Since taking Teva i have developed TMJ maybe just a coincidence. I had Pneumonia in the March last year then a couple of months later Covid and have been struggling since. I do take B12, Vit D but not consistently.

[SlowDragon Administrator in reply to tamari]

Get GP to prescribe extra 50mcg tablets and cut in half with pill cutter or sharp craft scalpel

Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

And no vitamins or supplements within 2 Hours

Vitamin D tablets, magnesium, HRT, iron or PPI at least 4 hours away from levothyroxine

Which brand vitamin D. Is it mouth spray or tablet

Get a weekly pill dispenser for vitamins and another for thyroxine

[tamari in reply to SlowDragon]

Yes to all of above, take levo with water and wait an hour before breakfast. I take Vit D Viridian caps. 2000iu, Solgar magnesium 200, Viridian high twelve B-complex B12, I dont like the B12 they make me feel sick. Can you recommend any brands?

[SlowDragon Administrator in reply to tamari]

You obviously need to increase amount of vitamin D

Suggest you try 4000iu daily for 2 months and then retest

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator in reply to tamari]

How long before test did you stop Vitamin B complex

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

Different B12 brands to try

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

[tamari in reply to SlowDragon]

I stopped B complex about a month before blood test. You have given me so much information which is really appreciated. I do feel i have a plan and fingers crossed I start feeling better in 3 months.

[pennyannie]

Hello Tamari :

The accepted conversion ratio when on T4 - Levothyroxine only is said to be 1 / 3.50 - 4.50 T3/T4 with most of us feeling at out our best when we come in this range at 4 or under.

So to find how well you are converting the T4 into T3 simply divide your T4 by your T3 and I'm getting 4.60 so showing your conversion compromised and you struggling to convert the storage hormone T4 into the active hormone T3.

I've seem a lot worse - and this could be just a question of improving your core strength vitamins and minerals/

Everywhere I researched suggested ferritin needs to be over 70 for any thyroid hormone replacement to work well.

I now find I need my vitamins up and maintained at around 100 for ferritin : 20 for folate : active B12 around 75++ ( serum B12 500++ ) ad vitamin D at around 100:

We also generally feel best when our T4 is up in the top quadrant of its range as in theory this should convert to a higher level of T3 at around a 1/4 ratio - T3/T4 :

Currently your T4 is only around 67% so a dose increase is also likely a step in the right direction.

Is your treatment for SIBO now resolved - maybe this endo could sanction prescribing liquid T4 for you - it is more expensive and do not know the ' rules ' as to when it is offered.

[tamari in reply to pennyannie]

Hi Pennyannie, thanks for all the info. I am only able to request Rifaxomin when i get a Sibo flare. What TSH should i be aiming for, lower than 0.72?

[pennyannie]

Once on any form of thyroid hormone replacement the TSH is a total waste of time and money.

Forget the TSH - and the yearly thyroid function test is a complete waste of time and money.

Aim to get your core strength vitamin and minerals up and maintained at optimal and ask for a dose irease in T4, as your metabolism is running too slow for you, and work on getting your T4 into the top quadrant of the range.

[Bearo]

I had problems taking 1000 vit B12 (made me feel motion sickness). I’ve changed to a 500ug and have no problems with that. And two doses several hours apart will equal 1000.

[tamari in reply to Bearo]

I have a problem with the Viridian high potency B complex they are too big and i always feel nauseaus after taking them. I think i need a B12 Cobalamin and a B Complex. Thanks for reply

[SlowDragon Administrator in reply to tamari]

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

B complex

try Igennus Vitamin B complex. Nice small tablets. Full dose is 2 tablets per day. Most people are fine with just single tablet 

igennus.com/products/super-...

[tamari in reply to SlowDragon]

Hi SlowDragon, thanks for all the info, is it ok to take Vit D3, K2-MK-7, and Magnesium together? Bit confused as to what Vitamins needs to be taken together for better absorption. Thank you

[SlowDragon Administrator in reply to tamari]

magnesium best taken at bedtime (or early evening 4 hours minimum before levothyroxine if you take levothyroxine at bedtime)

Vitamin D mouth spray can be taken in morning at least an hour after levothyroxine

Vitamin D gels/tablets best with food that contains fat ….so usually main meal of day….at least 4 hours away from levothyroxine