Hi, I was last in touch 3 months ago regarding my TSH results which were TSH 3.2, T4 13.1, T3 3.3
and had been taking 75 mgs Levothyroxine. I have since upped my dosage to 100mgs
My present readings are TSH 1.6, FT4 16.1, FT3 3.4
TPO antibodies normal below 34
Vit D 56 nmol/L
I still feel quite ill, any advice would be much appreciated.
sigmoid
Can you please add the reference ranges for your results, these vary from lab to lab so we need your lab's ranges to interpret your results. Your FT3 looks like it could be low in range and low T3 causes symptoms. Increasing your Levo has improved your FT4 but there isn't really any improvement in your FT3.
Are you doing your thyroid tests as we advise:
* No later than 9am
* Nothing to eat or drink except water before the test
* Last dose of Levo 24 hours before the test
* No biotin or B Complex or any supplement containing Biotin for 3-7 days before the test
Your Vit D level is low. The Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol with a recent blog post on Grassroots Health recommending at least 125nmol. Are you supplementing Vit D ?
Thank you for responding, Tests were all done before 9.00am, nothing to eat or drink, last dose of Levo 24hrs before test and left off all vits for a week.
Present readings...
TSH 1.6 - 0.27-4.2
FT4 16.1 - 12-22
FT3 3.4 - 3.1-6.8
I'm not converting very well Ft4 to Ft3 should I up my Levo dose again?
Can you suggest a good vit D supplement
sigmoid
So with those results I'd suggest the first thing to do is increase Levo. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. So an increase in Levo should reduce your TSH and increase your FT4. Then see what difference it makes to your FT3. Retest 6-8 weeks after dose increase. Chances are you may need to consider adding T3 at some point, but first things first. Get all ducks in a row - correct Levo dose, optimal nutrient levels and go from there.
As for Vit D, you might want to check out a recent post that I wrote about Vit D and supplementing:
healthunlocked.com/thyroidu...
and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.
Your current level of 56nmol/L = 22.4ng/ml
On the Vit D Council's website
web.archive.org/web/2019070...
you would scroll down to the 3rd table
My level is between 20-30 ng/ml
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).
So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 3,700iu per day, nearest is 4,000iu and cheapest way is to buy 5,000iu and take 6 days a week instead of 7.
4,000 x 7 = 28,000iu
5,000 x 6 = 30,000iu
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains excipients and works out more expensive. Some people find that the spray nozzle clogs up too.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
Another "all trans" one worth considering if the others aren't availaable:
amazon.co.uk/Vitality-Biore...?
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form. Some people find the taste unpleasant but you could add the drops to orange juice or something else.
natureprovides.com/products...
It may also be available on Amazon.
One member recently gave excellent feedback on this particular product here:
Here is what she said (also read the following replies):
healthunlocked.com/thyroidu...
Another important cofactor is Magnesium which helps the body convert D3 into it's usable form.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
naturalnews.com/046401_magn...
explore.globalhealing.com/t...
and ignore the fact that this is a supplement company, the information is relevant:
swansonvitamins.com/blog/ar...
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Well done on getting dose increase in levothyroxine
Was test done early morning and last dose levothyroxine 24 hours before test
Which brand of levothyroxine is 100mcg
Can you add ranges on TSH, Ft4 and Ft4
previous post vitamin results
Tests were done around 10.30am last dose 24hrs before test.
My Levothyroxine brands are Accord 50 mcg and Mercury Pharma 25mcg
should I stay with the same brand?
Tested in March 23 for:-
B12 487ng/L range 211 - 911 ng
Ferritin 66 ug/L range 10.00 - 291ug/L
Calcium 2.21 range 220 - 260 mmol/L
Folate 11.8 range 5.40ug/L
Taking Perfectil for skin, hair and nails.
Did you remember to stop taking Perfectil week before test
Vitamin D is far too low
Have you currently be taking any vitamin D?
Or magnesium?
Yes, I asked the GP for a trial period. Last dose of Levo 24 hrs before test.
I take 50mcg Accord and 2 x 25mcg of Mercury Pharma.
TSH 1.6 - 0.27 - 4.2
FT4 16.1 - 12 - 22
FT3 3.4 - 3.1 - 6.8
Doesn't look like I'm converting very well FT4 to FT3 should I up my dose of Levo again.
Is there a good vit D and magnesium on the market?
FT4: 16.1 pmol/l (Range 12 - 22)
Ft4 only 41.00% through range
FT3: 3.4 pmol/l (Range 3.1 - 6.8)
Ft3 low at only 8.11%
So you have room for dose increase in levothyroxine
Try 112.5mcg daily (cut a 25mcg tablet in half)
You could try splitting your levothyroxine as 2 doses as well
Taking 50mcg waking and 62.5mcg at bedtime (or vice versa)
This might help improve conversion
Presumably you aren’t already on strictly gluten free diet or dairy free diet
Yes, will try upping my dose of Levo and I'm not on a gluten free diet or dairy free diet.
Thank you
vitamin levels
Rather than taking Perfectil suggest you take a GOOD QUALITY vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
Other options
healthunlocked.com/thyroidu....
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)
How other member saw how effective improving low B vitamins has been
healthunlocked.com/thyroidu...
Not taking any vitamins at the moment, wasn't sure which ones to take.
Thank you for all the information and links.
Are you currently taking any vitamin D already
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...
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...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Suggest you try 3 sprays per day and retest in 2-3 months
you may need higher dose in winter than summer
Test twice yearly via NHS private testing service when supplementing
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
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
so if taking levothyroxine at bedtime…..magnesium at least 4 hours before that
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
I like the idea of a Vit D spray, I really need to get my vit levels up. I've been aching so much and cracking joints.....or is that age!
You also need BOTH TPO and TG antibodies tested
NHS won’t test TG antibodies if TPO antibodies are negative
Suggest you retest again in another 6-8 weeks privately including both thyroid antibodies
Have you had coeliac blood test via GP
Will test again for both antibodies TPO and TG in 6 weeks, not had a coeliac blood test will look into this also.....thank you
Your t4 is fine honey, your t3 is lacking. I can't take cytomel because it's too big of a t3 dump all at once into my system. I have been prescribed in America with a Time release compounded t3 of 12 micrograms every 12 hours.I've been on it for 15 years and no longer have hypothyroid symptoms.
You can get this in the United Kingdom but you have to go to a specialist consultant and there's about two of them to understand how t3 works.
Its frustrating.
Without knowing
A)what time test was done,
B)when last dose levothyroxine was taken
C) the lab ranges added on Ft4 or Ft3 results
it’s impossible to say if Ft4 or Ft3 are high or low
Hi Saritabb, Thank you for responding.
Yes, I'm not converting FT4 to FT3 very well, maybe I should up my dose of Levo again?
Knowledge lacking when it comes to Thyroid disease in the UK, that's why I'm so grateful to this site.
I will have to do a little research on Cytomel and Liothyronine T3 meds
Agree with Saritabb - Levothyroxine never - repeat never worked for me. T3 is the way to go whether you add it (under a Drs care), or go the glandular route (likewise under a Drs care). In fact, there is increasing evidence (read scientific studies) that many are over prescribed / prescribed the wrong medicines for hypothyroidism. drchristianson.com/blog/eve...
Mainstream medicine will most likely be years behind in even looking at these studies. In my own personal experience, it took years, and many hours of personal research, AND finally finding a Dr. with an open mind and a listening ear. I am alive and well, losing weight slowly but steadily and 3 years off of pharmaceutical thyroid hormone replacement - after 30 years of less than optimal “medical treatment”.
Thank you for responding.
I was thinking of upping my dose of Levo to see if that makes any difference to my T3
I'm not sure that will be the right way to go?
I'm pleased you are feeling much better and finally finding a Dr. to actually listen. Likewise I will be doing a lot more research on T3 meds....I think that's the way to go!
Take care
Most of us have done that, played around with the dosages (what choice do we have??!!). Please don’t read that I am personally recommending it. But if you do decide to experiment, you will likely find yourself over- dosed or under dosed as one finds the ceiling and the floor. It’s scary to overdose. Just remember, T4 (Levo) takes days to dissipate / come back down, but overdose symptoms will subside. T3 takes hours, dissipating much more quickly.
But many members do find they can get significant improvements by fine tuning levothyroxine, all vitamins optimal and often significant improvements gluten/dairy free
All these need addressing BEFORE considering adding T3
Here in U.K. testing Dio2 gene variation is recommended if still not well then
thyroiduk.org/deiodinase-2-...
regeneruslabs.com/products/...
if test positive, this can often help get trial of small doses of T3 prescribed alongside levothyroxine on NHS
No argument here Slow Dragon. There is significant improvement (It's better than nothing) - I lived worked and played, traveled the world, was a working mother and full time volunteer (all at the same time), on significant improvement.
And then there is healed.
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