helpful advice ? Please

[Mammaelf]

any interpretation on these results please?

tia

Currently taking 150mcg levo

[SlowDragon Administrator]

Was test done early morning and last dose levothyroxine 24 hours before test

Which brand levothyroxine are you taking

Do you always get same brand

Ferritin result?

What vitamin supplements are you taking

[Mammaelf in reply to SlowDragon]

same brand for the last five years.

Vitamins: B12 injection, vit D from gp every third month, berroca morning, magnesium night , folate 50mcg and iron 1 daily from gp

[SlowDragon Administrator in reply to Mammaelf]

Do you take iron 4 hours away from levothyroxine and other supplements

Vitamin D four hours away from levothyroxine

magnesium 4 hours away too

All other supplements at least 2 hours away from levothyroxine

Still important to test vitamin levels at least annually

[pennyannie]

Hello Mammaelf :

We generally feel at our best when on T4 monotherapy when our T4 is in the top quadrant of its range as this should in theory convert to a decent level of T3 tracking behind at around 60-70 % through its range.

Currently your T4 is around 23 % through it's range and your T3 just only around 2.70 % through it's range.

You are on a good dose of T4 - 150 mcg daily - and am thinking maybe you have stomach issues and not able to absorb the T4 medication very well - do you know if you do have issues and have you been offered liquid T4 ?

The accepted conversion ratio when taking T4 only is said to be 1 / 3.50 - 4.50 - T3/T4 and when we come is this ratio at 4 or under.

So to find how well you are converting the T4 into T3 we just divide your T4 by your T3 and I'm getting your conversion coming in at 4.44 - so slightly wide of the centre and showing your thyroid struggling a little.

No thyroid hormone replacement works well until your core strength vitamins and minerals, those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels.

i now aim for a ferritin at around 100: folate around 20: Active B12 75 ++ ( serum B12 500 ++ ) and vitamin D at around 100:

T4 - Levothyroxine is basically inert and needs to be converted by your body into T3 the active hormone that runs all your bodily functions, including your physical, mental, emotional psychological and spiritual well being, your inner central heating system and your metabolism.

Any physiological stress ( emotional or physical ), inflammation, ageing and dieting can also impact and down regulate T4 to T3 conversion.

Do you have any reading there for ferritin and inflammation ( CRP ) ?

I see you are also asking questions on a new drug for you - Spiriva Respimat - and just wondering if this may have contributed to you current symptoms of hypothyroidism ?

[Mammaelf in reply to pennyannie]

Sorry I thought I replied. No issues with new inhaler as just started it. But I self inject B12 and crp is highly at 4.91! Don’t know why?

[pennyannie in reply to Mammaelf]

Crp is an inflammation marker and a high reading means your body is upset and struggling :

High inflammation can also down regulate T4 to T3 conversion.

[SlowDragon Administrator]

Assuming test done early morning and last dose levothyroxine 24 hours before test

FT4: 14 pmol/l (Range 12 - 22)

Ft4 only 20.00% through range

FT3: 3.22 pmol/l (Range 3.1 - 6.8)

Ft3 only 3.24% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org/

Shows you are not on high enough dose levothyroxine and currently very poor conversion

First step need 25mcg dose increase in levothyroxine

Retest in 6-8 weeks including vitamin levels

Most people when adequately treated will have Ft3 at least 50% through range and often Ft4 (levothyroxine dose) will need to be at least 70% through range

[SlowDragon Administrator]

There’s no information on your profile

What’s the cause of your hypothyroidism

Do you have autoimmune thyroid disease, also called Hashimoto’s, usually diagnosed by high thyroid antibodies

Do you have PA (autoimmune)

Assuming that you do have Hashimoto’s, are you on strictly gluten free diet or dairy free diet

Your results show low thyroid levels despite a fair dose of levothyroxine

Approx how much do you weigh in kilo

Assuming you take levothyroxine everyday without fail

Have you been tested for various malabsorption issues

Eg

H Pylori

SIBO

Coeliac

[Mammaelf in reply to SlowDragon]

hi, I’m very over weight. No disease confirmed just under active ? Cpr level 4

[SlowDragon Administrator in reply to Mammaelf]

Have you ever had both TPO and TG antibodies tested privately or via GP?

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...

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.

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue with autoimmune thyroid disease

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here 

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

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.

if very over weight ….you might not need quite as much as 1.6mcg per kilo of your weight per day

[editheve]

hi sorry i cant help but look ike you have been given some really good advice ivd been on 100 levo for 13 years dr increased it to 125 for 6 months to see if it woud help with my sinus issues it did nothing and lowered my results so back on 100 and results are fine i just take a daily antihistamine dymista and washes fingers crossed its been ok for a few months and my nuralgia has gone into remission at the minuite after suffering for 5 solid months but good luck hope you get sorted asap eve .