Should I request an increase in thyroxine?

[Amber-sky]

Hi there. I’m a 56 year old fit and healthy female despite being recently diagnosed with Hashimoto’s thyroiditis. I have a medication review with the clinical pharmacist at my GPs soon and wanted to know if I should request an increase in thyroxine?

I have been taking 75mcg Teva for 6 months but find that tiredness and fatigue sets in, particularly in the afternoon. My current weight is 50kg.

I am gluten free and take vitamin D. I have updated my profile to show all of my blood test results, (both NHS and Medichecks) since the journey started and have also copied below

Many thanks in advance and also just to say how incredibly helpful and informative this forum is.

12.50pm October 2022 - NHS.

TSH 9.21 mIU/L (.3 - 4.2) 228.5%

Free T4 (fT4) 8 pmol/L (9 - 19) -10.0%

11am November 2022 - medichecks.

TSH 10.93 mIU/L (.27 - 4.2) 271.2%

Free T4 (fT4) 9.3 pmol/L (12 - 22) -27.0%

Free T3 (fT3) 3.8 pmol/L (3.1 - 6.8) 18.9%

T4:T3 Ratio 2.447 

Thyroglobulin Antbodies (TgAb) 76 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 90 IU/mL (≤ 34)

C-Reactive Protein (CRP) .35 mg/L (0 - 3) 11.7%

Folate - Serum 27.4 ug/L (8.83 - 60.8) 35.7%

Vitamin B12 150 nmol/L (37.5 - 188) 74.8%

Vitamin D 97 nmol/L (50 - 250) 23.5%

Ferritin 49 ug/L (30 - 150) 15.8%

9.40am December 2022 - NHS.

TSH 16.7 mIU/L (.3 - 4.2) 420.5%

Free T4 (fT4) 9.2 pmol/L (9 - 19) 2.0%

Free T3 (fT3) 4.4 pmol/L (3 - 5.4) 58.3%

T4:T3 Ratio 2.091 

Thyroid Peroxidase Antibodies (TPO) 110 IU/mL (≤ 35)

9.15am March 2023 - NHS.

TSH 4.53 mIU/L (.3 - 4.2) 108.5%

Free T4 (fT4) 11.4 pmol/L (9 - 19) 24.0%

9.20am May 2023 - NHS.

TSH 1.29 mIU/L (.3 - 4.2) 25.4%

8.30 am September 2023 - medichecks.

TSH .578 mIU/L (.27 - 4.2) 7.8%

Free T4 (fT4) 18.2 pmol/L (12 - 22) 62.0%

Free T3 (fT3) 5.4 pmol/L (3.1 - 6.8) 62.2%

T4:T3 Ratio 3.370 

Thyroglobulin Antbodies (TgAb) 64.3 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 96.9 IU/mL (≤ 34)

C-Reactive Protein (CRP) .374 mg/L (0 - 3) 12.5%

Folate - Serum 26.1 ug/L (8.83 - 60.8) 33.2%

Vitamin B12 150 nmol/L (37.5 - 188) 74.8%

Vitamin D 91.1 nmol/L (50 - 250) 20.5%

Ferritin 82.1 ug/L (30 - 150) 43.4%

[Bertwills]

Hi, I think there is room for a little increase but what I notice most is your low levels of Vit D and folate. You may feel better if you can concentrate on raising both of these. Taking a complete B vitamin supplement is probably a good idea if you can but if not a folate only supplement.

Better you mouth spray for Vitamin D is popular. I prefer an olive oil based D supplement that I buy from Amazon. It boosted my levels quickly.

[Amber-sky in reply to Bertwills]

Thank you very much Bertwills. I shall try boosting those vitamins first.

[Bearo]

So you are taking Thyroxine but your TSH is 9 and your FT4 is below range? You definitely need an increase. The general aim is for TSH to be 1 or below, and FT4 to be over 50% through the range. But it may take several dose increases to get there and it’s best not to rush it.

[Amber-sky in reply to Bearo]

Apologies Bearo as I put all of my test results down from 2022 so it looks confusing as the spaces are removed when posting. Here is my last test only:

8.30 am September 2023 - medichecks.

TSH .578 mIU/L (.27 - 4.2) 7.8%

Free T4 (fT4) 18.2 pmol/L (12 - 22) 62.0%

Free T3 (fT3) 5.4 pmol/L (3.1 - 6.8) 62.2%

T4:T3 Ratio 3.370 

Thyroglobulin Antbodies (TgAb) 64.3 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 96.9 IU/mL (≤ 34)

C-Reactive Protein (CRP) .374 mg/L (0 - 3) 12.5%

Folate - Serum 26.1 ug/L (8.83 - 60.8) 33.2%

Vitamin B12 150 nmol/L (37.5 - 188) 74.8%

Vitamin D 91.1 nmol/L (50 - 250) 20.5%

Ferritin 82.1 ug/L (30 - 150) 43.4%

And a slight update in that the surgery has booked me in for another blood test as I’m still fatigued, although it will only be TSH, T4 and T3 being NHS.

[Bearo]

No - my fault - I read Oct 22 as Oct 23.