I’m I 55-year-old white male. I had a total thyroidectomy approximately 20 years ago it was removed because it grew very large and was choking me , it had grown down into my chest cavity, and also around my trachea.
I take 150 µg of levothyroxine per day. Apparently I’m in the normal range. I find myself struggling on a daily basis with fatigue and depression.
I also have a low resting heart rate late 40s, early 50s per minute. My basal body temperature is approximately 36 first thing in the morning.
I’m finding things a little harder, the older I get .
I’m trying to find information about optimal thyroid range rather than normal. Any help or advice would be welcome.
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Geet123
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Optimal is not a number, it's how you feel. If you still don't feel well, then you aren't optimal, no matter what your numbers say.
Have you had full thyroid testing?
TSH
FT4
FT3
vit D
vit B12
folate ferritin
All sorts of things could be going wrong with your treatment, and that's the where the blood tests come in. So, give us the numbers you've got - results and ranges - and we'll see if there's something obvious.
I’ve not had a blood test for awhile I’m not sure if it’s the correct thing to do, but these are my test results from my patient notes
Test result Bone profile;Urea and electrolytes;Serum lipid levels;Liver function tests;FREE T3;25OH VITAMIN D (GP ONLY);VITAMIN B12;FOLATE (SERUM);Thyroid function test;FERRITIN Report, Abnormal, Need to speak to doctor (Patient Informed). Review not applicable
Coded entry Serum creatinine level (XE2q5) 79 umol/L [62 - 115] Information about this test
Coded entry eGFR using creatinine (CKD-EPI) per 1.73 square metres (XacUK) ≥ 90 mL/min
NICE no longer recommends adjusting eGFR for adults of
African-Caribbean or African family origin (NG203, updated August
2021).
Coded entry Serum lipid levels (XE2q7) - Please see NICE CG181: Lipid Modification Guidelines. Information about this test
I was told by my doctor that I was slightly overmedicated, but as I was stable for years, they left it as it was originally went to the doctor because I felt fatigued depressed.
The doctor decided that I was a typical for sleep that you sent me on a trial. The result from that was less than one episode per night, so another words I didn’t have it.
I was told I was fine🙁
After reading everybody else posts I can see that the only way forward is to get retested as a starting point.
Folate could be higher. Absolutely useless just saying > 4.12 because the scope is too wide. Folate should be in double figures and yours is only just in double figures, so if it were me, I'd want it higher.
Much too low. The bottom of the range is much too low. B12 should be at least over 550.
So, if I were you, what I would do is get some subligual methylcobalamin (B12), 1000 mcg, and take that for a couple of weeks. Then, get a good B complex - i.e. one containing methylcobalamin AND about 400 mcg methylfolate - and take that as well as the sublingual B12. That should bring your folate up nicely. Then, when the pot of sublingual B12 is finished, just continue with the B complex as a maintenance dose. Thorne does a good B complex, as does Igennus.
Low B12 like yours can cause a whole heap of problems, and symptoms that resemble thyroid symptoms.
Coded entry Serum free triiodothyronine level (XaERq) 5.5 pmol/L [3.5 - 6.5] Information about this test
Serum total 25-hydroxy vitamin D level (Xabo0) 53.1 nmol/L
Above 50 nmol/L: is sufficient for almost the whole population
Almost all the whole population, but not for those that are hypo! We need it higher. And yours is only just over 50. It would be better around 100. But, I can't advise you on what to take for that because I don't have the experience.
Serum TSH level (XaELV) 0.2 miu/L [0.35 - 5.5]
Low, but too bad. You won't be able to raise it without lowering your thyroid hormone levels, and that will make you feel even worse. It's really all about how you feel, not about the numbers, as doctors think. The numbers are just a rough guide.
Only 69.52% through the range. Could be higher. Plenty of room for an increase if you can persuade your doctor. And, if you still have symptoms, he should give you at least a 12.5 mcg increase. But, try and raise your nutrient levels a bit first, that might help.
Serum C reactive protein level (XaINL) < 4 mg/L [0 - 9]
That's fine.
I was told by my doctor that I was slightly overmedicated
Your doctor doesn't know much about thyroid, does he. He's only looking at the TSH. But, once the TSH gets below 1, it's a very poor indicator of thyroid status. He should be at least looking at the FT4, which is far from being too high - and, ideally at the FT3, but they don't test that! - and taking your symptoms into consideration, which they rarely do because they don't know what they are! Altered sleep patterns are hypos symptoms. But, they tend to treat all symptoms as separate diseases. Sigh.
Anyway, no way are you over-medicated. If anything, you are under-medicated. But, probably time you had more testing done.
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
You're not alone in that. Very few people ever do 'look into things'. They just trust their doctor that he knows what he's doing and has your best interests at heart. It's not always true - especially where thyroid is concerned because so few doctors know anything about it. But, if you're brought up to believe that doctor knows best, it's very difficult to go against that... Until, one day, it suddenly dawns on you that this person in front of you hasn't got a clue! And is making it all up as he goes along. That's when most people think 'hey, wait a minute, maybe I should be taking more interest in what's going on and how all this works!'
I was lucky that that day came pretty early for me. I'd never liked doctors due to the way they treated me - or didn't treat me - as a child. And, having my own children - three horrible pregnancies - confirmed that in the main, they weren't nice people. But about three months into my thyroid journey I realised they were also pretty ignorant!
So, don't beat yourself up about it. It's not the past that's important, it's what you do about it now that counts.
Well, I think that a generation or so ago, doctors were more trustworthy. Before all this modern technology, doctors were taught to diagnose by symptoms. These days, with all the blood tests, xrays, and god knows what else, they aren't taught symptoms so much anymore. So, maybe out parents and great-grandparents were able to trust them. But these days, we just aren't. Sad, but true.
as recommended, I’ve had an advance thyroid blood test done by Medicheck I have included the results , quite different from last year. If you wouldn’t mind, please could you share your thoughts with me.
👏👏👏👏👏GG you are so so right. Being in range is not always Optimal. It's how one feels that makes one Optimal. Thank you GG for being a Great Advocate and Educator for us .
Do you always get same brand levothyroxine at each prescription
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
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, and on levothyroxine
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test 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
Testing options and includes money off codes for private testing
most of the time I do you get the same thyroxine however I’ve just changed to pharmacy2U and so I have to wait-and-see what they send
And with yours and other peoples advice, I’m going to get a test full thyroid and vitamins etc as a starting point
Thank for all the links
I’ve known for years I’ve not felt right. The more more information I read more symptoms. I realise I have. I am so relieved. I found this forum as information seems very straightforward on here rather than the jargon. I’ve been reading on the Internet.
I will keep on reading to other peoples posts for info
when I have my test resultsI will post them once again. Thank you very much.
I have also replied to grey goose they did ask do I have any numbers. I did post my last blood test from my patient note not sure if I should’ve done this but I find it very difficult to decipher and understand😊
without knowing your blood test results for all thyroid vitals but from being the same age and gender and having experienced similar symptoms I would guess you are over medicated with T4 and have insufficient T3. I had / have chronic bradycardia and levothyroxine only treatment makes that unresolveable and unstable because insufficient T4 fails to raise fT3 whereas high levels of T4 reduce intra cellular T4 - T3 conversion also causing chronically low fT3 which particularly affects the heart. The best I can do is aim for absolutely normal levels of T3 T4 and TSH this means them being optimal for you NOT JUST ANYWHERE IN THE LAB RANGE! I would guess that for you that is about 15 fT4 4.5 fT3 and 1-2 TSH and for me is only then that I get control of low heart rate and prevent AFib.
Hi and welcome from another man, 56 yo, with thyroid zapped 20 years ago (hot nodules in my case). If mucked about with so much over the years including T4+T3, NDT and how T4+T3. Energy is ok but I'm now on antidepressants but that's as much to do with my situation as health. My energy isn't great and I have to fight to avoid napping. Just background.
One thing, as a man particularly, you could look at is not testosterone levels. They drop gradually as we age and you might get low. DON'T BOTHER along the NHS, get a private test. Mrdichecks do one (expressive) that covers all the testosterone markers AND all the thyroid and vitamin markers that people on this site ask for. Ask for the doctors report (included at no cost).
NHS treatment threshold is above an endocrinology limit, so there is legally scope for private treatment.
Do your own research. I went on TRT for 4 months and it mad no difference to me. I was clutching at straws.
You can also look at exercise, sleep hygiene and improving nutrition. I went plant based years ago and my energy improved. Now I focus on healthier food, less sugar, less processed crap.
For me, it's the holistic changes, including coming to terms with my age and some work on my mind.
hi and thank you for reaching out to me. Your story is interesting. I will take your advice and do some more research and I will stay in touch and let you know how I get on
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Total thyroidectomy struggle
TSH level increase after total thyroidectomy(8 years ago)
TSH &T4 levels after total thyroidectomy
Blood Pressure increases after 20 years on stabilised thyroxine
Total thyroidectomy 
