I recently posted here for advice on whether I need levothyroxine as I have been subclinical for 10 years and now my tsh seems to be creeping up the last few weeks from 4.88 to 5.59 and now 6.15 all in the space of 3/4 weeks. I wonder if it is linked to the introduction of testosterone, I started hrt end of January this year (gel and utrogestan) and testosterone 2 weeks ago. I had an advanced thyroid panel at medichecks last week and my antibodies are clear. Vitamin D low to normal and ferritin is low. I am taking supplements and also b12 shots. Can anyone interpret these results pls, do I need T3 or T4 or just Levothyroxine? My GP has only prescribed 25mcg (reluctantly) because the endo suggested my elevated TSH is not high enough for treatment and that my symptoms (weight gain, fatigue, concentration etc). However, now it’s starting to creep up, shall I take 2 x 25 from now, I have a consultation with my GP tomorrow afternoon anyway and can ask for 50 then (I have not been able to stay on Levothyroxine for more than a couple of months in the past as I start to get palpitations/sweating etc). Or should I see someone privately? Thanks!
TSH - 6.15 (range is 0.27-4.2)
Free T3 - 4.7 (3.1-6.8)
Free thyroxine 15.2 (12-22)
Thyroglobolin antibodies - 34.6 (0-115)
Thyroid peroxidase- under 9 (0-34)
Ferritin - 24.5 (30-150)
Folate - 16.6 (7-35)
Vitamin D - 59.5 (50-250)
B12 - 134 (37-188)
CRP HS (inflammation) - 2.06 (range to be below 3)
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Rambler16
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thanks. It was 13 a couple of weeks back, I’ve managed to get it up with ferrous fumarate tablets and also have ferrous fumarate liquid from the GP. My ferritin has been low for years, it was 5 at one point! My tsh has never been this high
This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself.
and I tested positive for H pylori. Not done anything about it as I don’t fancy going on loads of antibiotics.
So results above are from BEFORE starting on any levothyroxine
Your GP might be happy to increase dose Levo to 50mcg
As per guidelines
Suggest you print these out
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
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.
Just a quick note: i have read somewhere that the initial dosing per weight is not for your current weight. It is for the weight you would have for a BMI 23-24. So even if overweight, the initial dosing is roughly the same. So if for example you have a height of 175 cm, the target weight based on a bmi of 23 should be 72 kg. And the dosing should be 1.6x72=116 mcg. Which is much more logical as an initial dose than the very large numbers resulting from this function using our actual weight.
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.
Thank you, I have lots of reading to do. Correct- the results are pre starting Levothyroxine. I have put on a bit of weight in the last 6-8 months, I am close to 12 stone now and 5’5. I will try to work out the correct dose when I get a chance to look at this a bit later.
Wait minimum 6-8 weeks after any dose change before testing
As you get nearer final dose…..likely to need to wait more like 12 weeks…..you can test after 6-8 weeks …..then often necessary to wait another 2-3 months and retest again
Thanks. I was just a bit concerned about reading somewhere that I could be feeling worse on 25 because it’s such a low dose and not really a starting dose. I actually feel quite exhausted. I’m having my quarterly b12 jab on Friday, it’s a little delayed (by around 2 months) this time around because I thought I was doing fine without it.
thanks! Never too late. I spoke to a different GP today at my Dr surgery. She refused to increase from 25 to 50, said I have to have a blood test first in 6 weeks time. She said I am subclinical so 25 is fine for me for now. She refused to prescribe the liquid form and she said my T3 is fine. She wants to do another ecg and stool test and then make a plan. I’m not sure I should be adding T3 just yet, just trying to get my iron and Vitamin D up. My calcium is also low. Hormones eh! Did you have to see someone privately for the T3 and what was your tsh and dose when you first started?
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I'm not really clear about how long you have been on 25mcgs Levo?
Some doctors do use 25mcgs as a starting dose despite 50mcgs being OK for the majority of healthy people. If you have only just strted Levo then they will want you to be on that for 6-8 weeks before having blood tests and then a dose raise. Its a very slow protracted process.
If you could be working on your very low ferritin with added iron rich foods in your diet - chicken livers a few times a week, pate, red meat etc that would really help you with palpitations.
Palps & sweating can also be due to being on too lower dose so you need to get through that and wait for the next dose increase.
Thanks! I’m pescatarian….i started the 25mcg levo last Wed (6 Dec) immediately after my medicheck blood test which showed the raised tsh. So it’s only been a week.
As a pescetarian you will always struggle with a low iron level. Many members have done well raising their ferritin with this product. It has a terrible website but the product seems to work.
Thank you. Also, now do you think there Is there any point in seeing a private endocrinologist in the light of my medichecks blood results? I’m not sure they would suggest anything different to what the GP is doing.
At this point in time seeing a private Endo wouldn't contribute anything. You are taking Levo and made a start on treatment and there is nothing to be done to hurry things along other than the passage of time.
Get bloods done in 6-8 weeks and adjust dose then, post results in a new post for members to comment.
In the mean time be working on low vitamin levels as per recommendations here.
When you are much closer to being optimally medicated on Levo you can then review any requirements for added T3, its far too soon to be thinking about that yet as it complicates issues and you may not need it even. The majority of hypo people do well on Levo alone and getting vitamins to optimal levels.
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Help with medichecks blood results please.
Help with blood test results please
Results Advice Please
Can you help with new thyroid blood test results, please 
