Update on my post earlier this week. Re Private GP advice - due to under medication.

[Cat_bluenote]

Results from blood tests on Wednesday.TSH 6.87 (0.4 - 5.4)

T4 13.1 (11.5 - 22.7)

Assuming my GP will now agree to give me an increase! 🤞 I'll go prepared.

I think I'll still end up needing some help to get to an optimal level, at some point in the future. So grateful for all your support and information. It means a lot. Thank you 🙏

[pennyannie]

Hey there again ;

With a TSH now over the range - l can'r see your doctor not agreeing to a dose increase -

so let's hope this happens and you can at least move forward one step at a time -

and we will help you further along the way -

[Cat_bluenote in reply to pennyannie]

Thanks. I feel like I know now what should be happening, and I'm determined to make it happen and get well.

[SlowDragon Administrator]

You need increase of 25mcg per day …..so as currently on 25mcg and 50mcg on alternate days ….up to 50mcg and 75mcg on alternate days

Initially you might want to go to 50mcg daily

Wait 6 weeks

Then increase again and retest 6-8 weeks later

But you don’t need to share that information with GP

Which brand of levothyroxine are you currently taking

Many people find different brands of levothyroxine are not interchangeable

You will need further increases in dose over coming months

TSH should be under 2 as an absolute maximum when on levothyroxine

Most people find when Ft3 and Ft4 are at least over 70% through range then TSH will be around or under 1

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

Meanwhile get vitamin D, folate, ferritin and B12 tested and maintain OPTIMAL levels

[Cat_bluenote in reply to SlowDragon]

Hi Slow dragon, thanks for the links - Interesting reading. I'm currently on Teva (Hillcross) since November. Teva was the first brand I was given, then it changed to Mercury pharma, then Wockhardt for a few months. I haven't really noticed any difference, between them. It's so hard to tell when you have various symptoms anyway. I'd rather have one with the least ingredients really. It did make me wonder if the change to Teva could have made my TSH go up from 5.2 to 6.87? I'll never know, ( but it really would better if we could stick to a brand, especially when trying to get stable), it would take away the guessing. I don't feel I can ask, when I don't actually get noticeable physical symptoms.

I also upped my iron supplementation in December, but always taking 8 hours after Levothyroxin, so hope that shouldn't have affected it.

Obviously I need the increase in Levothyroxin anyway.

I've ordered advanced thyroid test from Medichecks, but I m going to wait 6 weeks, so I can check T3 and T4 after increase in meds. I'll carry on supplementing with D, B12, folate and ferritin in the meantime. Thanks again.

[SlowDragon Administrator in reply to Cat_bluenote]

I'll carry on supplementing with D, B12, folate and ferritin in the meantime.

Rather than B12 and folate …..a vitamin B complex would keep all B12 vitamins in balance

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily 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...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

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) and continue separate B12 until over 500

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Cat_bluenote in reply to SlowDragon]

Thank you , that's really helpful. 👍

[McPammy]

Your GP should now increase your levo dose. However, you could do with checking your T3 level also.

[Cat_bluenote in reply to McPammy]

Thanks. My last T3 check in October was low. I've purchased a T4/T3 test from Medichecks so I can check again in a few weeks.