Bit of history: started levo 50mcg in may 2023 after being diagnosed with sc hypothyroidism…so…
Medichecks test done 22 Aug 2023:
t4 14.3 (12-22)
t3 3.5 (3.1-6.8)
tsh 2.830 (0.27-4.2)
tgab 262 (0-115)
tpo 12.5 (0-34)
I sent those results to practice and triage nurse booked for an NHS test 4 Sept 2023 to check results because I didn’t feel well and symptoms came back.
t4 9.8(7-17)
tsh 1.96 (0.20-4.50)
Gp agreed a trial of. small increase. I increased to 75mcg (Wockhardt and Teva) and felt great after a bit of a rocky start, then after another couple of weeks started to feel not so good (on and off) - fatigued and achy again with pains in back and thighs same as i had before starting the levo and thought I probably might need another increase based on how I was feeling, but things settled again so I think it may have been related to periods.
NHS blood test 21 Nov 2023 (0830-ish, fasting, levo not taken until after test )
t4 13.8 (7-17)
tsh 0.10 (0.20 - 4.50)
************
LATEST BLOOD RESULT FROM MEDiCHECKS today to check on progress:
Taken at 0730 am, fasting, only water prior to test, not on biotin, last levo 24 hrs before test.
CRP - 3.6 (<3) medichecks doctor said this was high. Do you think it is too high?
Folate 45 (>7)
B12 active >150 (37.5-188)
vit d 82 (50-250) increase from 70 last nhs test (on vit d and k oral spray daily)
ferritin - I’ve been working hard on improving this through diet as it was 30 on last nhs test. I’m disaapointed because it’s Now 21.4 (30-264). My periods have been loads lighter and shorter since starting levo. I’ve been eating chicken liver pate twice a week, red meat, leafy greens, fortified cereal, fortified drinks, dark chocolate. I had a full blood count with NHS and I’m not anaemic. No obvious bleeding and I did a stool test for blood a couple of months ago and it was negative.
TSH 0.187 (0.27-4.2)
Free t3 4.2 (3.1-6.8)
free t4 17 (12-22)
TGAB gone up from 262 to 311 (0-115)
tpo 14 (0-34)
Notes from reporting gp on thyroid tests:
medichecks doctor gave advice and advised follow up with gp re: ferritin, crp and thyroid stuff. And also an iron supplement and test again in 12 weeks.
**I’ve seen the oral iron spray and wondered if that would be any good/ok as the vit d spray seems to be working for me?
Then the medi gp said
“Your tsh has reduced to 0.187, whilst your T3 and thyroxine are stable. This suggests your current dose of Levothyroxine may be too high.”
Eh?
they recommended following up with gp and maybe repeat test in a further 4-6 weeks, or if i have any symptoms like palpitations, anxiety, weight loss, tremors, loose stool, to consider decreasing the dose slightly.
I haven’t got any of those issues mentioned. I don’t actually feel too bad! Still not at all 100%, but I’m not really expecting that anyway. I get achy and tired but better than before levo and I am doing a bit more activity-wise than I was. Lots of symptoms have got better - less ibs attacks and cramps (not had to take meds for weeks!), less attacks of raynauds, constipation loads better, tinnitus completely gone, ear pain gone, hair not as dry. My weight is totally unchanged - goes up and down by 100g!!.
**I don’t think the levo dose is too high?? Do you?
“Your thyroglobulin antibodies remain positive.These antibodies are found in 1 in 10 normal individuals but can be associated with uncommon autoimmune thyroid diseases, especially Hashimoto’s disease.”
**So…does it mean Hashis or not? Bit confused.
Grateful for any further advice please
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Your TSH may be very slightly under range, however:
Free T4 (fT4) 17 pmol/L (12 - 22) 50.0%
Free T3 (fT3) 4.2 pmol/L (3.1 - 6.8) 29.7%
So in my book you are not over treated and likely need more Levo.
Your conversion isn't the best but yuo still need to get your FT4 much higher before deciding if theres further you can do with FT3.
B12 & folate look good.
D3 could be a teeny bit higher. Perhaps an extra spray every other day.
Have you had a full iron panel? This should be done before deciding if you need to take iron supplements in case your iron level is high which is possible.
Ferritin can be notoriously slow to increase - think year to 18 months.
Positive Tg antibodies do mean autoimmune hypothyroidism (not uncommon at all) and yes Hashimoto's so would be worth you trialling a strictly gluten free diet if you haven't already.
CRP is only fractionally raisied and not likely to be of any significance to anything.
Thank you so much for your reply, Jaydee. I appreciate it as I’ve been worrying about it all. I definitely don’t feel over medicated. I know my Gp won’t allow more levo with the tsh as it is. They were reluctant to increase when the tsh was 1.9. I don’t know what else I can do because if I make an increase of my own the tsh will go ever lower and next time my gp will definitely try to decrease my dose. I don’t feel too bad at the moment, but could be better. I’m mad that my tsh has dropped so flippin low on 75mcg when others see their tsh go up! Fuming! 🤣Ah well.
I’ll increase the d spray as you suggest. Blimey…I didn’t realise ferritin took so long to increase!! I haven’t had an iron panel…I don’t think so. I’ll have to look. Thanks for tour comments on tgab and crp. They were worrying me as the go note started going on about cardiovascular risk and frightened the living daylights out of me! I feel much better now. I’ll look at gluten free. I had a negative coeliac and otc gluten test, but i’ve seen on here how people say it made a difference for them.
You could try adding in some vitamin C or make sure you drink orange juice when you have your pate. It helps it to absorb better.
Other than that get the iron panel run just to double check levels before starting an iron supplement. A level of 21 must be making you feel awful in itself and won't be helping conversion.
You might have a fight to stay on the dose you are on but you can always quote the NICE guidelines:
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility”
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
Orange juice! Oh yesss! I forgot about that altogether. I’ll get some tomorrow. I think if I could improve the ferritin level that would help all round. I don’t know why it has dropped from 30 to 21…I don’t feel any worse than I did and my periods that were massively heavy are now a lot lighter and not as long since starting levo. I have had differences in results from nhs and medichecks though before .
As far as the gp is concerned they won’t even bother to test the tsh and t4 again probably until November. Last time I asked them for a blood test as I felt I needed an increases I ended up in an argument with the triage nurse. I’ll have to get another medichecks done in a few weeks to see how the land lies. Thanks for your help x
I’m on a mission now! Just had my orange juice with my pate. Had some dried apricots. Bought some spinach for tea. Bought some horlicks that has iron in for a drink at night. I’m cutting down coffee to 1 a day instead of 3! But not having one in the morning. I’ll have the orange juice then instead. I’m having all bran for breakfast which is fortified, but I read that wheat…or it might have been bran also affects absorption (my memory is shocking!) do you know anything about that Jaydee? Because when I looked up iron-rich foods it always says fortified cereal? Do you think All bran is ok? I’d like to carry on with that because it helps keep things moving along, shall we say.
Thats interesting as fortified cereal is as you say a recommended source of iron which can contain bran, never mind if the fortified cereal you prefer is All Bran.
So maybe you're not absorbing as much iron due to it's source, however the good news is that taking ascorbic acid AKA vitamin C counteracts that.
If you get fed up with drinking orange juice all the time then you can buy a separate vitamin C supplement.
Thank you for checking, Jaydee. It’s interesting and odd isn’t it. All Bran has a really good dose of iron in it per serving. I really think vit c/orange juice will definitely make a difference for me.( Thanks for your reminder about that). And cutting down the coffee. I only started drinking it before hypo diagnosis when the constipation was horrendous. Thankfully, much better now. I think I could probably phase it out and change over to something else. I’ll have a look at what else is available.
Bran is known to strip nutrients from the bowel. If I recall it’s the phytic acid it contains that does that. Might be preferable to use something else to ‘move things along’. There are any number of ‘good’ things to replace bran in the diet, which are not harsh to the gastrointestinal tract.
Yikes! Thanks for the info. I will definitely get something else. I think the moving things along constipation issue may have been due to the hypo anyway. I went on the all bran because of that, and because of its iron content. I’m going to try porridge again and add prunes or apricots, something like that
Ordinary oats porage did not work for me, even though I am Scottish. I find buckwheat porage much more palatable, also gluten free. I grind it in my Vita mix with no problem. Lovely with nuts and seeds (great for gut micro biome) and or fresh or frozen fruit. I may be boring but I feel it’s a real treat and it keeps the constipation away.
Thank you for this! Doesn’t sound boring to me! Sounds lovely. Remember…you’re talking to someone who’s been eating All Bran which is basically shredded cardboard! 🤣 It’s hard to know what to go for so great to have some ideas and suggestions. I was reading earlier today about buckwheat. I’ll have a look in the gluten free stuff tomorrow and see what I can find. There’s also a smooth version of oats that I saw which I think must be like Ready Brek…it can be made with water and contains about 5mg of iron per serving so I’ll have a look at that too.
Iron in All bran appears to be just that - iron. So absorption will require the pieces of iron (obviously very fine) to be reacted with an acid in order to be absorbed.
thanks HSD. I think porridge started to give me ibs cramps…but now I think about it, it may have actually been the hypo that was the issue back then. I’ll give it another try.
Just sitting here…overthinking stuff as usual…Jaydee, do I need to drink orange juice wirh every meal? Also, I’m on ppi omeprazole which won’t be helping the absorbtion , but I try 3 or 4 times a year to come off it, but by tea time the acid is very bad. I’ve been on it for years and I now suspect the reflux was really hypo related all along as the scope didn’t show anything at the time and they stuck me on omep which I was grateful for back then because I didn’t know any better. So…I still need the omeprazole. I usually take my thyroxine about 4am, and then the omeprazole before breakfast. I was wondering if changing the time of the omep to say 10am might help with absorbing more iron from all the daily meals? Do you have any advice on this, or know any members who I can tag who might?
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