Desperate for direction

[Bluekipper]

I am diagnosed hypothyroid. I take 75mg levothyroxine a day.

i have had my latest thyroid results from Monitor My Health. I think they use NHS ranges.

15/01/2024

3.7 pmol/L

FT3 levels normal (normal range 3.1 - 6.8 pmol/L)

thyroxine

15/01/2024

16.4 pmol/L

FT4 levels normal (normal range 12 - 22 pmol/L)

TSH

15/01/2024

1.45 mu/L

TSH levels normal (normal range 0.27 - 4.2 mU/L)

VITD- 105

15/01/2024

HB

153 g/L

Normal

FERRITIN

15/01/2024

139 ug/L

Normal

TSAT

15/01/2024

27 %

Normal

ACTIVE B12

15/01/2024

78 pmol/L

Normal

FOLATE

15/01/2024

5.1 ug/L

Normal

I ALSO TAKE SERTRALINE. 100mg p.d. I have been taking that and Levi together in the morning for convenience.

Right now i feel absolutely floored. I took a short course of Metranizopole to treat infection following a tooth extraction. Just feel that i want to be in bed all day.

If anyone can comment on my results i would appreciate it. Thankyou

[pennyannie]

Hello Blue Kipper -

Please amend your post to read hypothyroid -

Press the ' More ' tab and go into edit post :

[Bluekipper in reply to pennyannie]

appreciated

[SlowDragon Administrator]

First thing is to start taking levothyroxine correctly

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach, on its own and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

Suggest you change to taking at bedtime, then retest in 6 weeks

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)

If take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Some supplements and medications like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

What vitamin supplements are you taking

Folate is low

[SlowDragon Administrator]

You are likely not on high enough dose Levo unless extremely petite

How much do you weigh in kilo approx

Guidelines on daily dose levothyroxine likely to be required is approximately 1.6mcg per kilo of your weight per day

Also which brand of levothyroxine are you taking

Do you always get same brand at each prescription

Also

Is your hypothyroidism autoimmune?

Have you tested BOTH TPO and TG thyroid antibodies

[Bluekipper in reply to SlowDragon]

My weight is 85kg… my antibodies were tested at one stage in 2018 and were less than 10 for TPO and less than 9 for TG.. does it mean it is autoimmune even if quite low figures? Thanks so much for your help. I will increase folate. Does my B12 look low? Maybe i should try NDT as someone said maybe I’m not converting to T3 well?

[SlowDragon Administrator in reply to Bluekipper]

Did you test as recommended?

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)

I would retest in 6-8 weeks after taking Levothyroxine correctly ……….and improving low B vitamins

Then you may have room to increase levothyroxine as the next step

You may eventually need T3 prescribed alongside levothyroxine if Ft3 remains low

You might get this on NHS ….eventually

Or if looking at NDT …..it’s a financial commitment and all but impossible to get on NHS

[Bluekipper in reply to SlowDragon]

I did all you say save taking last dose of levothyroxine 24 hours before. I had taken it 8 hours before! I have ordered the suggested Bvits and will get a thyroid test from mediceks. You have been a great help.

[pennyannie]

Hey there again :

Are you referring to Metronidazole - for the tooth extraction and how long ago was this and do you think this the cause of whatever is going on now ?

Levothyroxine - or any thyroid hormone replacement for that matter - is a very fussy hormone - and should be taken on an empty stomach with a glass of water and you need to wait around 1 hour before you eat or drink anything.

So - first off I wouldn't take the anti depressant at the same time as the Levothyroxine :

Maybe switch one or the other to before you go to bed ?

How long have you been diagnosed hypothyroid and do you know if your antibodies were checked and that you have an Auto Immune Thyroid Disease ?

No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal levels :

Your folate and active B12 levels look a bit low -

I now aim for folate at around 20 with active B12 at 75 ++ and that being around 125 - with a ferritin at around 100 and vitamin D at around 100 :

Once on thyroid hormone replacement the TSH is the least reliable marker and generally we need the TSH under 2 with many of us feeling better when the TSH is under 1 and towards the bottom of the range :

We generally feel best when our T4 is up in the top quadrant of its range with the T3 tracking slightly behind at around 60/70% through it's range.

So your T4 is at just 44% through its range with your T3 coming in at just 16 % through it's range - so in the first instance I would think you need at least one dose increase in Levothyroxone.

What dose are you currently taking ?

Increases are generally by 25 mcg a day and then a further blood test to track your levels at around 6-8 weeks when hopefully you will have experienced some relief of symptoms and the whole routine repeated again until your thyroid hormones have built up to a decent level and hopefully you have relief of the hypothyroid symptoms being experienced.

[Bluekipper in reply to pennyannie]

The metronidazole was a 5day course. I finished it a week ago. Dentist asked what medication i was on before prescribing of course. Official line is that no issues in taking antibiotics with levothyroxine. However there are plenty of anecdotal reports online about a collapse in energy following short course of antibiotics in a hypothyroid patient.

I am currently on 75mg pd Levo.

Do you have any recommendations for B12+folate supplements?

Thanks so much for your reply.

[pennyannie in reply to Bluekipper]

Yes - I know the official line and choose to go with the wealth of experience on this forum from members who have experienced similar and suggestions as to what to do going forward.

I take Ingennus Super B complex but there are many option available.

You can't know about your conversion until your T4 is up in the top quadrant of the it's range and you have a decent store of this thyroid pro-hormone to convert into T3 the active hormone.

Without ranges it's difficult to rule in or out the thyroid antibodies but from memory I think both these look low so guessing ok.

[TiggerMe Ambassador in reply to Bluekipper]

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[Bluekipper]

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[helvella Administrator]

To make clear for anyone following, there are no NHS ranges for most tests - and especially not thyroid tests.

These tests vary by lab.

You really do have to check them each time you have a test.

For Monitor My Health, if you make the window of your browser narrow, the display changes from a graph to a text box which (for most tests) shows your result and the range (reference interval).