I’m on 75 mcg Levo per day, increased from 50 mcg per day 5 weeks ago. My symptoms (heartburn being the most noticeable) were getting less since increasing the dose. Now that I’m approaching my 6 weeks blood test, my symptoms are getting worse again. Is this normal?
Most recent test results from 08Jan24, not taken Levo 24 hours prior:
TSH 1.53 (0.27 - 4.20)
FT4 12.7 (12 - 22)
FT3 3.2 (3.1 - 6.8)
Iron 16.2 (6.6 - 26.0)
TIBC 70 (41 - 77)
Transferrin saturation 23% (20 - 55%)
Ferritin 14 (13 - 150)
Little bit of background; I tried NDT in December, which made my FT4 too low and that’s when my heartburn kicked off. Test results from 19Dec23, NDT taken about 4-5 hours prior) :
TSH 0.75 (0.27 - 4.20)
FT4 12.4 (12 - 22)
FT3 4.6 (3.1 - 6.8)
I’d love to know what’s going on
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Now that I’m approaching my 6 weeks blood test, my symptoms are getting worse again. Is this normal?
Yes perfectly normal……shows your body is getting ready for next 25mcg increase in Levo
Get bloods retested 6-8 weeks after each increase (or brand change) in levothyroxine
Which brand of levothyroxine are you currently taking
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)
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
SlowDragon thank you, really good to know this is not out of the ordinary.
I'm currently taking Tirosint.
Will do test as early as possible in the morning.
I had a hemithyroidectomy 5 years ago, after which I became truly hypothyroid but my doctor told me, based on old blood tests (and symptoms maybe) I'd been hypo for much longer.
Supplements:
Omega 3 fish oil (Nordic Naturals) 1/day
Beef liver (Gains Nutrition) 1 caps / day
Vit E complex (Cytoplan) 100 mg / day
Ionic magnesium chloride (Good State) 300 ml / day
Calcifediol (D.velop) 10 mcg / day (type of vit D)
Vit K2 MK7 (Vitamaze) 140 mcg / day
Emulsified vit A palmitate (Biotics Research) 600 mcg / day
Apple Cider Vinegar w mother (Nutravita) between 600 - 1,800 mg / day
Benfotiamine B1 (Doctor's Best) 150 mg / day
Riboflavin B2 (Health Leads) pinch, as needed
Methylfolate B9 (Ethical Nutrition) 50 mcg / day
S boulardii (Klaire Labs) micro dosing daily
Gaviscon Advance - as needed, typically 2 - 4 tabs / day
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Any obvious reason for ferritin deficiency….apart from being left on ludicrously low dose 25mcg levothyroxine too long
Approx age?
Pre or post menopause
Vegetarian or Vegan
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
strongly recommend you get B12, folate and vitamin D levels tested too
Have you retested ferritin levels yet - no, will retest next week, with my other tests. I've started being more careful to not have magnesium supplements within 2 hours of eating meat, so that maybe that can help my ferritin. From what I've understood, magnesium can prevent absorption of iron, so maybe this can help. I try to not have calcium within 2 hours of eating meat either, but I've just had to take a post dinner Gaviscon again.
You were vegetarian…..but now eating meat? - indeed. My iron is finally in range again.
GP should be doing full iron panel test to investigate your ferritin deficiency - will do full iron panel next week. I've read that taking synthetic vit A and / or vit D can affect iron status, so I wonder if there might be something there? I take both.
My serum B12 is often too high, so I don't supplement with that. I had B6 toxicity in 2022. I wasn't supplementing that much, but I had diarrhea daily (now much, much better), which can lead to low intracellular B6 and high serum B6, from what I've read. So I don't take B6 anymore either. I don't feel right when I take it.
Any obvious reason for ferritin deficiency….apart from being left on ludicrously low dose 25mcg levothyroxine too long - possibly vit A / vit D supplementation. Heavy periods (stage 4 endometriosis). Leaky gut. Mold toxicity (hoping to move in net few months, new house is being mold remediated atm).
Approx age? 45
Pre or post menopause - pre
Vegetarian or Vegan - no
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. - I have MCAS (possibly due to mold toxicity) and am hypersensitive to supplements etc. I've tried pretty much every iron supplement under the sun and can't do any, hence why I started eating meat again. I didn't want to but seeing my iron level go up, told me I shouldn't stop eating meat.
Eating iron rich foods like liver or liver pate once a week - I take 1 liver supplement per day, am too sensitive to do more unfortunately
plus other red meat - eat plenty of beef, pork, red poultry etc
pumpkin seeds - every day
and dark chocolate - definitely every day, 100% cacao
plus daily orange juice or other vitamin C rich drink can help improve iron absorption - I eat plenty of fruit, e.g. blueberries, raspberries, apples, bananas, grapes. I don't do too well w citrus fruits, possibly mast cell issue.
Thank you so much for all the links, I hope to get through them all this week. I much appreciate all your help!
SlowDragon you’re very kind, thank you. I feel like I’m only just beginning to learn about hypothyroidism. I’m happy to be part of this group, I’m learning a lot here.
Hi SlowDragon , I've just received my thyroid test results. May I ask you to please take a look for me? Curious re my low-ish TSH and my heartburn.
***14Mar24 (75 mcg Levo per day)***
TSH 0.58 (0.27 - 4.2)
FT4 16.5 (12 - 22)
FT3 4.2 (3.1 - 6.8)
Using the information I've found online, for most people to feel their best, FT4 should be midrange (17) or a bit higher, so here's a bit of room for improvement still. FT3 should be upper quartile of the range, so ideally above 5.9, so definitely room for improvement here still.
What I can't figure out, is why my TSH is quite low? Might this have anything to do with the fact I took NDT in December? Might this be related to my stomach acid? It's been bad. Or do I maybe simply need to increase my dose from 75 mcg to 100 mcg per day?
Quick re-cap of my test results around that time:
***19Dec23 (on NDT)***
TSH 0.75 (0.27 - 4.2)
FT4 12.4(12 - 22)
FT3 4.6 (3.1 - 6.8)
***08Jan24 (on 50 mcg Levo per day) ***
TSH 1.53 (0.27 - 4.2)
FT4 12.7 (12 - 22)
FT3 3.2 (3.1 - 6.8)
***Other interim test results from today (14 Mar 24)***
Iron 14 (6.6 - 26) - down from 16.2 on 08 Jan 24*
TIBC 65 (41 - 77) - down from 70 on 08 Jan 24*
Transferrin saturation 22 (20 - 55) - down from 23 on 08 Jan 24*
Ferritin 21 (13 - 150) - up from 14 on 08 Jan 24**
25OH vit D 89 (50- 200) - was 84 on 08 Nov 23
B vitamin panel and mineral panel are both pending.
*It is worth noting I had finished my menses on 29 Dec 23, before my blood test on 08 Jan 24. My menses has just started on 11 Mar 24, so just days before today's blood test. Perhaps this has influenced my test results.
**I've been keeping at least 2 hours between eating meat and taking magnesium supplements / consuming dairy.
TSH is pretty unreliable, I'd be guided by your frees, you are right that an increase is needed perhaps 12.5mcg per day to sneak up on your optimal results
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Increase levothyroxine or add liothyronine 
No improvement with Levothyroxine increase
Latest medichecks results - would welcome your advice as to the next step to take - thank you
Blood results advice - should I increase my NDT slightly? 
Increase needed but do I increase T4 or T3?
