I have posted a few times in the past - more recently about my private dr suggesting T3 medication route. After getting advice on her I decided not to pursue that at this time and instead titrate my T4 / Levo up a step (from 50mcg to 75mcg daily) - have just done blood test after 8 weeks (a bit later as have been away) and wanted to gain some advice on the results and whether it’s looks like my issue is conversion. Previously I had gone from 25mcg to 50 mcg and there was little change in my TSH. I cut out eggs and peppermint tea as read this can have an impact, and am trying to focus on sleep management, diet and restorative exercise as much as possible. Antibodies are still out of range as well but a small improvement.
The most recent results show I’m now low in Vit d so I’m aware that will need addressing.
Attached picture is my recent results and I will post previous ones in a comment below.
Thanks
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Gosierunn
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Just checking, are you allowing 24hrs from last dose of levo & blood test?
What time are you taking your blood test?
We need OPTIMAL levels of vitamins for our thyroid hormone to work well.
my interpretation.
Ferritin should be around 90 - 100 for best use of thyroid hormone. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc
Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150.grassrootshealth.net/projec...
B12 is far too low. Suggest you start a good quality methyl B complex to help keep all the B's in balance.
B complex suggestions: Slightly cheaper options with inactive B6:
I know. I just have been focused on the Levo and not wanted to introduce too many things in one go. My Vit D have been in range up to now - and honestly k get so overwhelmed by what supplements (eg ingredients and brand) and combinations (eg Vit k with bit D) that I just end up feeling stuck!
wanted to gain some advice on the results and whether it’s looks like my issue is conversion.
I would say it most definitely is, yes.
FT4: 18.6 pmol/l (Range 12 - 22) 66.00%
FT3: 3.7 pmol/l (Range 3.1 - 6.8) 16.22%
Percentage-wise, the gap between your FT4 and FT3 is much too wide. With an FT4 of 66% your FT3 should be at least 60% if not higher, if you converted well.
You still have room to increase your levo, of course, but I rather doubt that is going to raise your FT3 enough to make you well.
It's not just your vit D that is too low. Your ferritin and vit B12 are also too low. Optimising them might help your conversion, but as you have Hashi's, it probably won't help enough. Hashi's people are just poor converters.
Don't fixate on your antibodies. Once you know that they are positive there's no point in retesting them because the actual number is irrelevant. It doesn't give you any useful information. And even if they disappeared altogether, you'd still have Hashi's, that doesn't go away. It's not the antibodies you need to worry about!
Previously I had gone from 25mcg to 50 mcg and there was little change in my TSH.
Well, we're really not that interested in the TSH, are we. It's not the most important number, the FT3 is. And as you're a poor converter, and increase of 25 mcg levo is not going to increase that very much, and therefore your TSH will stay high.
I cut out eggs and peppermint tea as read this can have an impact
And impact on what??? I've never heard that before. Can you link us to where you read it, please? I'd be curious to read it.
Thank you for this. Can’t remember where I read the eggs thing, saw a post on here about peppermint tea… clutching at straws I suppose, but I’m willing to try anything! The impact was on conversion though…
Thing is at the moment, I don’t feel really unwell - energy levels are ok (I have young children so sleep doesn’t always happen!) so am wondering if it’s worth perusing the vitamins (as suggested by post above) before I start on T3 - I’m conscious that the overwhelming advice on here previously was that trying to get optimal results with T4 is preferable over introduction of t3 where possible.
My antibodies were at 2000 when k was first diagnosed and have read a lot about the impact of lifestyle changes on reducing antibodies and feeling well so I’m not sure I agree with that aspect and will continue to keep testing.
Well, as I said, I've never heard of eggs or peppermint tea affecting conversion, but I rather doubt it. I've always eaten a lot of eggs and my conversion was always good, even though I couldn't tolerate levo.
the overwhelming advice on here previously was that trying to get optimal results with T4 is preferable over introduction of t3 where possible.
Oh, I agree! It makes life much simpler. But, with your numbers it's obvious that for you that isn't going to be possible.
am wondering if it’s worth perusing the vitamins (as suggested by post above) before I start on T3
I think it is, because the body needs optimal nutrients to be able to use the hormone you're giving it. Especialy T3.
As for antibodies, they don't cause symptoms. Yes, you will read a lot of conflicting opinions about them - and a lot of rubbish, too! But, the fact is that antibodies have a job to do cleaning up the blood after an autoimmune attack on the thyroid, they do it, and then most of them go away. Which is why they fluctuate. But they are not doing the attacking themselves. If people feel well after life-style changes, it's probably due to the life-style changes themselves, not to the reduction of the antibodies.
ok thanks - I think you commented on my previous post that at that point my FT4 was still only 44% through the range, and it should be more like 75% through before you can say with any conviction if I have a conversion problem. And, with a TSH over 4, you're a long way off optimising your FT4. To see how well you convert you need the FT4 a lot higher, and the TSH around 1.
I probably did say that, yes, it sounds like me. But now your FT4 is a lot higher but the FT3 has hardly moved. So, I think we've proved our point, don't you?
Do you think this means I absolutely should go on T3? I feel scared about taking it! And I’m unlikely to get it on NHS so will have to pay for it, which isn’t ideal.
I think some of the nhs not prescribing stuff has affected me probably. But I have heath anxiety and have read some descriptions of folks taking it and having increased heart rate (to the point of going to A&E) and honestly that frightens me.
Yes, you're always going to read horror stories, but that doesn't mean it's going to happen to you - or even that it actually happened to the person telling it! Myths are rife. I've been taking T3 for many years and never had an increased heart rate.
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
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
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 can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
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
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
Post discussing how biotin can affect test results
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.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
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).
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