Hi, I'm 55 and have had hypothyroidism for approx 30yrs. My current thyroxine dose is 112.5mcg daily. My TSH bounces up and down along with my weight and the GP keeps switching my thyroxine dose as a result. It's making life difficult swinging between hyper and hypo every few months and I have awful symptoms including hairloss on a regular basis.
I've recently had a blood test with medichecks and my gp has done one too. Im having a telephone consultation with him in a couple of weeks and would appreciate some help so I can get off this merry go round of going up and down. I'm struggling to concentrate at the moment, probably because I'm undermedicated. My medicheck test unfortunately came back minus the folate result which I'm told can often fail with fingerprick tests. I also have rheumatoid arthritis and am on Abatacept. As my appointment to speak to the gp isn't for a couple of weeks I've increased my thyroxine today to 125mcg as I have spare tablets.
Any advice you can offer would be really helpful. 😊
Medicheck results
CRP 1.84
Ferritin 79.9 (30-264)
Folate failed
B12 123 (>37.5)
Vit D 52.7 (50-250)
TSH 6.81 (0.27-4.2)
Free T3 3.9 (3.1-6.8)
Free Thyroxine 14.2 (12-22)
Thyroglobulin Antibodies 19.3 (0-115)
TPO antibodies 14.4 (0-34)
GP Results
TSH 8.38 (0.3-5.5)
FT4 14.4 (11.5-22.7)
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Levo is a very fussy indeed hormone, it pays to pay attention to how you take it.
Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.
What was your result when your GP said you were hyper? Actually they mean over replaced as not possible to be hyper when on Levo.
Your FT4 is only 22% of range at the moment but I suspect that there may be an absorption issue here. An extra 25mcgs Levo certainly shouldnt take you over replaced.
How are you taking your blood tests? Time of day is important as TSH varies throughout the day. Its highest at 9am or earlier.
Also very important not to take your Levo just before the test. Allow 24hrs between last Levo dose & test. Take it after the test that day, not before or the test will measure what you have just taken which looks like a lot on results.
Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).
Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.
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. Most people need a minimum of 3,000iu per day.grassrootshealth.net/projec...
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
Thanks for taking time to reply Jaydee 🙂 I've looked at your comments and will make the changes you've suggested. I was taking my thyroxine too close to breakfast so will take it earlier in future. I followed the blood test protocols so that's ok. I'll look into the vitamin D supplements today and work on my ferritin. My thyroid has been checked more regularly over the past couple of years at my request as I was dieting and as my weight reduces my TSH drops too. When my TSH gets too low my hair falls out. My gp changes my dose only when my TSH is out of range regardless of how I'm feeling. At my last change in March I argued for 112.5mcg but I've still gone out of range again. The figures I have are as follows
(Range tsh 0.3-5.5) (Range t4 11.5-22.7)
May 22 (tsh 0.1) (t4 21.4) gp said decrease to 100mcg
Aug 22 (tsh 2.57)
Nov 22 (tsh 3.51)
Feb 23 (tsh 3.67)
May 23 (tsh 9.37) (t4 14) gp said decrease to 125mcg
September 23 (tsh 0.34) (t4 20.1)
Jan 24 (tsh 0.53)
Mar 24 (tsh 0.22) (t4 21.4) gp said increase to 112.5mcg
Aug 24 (tsh 4.68)
Nov 24 (tsh 8.38) (t4 14.4) pending change so I've upped myself to 125mcg
Sorry if that's a lot of waffle but I was unsure how much is need to get a picture
Your GP is going by TSH alone which is never a good thing as can be unreliable despite what they think.
We do need to see a full thyroid panel to know if we are converting well and how much of T4 & T3 we have. Suggest once you've been taking Levo differently you buy a private test to check where you really are.
Some of your results, although no FT3 to check for conversion, are not too bad, like March 24 & May 23.
How much do you weigh as we can work out a very approx final dose for you by that?
Weight in kilos x 1.6 = approx final dose
As others have said, switching from a multivit to separate supplements - usually just D3+K2 and a B complex will be much better for you as higher dose and betetr quality vitamins.
I took a deep breath and got on the scales. My current weight is 94 kilos but this will come down as I'm on a reduced calorie diet. A lot of my problems do seem to happen as my weight fluctuates a lot. I'd be interested to know how often levels should be checked during weightloss. Should it be after say 2st weightloss as I have a few stone to lose.
A calorie reduced diet inhibits conversion of T4 to T3. Better to wait to get to your correct dose plus optimal vitamins and see what happens.
So your final dose will be approx 150mcgs and 100mcgs certainly wont be enough for you. Your FT3 on one test was low. Dieting will affect that as well as not enough Levo.
Thanks for that advice SlowDragon. I was wondering about this myself. I was taking the multivitamin on advice of my rheumatologist so I'll look into this. Yes I was taking them at the same time as my thyroxine.
I'm definitely changing what I've been doing. I just thought if I took my tablets each day it'd be OK but clearly it's all a lot more complicated than that.
Never, ever take nutritional advice from a doctor. They know nothing about it, they don't do it in med school. You might just as well ask advice of the person sitting next to you on the train, it's that random.
It's just shocking. I struggle so much with my weight and went to my GP for advice. All they say is go to weightwatchers or slimming world. Hopefully if I can get my thyroid and vitamins sorted I can feel well and stop yoyoing. I worked hard to lose almost 3st over the past year and then gained a stone since my hip replacement in July.
What they refuse to understand is that hypo weight-gain is not about how much you eat or exercise, it's a hypo symptom and is more likely to be due to water-retention that fat. And no diet or exercise routine is going to get rid of that! You need optimal thyroid hormone levels - and even then it's difficult. But they have no idea what an optimal thyroid hormone level looks like! And that it's nothing to do with the TSH, which isn't even a thyroid hormone. It's about the FT3, and getting that to the right level for you as an individual. They haven't a clue about all that.
Just a comment, a low TSH is not responsible for hair loss. The TSH is a hormonal feedback from your pituitary gland in response to you taking thyroid hormones. If your hormones go higher, the TSH goes lower and visa versa. However, please note that this feedback is very often not working properly in patients with thyroid disease, and your TSH can go low even when your thyroid hormones and not that high. This is why it TSH not a good gage for dosing your medication and your free T4 and free T3 values should really be the guide.
In general, an adult replacement dose is 1.6-1.8 mcg per kg of body weight. This is also documented in the NICE guidelines. So a person weighing 63 kg would need around 100 to 113 mcg levothyroxine (some might need more, if they have absorption issues).
Low Vitamin B's, low iron and low Vitamin D are all associated with hair loss. As your levels of these nutrients are quite low, this is most likely the reason for your hair loss. Once you are on a good supplementing regimen, this will improve.
As others have mentioned, multivitamins are not recommended, as they contain cheap ingredients which your body cannot utilise and you do not want to supplement with things you don't need (especially iodine and the iron will prevent the absorption of other nutrients).
Most people here take:
Vitamin B complex (containing methylfolate, as better absorbed) such as Igennus B-complex or Thorne B vitamins
Magnesium supplement (in the form of magnesium citrate, glycinate, maleate or taurate)
Vitamin D3 + K2 (3000IU Vit D is good start, then test again)
If you cannot raise your iron sufficiently enough through diet alone, there are iron supplements available, but you need to test regularly, as you do not want to go over range.
I know it is quite a lot of information to start with, but once you get into a routine taking your medicine and your supplements at a later time, it will become second nature.
Thanks for this Tina_Maria. I'm going to bin the multivitamins and look into the ones suggested. It does make sense that the hairloss is likely related to vitamin deficiency.
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