my latest test - I’m confused

[Kimmi01]

these are my latest results but I have been on 50mg thyroxine and vitamins (thyro complex) which apparently have amino acids to help the body convert t4 to t3 and although I feel slightly more human than I did a year ago, my nails, skin and hair are still a mess, not to mention constipation and I’ve been struggling with blepharitis as well for the past month. Can someone tell me, are these levels an improvement? And also, where do l go from here? Thank you in advance 😁

[TiggerMe Ambassador]

This is a starter dose which really needs increasing to 75mcg and rechecking in 6-8 weeks, your vits are good but it's unlikely the thyroid complex is the best thing for you as it probably contains an unsuitable cocktail

You received great advice on your post 8 months ago, worth re-reading... healthunlocked.com/thyroidu...

[greygoose]

FT3: 3.4 pmol/l (Range 3.1 - 6.8) 8.11%

FT4: 15 pmol/l (Range 12 - 22) 30.00%

Well, it's not working, is it. These things rarely do. In fact, they're usually a very bad idea because they contain things you don't need, like iodine.

You are a poor converter, but you're also under-medicated. Which isn't surprising on only 50 mcg levo. How long have you been on that dose? It should have been increased to 75 six weeks after starting it, because it's just a starter dose.

Impossible to tell you if your levels have improved because we don't have your previous levels. But your TSH is too high and your thyroid hormone levels are too low.

Folate, B12 and vit D are fine, but conversion isn't just about nutrient levels. There are many, many possible reasons for poor conversion, and the likelihood of you finding yours are pretty slim.

Where do you go from here? Well, first step should be getting an increase in levo to 75 mcg, waiting six weeks and retesting. You'll probably need a couple of increases to get your FT4 to a decent level.

[Kimmi01 in reply to greygoose]

Thanks so much, I keep getting fobbed off by the dr re increase so I’ll go and be confident now. This is last years results on 25mg , I don’t think there’s much in it even though I’ve been on 50 mg for about 8 months I think.

Last years results on 25mg

[greygoose in reply to Kimmi01]

Very few doctors really know how to treat hypo. They believe that as long as your results are somewhere within the range everything must be alright. They don't have much idea how to interpret blood test results, either! But you must be firm. You absolutely need that increase in dose.

[Kimmi01 in reply to greygoose]

Yes I’m having a lot of trouble trying to even get an appointment at my dr’s they have this new internet apt thing now and if you don’t try to get an apt around 6.30am when that opens, you have no chance. Also they get in different doctors so you never see the same person. It’s very frustrating. So fingers crossed for tomorrow 😂

[greygoose in reply to Kimmi01]

Sounds awful! It's cruel to make sick people jump through so many hoops. Fingers crossed indeed!

[SlowDragon Administrator]

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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

Some people need a bit less than guidelines, some a bit more

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

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).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

[Jazzw]

Your results—like your last set of results—show that you’re undermedicated for your hypothyroidism. Getting an increase to 75mcg levothyroxine should be your next ambition but remember to avoid Teva as it didn’t suit you last time.

Well done on getting your vitamin and mineral levels higher—but I suspect you won’t feel significantly better until your thyroid hormone levels are optimised.

[Kimmi01 in reply to Jazzw]

Thanks so much, I’ll try for the increase in thyroxine.

[SlowDragon Administrator]

Best to avoid any multivitamins and especially that are called thyroid “complex.”

Likely to contain iodine not recommended for anyone on levothyroxine

[pennyannie]

Hey there Kimmi :

Just to add please ensure any drops, sprays or ointments you use to ease the eye pain / discomfort - need to be Preservative Free - even those prescribed by the NHS -

Soak a clean flannel in hot water - wring out and lay down with the flannel as pad over your closed eyes - relax and gentle massage your eyes with your fingers - pressing gently down - especially around the lash base pressing gentle through the flannel pad.

This should release any debris blocking the tiny lacrimal glands and if you can repeat this process 3/ 4 times a day - over a few days - this should help :

Well done on the vitamins and minerals - everything is such a slow build - but things are improving but you need to increase your thyroid hormone replacement - as we generally feel best when the T4 is up in the top quadrant of its range as this should then - produce a high enough T3 to elevate the symptoms of hypothyroidism being tolerated.

Once on any form of thyroid hormone replacement the guidelines suggest the TSH should be maintained under 2 - and we generally feel better when the TSH is down under 1 towards the bottom of the range.

[Kimmi01]

thanks so much, I’ll look at that (thyroid) and try to insist on an increase. Blepharitis, I’ll ramp up the hot flannel as I’m only doing that twice a day. And I’ll add the drops/cream too. Thank you.

[pennyannie in reply to Kimmi01]

There are many OTC products to choose from - just ensure ALL are Preservative Free -

Over night I squeeze out a little from a tube of a much more dense, heavy duty preparation so you must use it last thing - before going to bed as your vision will be all blurry - but your dreams are still in Technicolour !!

[Kimmi01 in reply to pennyannie]

Hello pennieannie, what do you use? My outer eyelids are also so sore with all the washing (using baby shampoo). So it would be helpful if you know something more soothing. Thanks

[pennyannie in reply to Kimmi01]

Thankfully my issues are now not acute -

but I didn't use anything - other than water around my face and eyes -

I'd stop any shampoo around your face and eyes -

I now use Hydromoor Preservative Free individual unit dose eye drops - which I started buying from Moorfields Eye Hospital some 10 years ago -

then found them on butterflies-eyecare.co.uk -

and then managed to get on prescription though the NHS keep taking away from me -

and Hylo-Night Preservative Free eye ointment which I found very easily on the net -

[Pandora777 in reply to pennyannie]

I don’t have TED thank goodness but I am having trouble with eye twitching which is a sign my levels are slightly raised. It is driving me mad and I am wondering if any eye drops might help calm it down. I think people think I am winking at them which is quite embarrassing. lol

[pennyannie in reply to Pandora777]

I don't know - but can 2nd that eye twitch -

Sometimes my chopping up of my NDT is a bit ' off ' and not as accurate as it should be and just now - telling myself - I need a new pill cutter or eyes !!

[Kimmi01 in reply to pennyannie]

Thanks, it’s a great help to hear from someone else who has had it - I’ll try to get those and see if they help and I’ll stop the baby shampoo now. Thanks so much.

[pennyannie in reply to Kimmi01]

Just keep only with the eye massage routine as well so to try and stimulate the tiny lacrimal eye glands.

[Kimmi01 in reply to pennyannie]

Yes I will, I think it’s the inside ones that are blocked now in my left eye. Quite painful.