TSH has gone very low T3 normal and T4 upper end of normal but I feel worse than ever on 100mg Levothyroxine. Any suggestions

[ChilliBangBang]

I have been taking Levo for 5 months, 10 weeks at 50mg and 10 at 100mg after a diagnosis of hashimotos (TPOA level at 135kIU/L)

I have just had my bloods tested ready for my appointment later this week and the results are:

TSH is 0.075 mIU/L (0.27 - 4.2)

T4 is 21.7 pmol/L (12 - 22)

T3 is 4.3 pmol/L (3.1 - 6.8 )

Ferritin is 39.8 ug/L (30 - 264) - highest I think I have ever had!

Folate is 45.4 nmol/L ( >7 )

Active B12 is 60.9 pmol/L ( >37.5 )

Vit D is 67.8 nmol/L (50 - 250 )

On the face of it, my vitamins and iron are pretty good (for me)

Why do I feel so shocking and symptoms are as bad if not worse than ever (Fatigue, brain fog, itching, constipation, waking up throughout the night, awful joint pain, swollen legs, puffy face - the list goes on)

Before my diagnosis I often said to my husband that my throat felt as though I was going to get tonsillitis, not really painful, just not quite right. Now I have a constant lump in my throat that makes swallowing uncomfortable.

Can any one help with what I should be discussing in my appointment this week please?

I also take Vitamin D, selenium, folate, calcium, zinc, omega 3, magnesium complex (Bisglycinate, citrate and malate), a pro and prebiotic supplement as well as natural yoghurt and homemade granola to up fibre intake.

Thanks for taking the time to read.

[TiggerMe Ambassador]

So you aren't converting very well, your Vit D needs bumping up to 125nmol/L if you put your details into this calculator it will tell you what you need to take for this to happen... grassrootshealth.net/projec...

Your ferritin is way down as is your active B12 which wants to be nearer top of range 150

It could be that cutting out dairy will help to lower antibodies

You may need to revisit your HRT regime

[SlowDragon Administrator]

B12 too low

Rather than just folate

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later stop separate folate and instead 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

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Great reply by @humanbean on B12 here

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week

Post discussing different B complex

healthunlocked.com/thyroidu...

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 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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-supplement until Active B12 over 70-100

[SlowDragon Administrator]

Which brand of levothyroxine are you taking Is

Do you always get same brand levothyroxine at each prescription

Was test early morning, ideally before 9am, only drinking water between waking and test and last dose Levothyroxine 24 hours before test

Are you on strictly gluten free diet

How much vitamin D are you taking

Is it mouth spray or tablets

Ferritin is still far too low

Are you 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

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

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

List of iron rich foods

dailyiron.net

[ChilliBangBang in reply to SlowDragon]

Thanks for your reply.

Im taking Accord brand, always the same brand so far.

Test was first thing in the morning, around 7am, nothing at all from waking to taking the test and 24 hours since my last dose.

Not gluten free (only gluten reduced)

1000mcg vit D oral spray

Taking Spatone iron supplement on advice from doctor but not had a full iron panel for a long time so will arrange this. Was still taking the supplement the full week of the blood test as didnt know to stop - will do this next time. I always take the supplement with juice and have pumpkin seeds, flax seed and almonds every day but will try to up the iron intake. I am not a vegetarian so eat meat regularly (although not liver pate as the thought makes me feel quite ill!)

Will arrange a B complex and B12 - capsule size doesnt bother me, the number of things I am taking these days I have become quite good at taking them!

Thanks again