My thyroid is underactive, and i take 50mg of levothyroxine a day. I'm still fatigued, and slow to lose weight. I have been testing my adrenals and thyroid, plus other things (fasting blood glucose, iron levels, inflammation) to finally take control of my body and stop living like this!
My thyroid results show high TSH and low T3.
My cortisol strangely spikes very high in the morning - and comes down in the afternoon.
Thanks so much - yes i have coeliacs and thankfully not hashimotos (auto-immune thyroidism).
Test was taken first thing in the morning. B12 and irons tested very recently (within the last month).
I've been on 50 mg for a long time now (maybe 5/6 years). At one point my gp randomly started prescribing me 25mg, so i went with that for a while and felt awful!
If I have such low T3, i'd rather try NDT from a reputable online source - wouldn't this be a good idea? I have tried to ask for T3 through the GP, but its a big no.
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free, but contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
When adequately treated on just Levo aiming for Ft4 at least 60-70% through range
Insist to GP politely on 25mcg dose increase to 75mcg daily
List all your hypo symptoms
As you have been left far too long on far too small a dose of levothyroxine ……You might initially want to increase slowly to 62.5mcg daily for 4-6 weeks before increasing to 75mcg
Retest again in 2-3 months after being on 75mcg daily
hiya, thanks again for all the help SlowDragon and for taking the time out in your day to help!
I'd always thought: "I'd been taking Levo, and my T3 is always low, so it must be a conversion issue. " So am I right in thinking that the closer the % are (of T4 and T3 within their ranges), the more efficient the T4 to T3 conversion?
The thyroid adrenal tests were done in January 2025, just last month. I have a previous thyroid test done in 2018, which i've put above to compare.
I've definitely got the gist of the above, including asking my GP to gently increase my dose.
So am I right in thinking that the closer the % are (of T4 and T3 within their ranges), the more efficient the T4 to T3 conversion?
Correct, yes ……currently you have excellent conversion of Ft4 to Ft3 ……but both are low because you have been left of only standard STARTER dose
Guidelines are quite clear that dose levothyroxine should be increased slowly upwards until on approximately full replacement dose of 1.6mcg per kilo of your weight per day
Unfortunately many GP’s haven’t actually read the guidelines
And/or
They are frequently terrified of giving patients too much Levo…..and we see many patients like yourself left languishing on grossly inadequate dose
If GP is reluctant to increase dose, pander to their lack of knowledge and request a “trial” increase to 75mcg
I have a previous thyroid test done in 2018, which i've put above to compare.
so how much Levo were you taking in 2018 and what vitamin supplements exactly
Are you supplementing iron at the moment (or up through the test results you posted above?)
edit - you have an indicator of iron overload. With that in mind before anyone here can give insight into how you might address - need to know more about your iron history, if supplementing - how much and when, and if you are aware of how much iron you are ingesting.
One set of test results at one point in time - particularly with possible iron overload - does not tell us enough. Let us know what you can!
humanbean a few mixed results here … I’m not certain what it points to.
Ie,
High TSat ( 55.6%) usually a flag for iron overload. OP does not supplement or even eat a lot of iron rich foods. First thought hemochromatosis, but not given the low HB/rbc and low ferritin and the below.
I don’t see a transferrin number to help confirm it’s a false high, maybe I’m overlooking it, or should we just assume that?
So now we look for reasons for low iron profile -
CRP is also low… does this rule out inflammation-related anemia of chronic disease?
I see no stand out liver issues in the cbc, or not severe if any.
Maybe down to OPs celiacs and significant absorption issues and low transferrin production (if we can confirm that number.)?
And so SD - I waffled on whether hemochromatosis could be at play but backed off due to the low ferritin and cbc items. Should have left it as “unlikely” vs ruling it out.
If available, a genetic test would eliminate a variable.
As in the case of high tsat when transferrin and ferritin are low, one could decide to supplement since the high tsat is a false high. A hemochromatosis test may be the crystal ball to show why that may or may not be a good next step.
The other thing re the very informative link you posted is it starts with “Suspected celiac as a result of this iron deficiency anemia.”
I originally was thinking the other way around - the celiacs is causing absorption issue, ie, a metabolic “cause” for the issue, vs a liver/inflammation/other actual cause.
I throw all this out there - a little out of my depth but thinking humanbean may add a layer of clarity!
My Ancestry DNA test did reveal I have one genetic mutation (out of three?) suggesting possible haemochromatosis
my coeliac DNA test done by NHS after my endoscopy confirmed definitely gluten was an issue. Coeliac DNA test was inconclusive……things aren’t always clear cut
But at practical level cutting gluten out completely ……and subsequently dairy too ….both have given clear benefits
How would having Hashimoto's affect my treatment? Would it mean anything if i did have it?
Medics are generally disinterested as to cause of a patient’s hypothyroidism
But yes it’s important to know
As you have one autoimmune disease (coeliac) other autoimmune diseases are more likely
Autoimmune diseases often appear together
Assuming, despite negative antibodies, your hypothyroidism is autoimmune
An ultrasound might reveal more
With Hashimoto’s approx 5% have coeliac, but further 81% of us with hashimoto’s have (or develop) gluten intolerance
Dairy intolerance is also common, approx 50% find benefit of cutting dairy out
Early stage autoimmune thyroid disease…..levels can hop up and down a lot …..but, over time thyroid becomes more damaged until it stops functioning completely
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Well, that's what hypothyroidism is: high TSH, low FT4/3. And the way to raise your Free levels is to raise your dose of levo (T4). And once your FT4 gets up to about 75 % through the range, compare it to the FT3 to see how well you convert. You might need to add some T3 to your levo.
50 mcg levo is only a starter dose. How long have you been on it?
However, one would expect your TSH to be higher with such low Frees. So, what time of day was the blood draw for this test?
Absolutely no point in testing rT3, it doesn't give you an useful information. It will tell you if your rT3 is high, but it won't tell you why.
If I were you, I'd leave your cortisol alone for the present. Once you're on a decent dose of levo, retest it and see how it has changed. It is good that it's high in the morning, and low at night so that you can sleep.
I'm really keen to try a mix of T4/T3 through NDT or Armour etc,
Absolutely no point trying anything else until been on correct dose Levo at least 3-6 months and all four vitamins tested and improved to GOOD levels
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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)
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
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).
i see - I've gone by the advocacy on Stop the Thyroid Madness that promotes moving away from levothyroxine... but i will start by requesting my GP increase my levo dose, and then test again.. thanks!
I tried NDT. I found that being on synthetic T4 with added T3 for me personally works better. NDT has certain amount of T4 and T3. Going with T4 and T3 I found that I can adjust easier my T4 and T3 easily. Wishing you your best sorting out.
I'll pursue the advice of trying to balance things out just with Levo for now, which is also the simplest option - but i'm interested to know if you've had to go private, to be prescribed a T4/T3 mix?
I understand you. I'm in US. The next time you run labs with your Thyroid markers try to have FT4 and FT3 done. Like this you can see if your a good converter T4 to T3. If your a Great converter you might not even need to add T3 to your T4.Best wishes for a Great Outcome.
I really, really would not introduce ashwagandha if I were you. It's unpredictable and you just don't need it. Experiment with it at a later date, when your thyroid hormones are at a decent level, if you like. But right now you really don't need that complication. Ashwaganbdha is not all it's cracked up to be. Just leave your adrenals alone to settle down.
Just want to add how grateful I am, after so much struggling and fatigue, for there to be people actually willing to go through all the numbers with me, and support and help with this journey 🩵
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High free cortisol with low serum Cortisol issue
AM cortisol high / how to interpret results 
High cortisol on NDT 
Adding t3 - high cortisol
