Bloods "Normal", Body Doesn't Agree!

[Mrsdeepsleap]

Was initially diagnosed hypothryoid October last year; TSH was 115 (range 0.55-4.78), and T4 <3.9 (range 11.5-22.7). As you can imagine, I felt very rough at that point! Started on 50mg Levothyroxine early October, increased to 100mg late November (due to thyroid inflammation), and have been on that dose ever since. Had more bloods tested last week, and got results from GP today (attached). All results are normal, and in the middle of the ranges, so not even as if they are just in the normal range, but I still feeling symptoms (tiring very easily, muscle weakness, joint and muscle pain, brain fog, puffy face, weight gain, feeling the cold more), and due to these, unable to go back to work currently. GP seems to think my body just needs time to repair; I know this may differ vastly from person to person, but what are your experiences with symptoms after bloods are in the normal range? Do I just need to be patient, or could there be more to this? Really grasping at straws at this point!!

I do take my Levothyroxine at least half hour before caffeine or other meds, supplement with Solgar Vitamin B Complex 100, Taurine, and British Supplements Triple Magnesium complex. I have type 1 diabetes, good control using an insulin pump. Also take 2.5mg Bisoprolol.

[SlowDragon Administrator]

was this test early morning and last dose Levo 24 hours before test

Do you always get same brand Levo at each prescription

As per my reply to your previous post

healthunlocked.com/thyroidu...

You need to get TG antibodies tested

Plus B12, folate and ferritin

Vitamin D is too low at 56nmol

How much vitamin D are you taking

I do take my Levothyroxine at least half hour before caffeine or other meds, supplement with Solgar Vitamin B Complex 100, Taurine, and British Supplements Triple Magnesium complex.

Did you stop B complex 3-5 days before test

Magnesium should be taken afternoon or evening at least 4 hours away from levothyroxine

Vitamin D tablets also 4 hours away

Allow at least an hour between levothyroxine and anything other than water

No vitamin supplements or other medications within 2 hours

[SlowDragon Administrator]

vitamin D

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator]

Free T4 (fT4) 14.5 pmol/L (11.5 - 22.7) 

Ft4 only 26.8%

Request “trial “ increase in Levo to 112.5mcg

Retest in 6-8 weeks

Approximately how much do you weigh in kilo

[Mrsdeepsleap in reply to SlowDragon]

All supplements were stopped 5 days before bloods, and last levo dose was slightly over 24 hours before; test was done at 8.20am. I have had a change of levo brand, not sure of the make of the first lot, but last prescription was Tevo since 23rd Jan. Haven't noticed any difference since the change. Most days other meds and caffeine are taken at least 2 hours after levo, and magnesium taken 12 hours after levo, in the evenings. I weigh approx. 88kg. Will get some vit D and see if that helps. Thanks.

[SlowDragon Administrator in reply to Mrsdeepsleap]

88kg suggests that you may eventually need approximately 140mcg Levo per day

Perhaps push for 25mcg dose increase…..but initially increase by 12.5mcg (cutting 25mcg in half)

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 always be below 2 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

Come back with new post once you get vitamin and antibodies test results

You only need stop any supplements with biotin in (eg vitamin B complex) other supplements continue up until day before test

when you stop B complex take a daily methyl folate instead those few days