Thyroid results from 24th February 2025 :
T4 -16.5 (12-22) T3-4.3 (3.1-6.8) TSH-0.56 (0.27-4.2)
Jan 2025:
T4-18.1 (12-22) T3-4.9 (3.1-6.8) TSH 0.289 (0.27-4.2)
No recent vitamin results to post.
Still feel awful - severe fatigue, pain all over, weight gain etc.... Want to start small dose T3 now - advice welcome please. Thank you 
You can see TSH is slowly increasing and Ft4 reducing .
You could look at adding 25mcg extra 1 day a week
Retest in 6-8 weeks
Meanwhile presumably you are working on low vitamin levels
Vitamin D a at least over 80nmol
Ferritin at least over 70
Exactly what vitamin supplements are you taking
January 2025:
Iron 9.6 (10-30)
TIBC 55 (45-81)
UIBC 45.8 (13-56)
Transferrin Saturation 17% (25-45)
Ferritin 32 (30-207)
Vit D has gone from 50.5 (>50 sufficient) to 65.
Thanks SlowDragon. Just saw endo today and they told me not to increase anymore as numbers are good (!) so wouldnt have enough tablets every month to add in extra 25mcgs weekly myself. Yes working on vitamin levles - iron, Vitamin D, folate and b complex.
Did you adjust Levo between dose & wait 6 weeks?
Just checking, you test as recommended, fast overnight? Early morning draw, cease biotin 3/7 days before draw & delay replacement until after test?
Your nutrients were low a few months ago, have you worked improving them?
Optimal nutrients will help with FT4:FT3 and deal with symptoms which may be mimicking thyroid problems.
Your levels are currently
FT4: 18.1 pmol/l (Range 12 - 22) 61.00%
FT3: 4.9 pmol/l (Range 3.1 - 6.8) 48.65%
So conversion isn’t terrible, but you aren’t quite optimal for you.
Majority do manage with right level of levo replacement & optimising nutrients. Introducing T3 often means TSH becomes fully suppressed, which concerns drs & leads to reduction in levo prescription.
Thanks PurpleNails. Yes left 6 weeks between adjusting dose and adhered to testing protocols. New results are:
T4 -16.5 (12-22) T3-4.3 (3.1-6.8) TSH-0.56 (0.27-4.2) Dont know why numbers are worse than January given that ive increased levo.
Take iron, Vitamin D, B complex and folate. Have to pay private for vitamin tests so will have to wait a while before getting them done again.
I’m mis-read that. Levels have not improved.
I’m struggling to make sense of a lower FT4 & FT3 after a levo increase & why endo views that as acceptable. Push for increase.
Have you changed the brand of levo or timings, Still take away from food, supplements, other medications?
You need FT4 higher, because I’m not seeing a consistent high FT4 & low FT3. Which is at what stage it’s suggested T3 be considered.
Most would be unwell. & feel best with FT4 in top third of range FT3 over 50%.
FT4: 16.5 pmol/l (Range 12 - 22) 45.00%
FT3: 4.3 pmol/l (Range 3.1 - 6.8) 32.43%
I know, I feel terrible which is what made me think of starting T3. I dont see endo for 6 months now so bit stuck. Even if I had said to them that these numbers were not good they would have argued with me!
Same brand of levo - Vencamil - and take at midnight so well away from everything - have no idea why numbers are down - very disappointing.
How much to 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)
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.
If this shows you are under replaced email endocrinologist requesting “trial increase “ of 50mcg PER WEEK
That’s 12.5mcg extra 4 days a week
Retest again in another 8-10 weeks
If they refuse…..look at seeing different endocrinologist
Is this one on NHS …..are they a diabetic specialist?
Looking for Ft4 (levothyroxine) at 60-70% through range and Ft3 not far behind
Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists
Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to NHS
thyroiduk.org/contact-us/ge...
Im 10 stone at the minute. Yes, nhs doctor and diabetes specialist. They are very definite about not having suppressed TSH so not sure they would give me an extrra 50mcgs to take weekly at current TSH. They also take a very long time to reply to emails!!
There is only one doctor on that list for my area and they dont do NHS just private and I have seen them before and no good and very far away from where I live so not sure what I can do now...
They are very definite about not having suppressed TSH.....
Do you understand that by adding T3 your TSH will become much lower than it is now and possibly even suppressed depending on how much T3 you add?
If your Endo and/or GP are not aware that you are taking T3 then likely they will just reduce how much Levo they will prescribe. It can cause a number of issues with your Levo prescription.
We always say that people really do need good vitamin levels before even thinking about adding T3, as it can cause intolerance issues with the T3.
Have you changed the iron supplement you are taking? Many members get on well with this product:
threearrowsnutra.com/en-uk/...
Your folate was low too. Have you changed or added to your supplements to increase your folate level?
I would recommend adding in a small amount more of Levo as SD has suggested. This will help in the mean time before your vitamin levels improve.
Unfortunately with hypothyroidism there are no quick fixes.
Ive found some spare Vencamil 100 tablets I had and the way my prescriptions fall I should have a spare 100mcgs each month so will be able to add in 25mcgs a week but will start with 12.5mcgs as suggested by Buddy195.
I take Bcomplex that has folate in it and iron spray as get worsening gastritis if I take any iron tablets. Will retest vitamins and thyroid in the near future and see if improvements. Thank you for all the advice much appreciated.
I'd suggest you do try the heme iron product I mentioned. Its much gentler on the stomach that usual iron supplement & works well.
Adding Levo in is the way to go for now, you can also source Levo privately but again you will be needing to explain to your GP your lower TSH.
As others have suggested, I would look to improve key thyroid vitamins as a first step. I’ve personally found that if these are not optimal, my thyroid bloods also dip…so this could be the same with you.
I think it’s sensible to consider increasing Levo slightly. Others have suggested 25mcg, & many members have no adverse symptoms adding this. Personally I’m a fan of ‘low & slow’, so would start by adding just 12.5mcg. I’ve found small increases mean I don’t miss my ‘sweet spot’ where I feel most well.
I would not consider Liothyronine/ combination treatment at this point, as this will likely suppress TSH/ further alarm your endo/ GP. If combination treatment is to be trialled in the future, I’d look to find an endo supportive of this.
Do keep posting & updating us on your progress 🦋
New results after increase
Latest blood results. Could anyone help interpret these please 😊
My latest blood test results, Hashimotos 
Thyroid Monitoring Results
Latest blood Results .... please advise 😊
