under active thyroid depression and no energy - HELP

[Patch2025]

Thyroid levels normal as per GP - my depression fatigue and memory severe Been on Levothyroxine 50mg daily for three years gp says correct dose

[SlowDragon Administrator]

welcome to the forum

Please add most recent thyroid and vitamin results

Very unlikely 50mcg is adequate dose as it’s only the standard STARTER dose

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.

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[Patch2025 in reply to SlowDragon]

Hi,

I got my private blood tests back are you able to take a look at my results please?

TSH levels - normal

Result 1.78 Range 0.27-4.2 mU/L

FT4 levels normal

Result 18.7 range 12-22 pmol/L

FT3 levels normal

Result 3.9 range 3.1-6.8 pmol/L

TBO test says <9 IU/ml states have normal levels of antibodies

Thank you for your help

Lauren Gadd

[GlowCoach Administrator in reply to Patch2025]

Do start a new post with your blood results.

[SlowDragon Administrator in reply to Patch2025]

Was test early morning and last dose levothyroxine 24 hours before test

Assuming yes

Free T4 (fT4) 18.7 pmol/L (12 - 22) 67.0%

Free T3 (fT3) 3.9 pmol/L (3.1 - 6.8) 

Ft3 only 21.6% through range

Shows very poor conversion rate of Ft4 to Ft3

most people when optimally treated will have Ft3 at least 50% through range

You could request SMALL increase in Levo to 62.5mcg initially

Request as a “trial”

Retest in 8 weeks

Next step get vitamin D, folate, ferritin and B12 levels tested

Exactly what vitamin supplements are you taking

When were vitamin levels last tested

Test annually

Request GP test …..Or include in next thyroid test

Recommend you also test BOTH TPO and TG antibodies

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

NHS only tests TG antibodies if TPO are high

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

[Patch2025 in reply to SlowDragon]

Hi,

Thanks so much for replying yes it was early morning and last dose 24 hours prior. I have not had any vitamin blood tests done but I take vitamin D with K2 and mushroom gummies and am going to order B12 to try and help with the energy levels I’m a vegetarian and not a great diet but I’m eating lots more veg and fruit now. Over a week ago I increased my Levo from 50 to 100 myself and I had the bloods done Monday so would it have been even lower if I had not increased? Thanks Lauren

[SlowDragon Administrator in reply to Patch2025]

am going to order B12 to try and help with the energy levels I’m a vegetarian and not a great diet but I’m eating lots more veg and fruit now. Over a week ago I increased my Levo from 50 to 100 myself and I had the bloods done Monday so would it have been even lower if I had not increased

Ft4 result falsely high then

Only test 6-8 weeks after being on constant unchanging dose and brand of Levo

Test B12 and ferritin

Both very likely low if vegetarian

monitormyhealth.org.uk/anae...

Optimal vitamin levels are

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 over 70

Folate at top of range

Ferritin at least over 70

Low vitamin levels result in poor conversion and lower TSH

[Tina_Maria in reply to Patch2025]

Free T4 (fT4) 18.7 pmol/L (12 - 22) 67.0%

Free T3 (fT3) 3.9 pmol/L (3.1 - 6.8) 21.6%

T4:T3 Ratio 4.795 

Even though your T4 is not that bad considering your low dose (however, some people will need it higher though), your T3 is very low and only at 21%. Most people feel best when both T4 and T3 are between 65-80% through the range. Your low T3 is very likely giving you the symptoms, as T3 is the active hormone and regulates your metabolism. It also looks like you are not converting enough T4 to T3, hence your T4 level is much higher compared to your T3.

As slowdragon has mentioned, the prescribing guidelines state that a normal replacement dose should be around 1.6 mcg per kg of body weight - so for example if you weigh 63kg, you would need around 100mcg levothyroxine as a replacement.

You should test your nutrients such as ferritin, folate, vitamin B12 and Vitamin D. All these will help you convert T4 to T3 more efficiently, if your levels are optimal. If these levels are low, you would need to supplement to bring those levels up.

You could ask for an increase in medication and you can cite the prescribing guidelines to indicate that you would need more levothyroxine and also that you are still symptomatic (look at initiation and titration).

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

You could ask for a trial increase, sometimes that goes down better with the GPs.

With regards to the weight, again it is the T3 that determines your metabolism and as you have too little, you will find it very difficult to lose weight. This is not a dietary issue, but a metabolic one and by correcting your slow metabolism and improving your low T3, this situation will get better.

[Patch2025 in reply to Tina_Maria]

Thanks so much can’t wait to feel better and never would have known if I had not done private blood test as doctor don’t do T3 that’s mental so I have felt like crap for three years and it could be that!!

[Tina_Maria in reply to Patch2025]

Indeed, but be careful with your big increase, you should go to 75mcg levothyroxine first and then perhaps to 100 mcg levothyroxine - too big an increase can cause symptoms of over replacements or palpitations, so try to be patient.

Also, if you are not converting well to T3, you may have your T4 levels too high when you increase by that much, which is not advised. I know that you are fed up with feeling poorly, but smaller steps are better and if you work on your nutrients as well, you may be in a much better place after the 25mcg increase. If the levels are still not right after 6-8 weeks, you can then increase your levo again (if there is room) or perhaps you may need a small bit of T3, if your conversion has not improved ..... so slowly but steadily is the ticket.😉

[serenfach]

DO NOT take your Gp word for "correct dose". Go to the surgery or ring them and ask for at least 3 previous results to printed out for you. They have to give them to you and they are free, and it should not take more than a couple of days at most.

When you have the results, bung them in here and we can help further. I can pretty well guarantee you are not on the right dose. Most of us here have been where you are now, and through this forum, have managed to get a lot better.

I know it sounds awful, but do not let your GP dictate your health. I made this mistake for years before I realised they know enough about thyroid health to write on the head of a pin. So get the results, and come back. This forum really cares and will help you get better. Sending a hug.

[Patch2025 in reply to serenfach]

aww thanks so much gives me some hope and confidence. It’s so bad isn’t it them not knowing etc I’ve just paid privately for a full thyroid check for t3/4 and antibodies etc as they don’t test for all that in gp blood test will post my results. The brain fog memory loss fatigue depression is now so out of control im praying it is my thyroid or I’m screwed! And I’ve never been overweight always been a size eight and have put on a stone and a half which depresses me more. Despite serious healthy eating can not budge a pound x

[serenfach in reply to Patch2025]

It does not matter what you do with weight if you are underdosed - it will keep piling on. Do not diet - it makes things worse, and dont overdo it, as this makes it worse too.

Think of your thyroid as the oil in your car - you would not rev it, or not put petrol in... You would take notice of the red light and check the oil and top it up, and be gentle with the car until you can get oil. It is exactly the same for your thyroid.

I was teaching computers when I was very underdosed, and some days I was hard pressed to remember what a keyboard was! It will get better - it can be a slow process to find your sweet spot with thyroid replacement, but life gets good!

A private test is a good idea. Hope to see you back soon!