Hi everyone.I was diagnosed with hypothyroidism last year by my gp. My most recent blood test results at tge beginning of March were as follows; TSH = 2.04 and my T4 = 15.1 . I'm currently taking 75mgs of levothyroxine ( started on 50mgs) yet my symptons have not lifted. I'm still plagued with extreme fatigue ( feel like I've been sedated) muscle pain, legs feel heavy when I'm walking, have trouble getting to sleep at night, brain fog, breathlessness on walks, severe constipation ( it's like parting with rock and I often bleed ) My gp refuses to increase my dose of levothyroxine and basically keeps saying , come back if nothing changes. I've been back several times but he just listens and then repeats himself saying my TSh is within normal range. Any advice would be appreciated. Thanks.
Underactive thyroid / recent blood test results - Thyroid UK
Underactive thyroid / recent blood test results
Welcome to the forum Cockerspaniel007
Please can you add ranges (in brackets after results) for TSH and FT4, as these can vary between laboratories. Was FT3 tested at all?
Have you ever had antibody tests to see if your condition is auto immune, AKA Hashimotos and key vitamin tests (ferritin, folate, vitamins D and B12)?
In the first instance, do ask your GP for the above tests. We don’t recommend supplementing key vitamins without testing first (and sharing results with us).
If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:
thyroiduk.org/help-and-supp...
Thanks for your reply SlowDraggon. The range on my TSH is 0.55 - 4.78 ( My result was 2.04 ) T4 Range is 11.5 -22.7 ( my result was 15.1. My surgery doesn't test for F3. My folate was 10.5, Ferritin 55, and B12 454. Coeliac was 0.3 ( anything under 7.1 considered okay) As I had to deal with a extremely awkward receptionist I was unable to establish if my Vit D had been tested or if I had been tested for Hashimotos disease ( excuse my spellings). I have an appointment on the 25th with my gp so will check.
The ranges are TSH - 0.55 - 4.78 ( My result = 2.04 FT4 - 11.5 -22.7 ( My result 15.1) No testing for T3. Folate10.5 , Ferritin 55 , B12 454 , Coeliac 0.3 . Unable to ascertain at this stage if I have been tested for Hashimotos or Vit D as receptionist unhelpful.
Can you also add references for vitamins please- as these can also vary
My most recent blood test results at tge beginning of March were as follows; TSH = 2.04 and my T4 = 15.1 . I'm currently taking 75mgs of levothyroxine
Please add range on Ft4 result
How long have you been on 75mcg
ALWAYS test thyroid levels 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)
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
have you had vitamin levels or thyroid antibodies tested
If not, get these tested
Exactly what vitamin supplements are you taking
Which brand of levothyroxine are you currently taking
Do you always get same brand
Hi, The range on the TSH is 0.55 - 4.78 ( My result was 2.04. FT4 range is 11.5 - 22.7 My result was 15.1. No test done for T3.I started on Levothyroxine 50mgs May last year and was quickly increased to 75mgs ( soon after without blood test) The make I'm on is Vencamil and always been the same. My Folate was 10.5 , Ferritin 55 B12 454 and Coeliac 0.3. Not sure about Hashimotos or Vit D as receptionist unhelpful. Got an app with gp on 25th so will check. Not sure what TBO and TG antibodies are ?
Thanks for the tip re blood test and leaving taking dose 24hrs before. Not done this previously. Any advise re my results as per ranges. Thanks so much.
helpful calculator for working out %
Free T4 (fT4) 15.1 pmol/L (11.5 - 22.7)
Ft4 only 32.1% through range
Was test done early morning and last dose levothyroxine 24 hours before test
Many (most?) people when adequately treated on just levothyroxine will have Ft4 at least 60-70% through range. Often TSH around or below 1
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)
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.
See GP and list your hypo symptoms
Take copies of relevant guidelines printed with you
Request “trial “ increase in Levo to 100mcg daily
Don’t change brand……. Only change one thing at a time
Vencamil is often most effective brand for many as its lactose free and mannitol free
Not sure what Tpo and TG antibodies are ?
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
as you have one autoimmune disease - coeliac, it’s almost certain that your hypothyroidism is also autoimmune
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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
NHS only tests TG antibodies if TPO are high
As you are on gluten free diet TPO antibodies may not necessarily be high
Gluten free diet tends to reduce antibodies
Dairy free can also lower antibodies
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
My Folate was 10.5 , B12 454
What’s the range on folate?
Normally either 3-20 or 8-60
Either way Folate of 10 not brilliant and B12 best at least over 500
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later 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 2 per day and/or 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 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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 if last test result serum B12 was below 500 or active B12 (private test) under 70
Ferritin 55
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
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thanks for the tip re blood test and leaving taking dose 24hrs before.
So how long before this test was last dose levothyroxine
If less than 24 hours your Ft4 result is false high result and you’re actually more hypo that these results show
Thanks so much for all the information , looks like I've got some reading to do. Interesting what you said about weight as the gp has never weighed me. I'm 6ft 1" and 168 pounds ( 76kgs) When I spoke to one of the gp's last week I mentioned this but he didn't seem interested. I asked him if there was some wriggle room within my ranges for an increase of 25mgs but he point blank said no. I've ordered some vitamins from Green leaf blends and also take magnesium , ashawanga and turmeric. I'm due to see a female doctor on the 25th ( won't tell you what I think of the male doctor I saw) so might get some sense from her. Yes, when I last had a blood test I took my levothyroxine as normal in the morning and then went for the test ......won't be making that mistake again.
when I last had a blood test I took my levothyroxine as normal in the morning and then went for the test
Request a new test ……you could tell a “white lie” and say “you forgot to stop taking your high dose biotin supplement”……and now read that this could affect test
Book new test for early morning, ideally before 9am and last dose levothyroxine 24 hours before test
And once you start on vitamin B complex …..you need to remember to stop it 3-5 days before test….as it contains biotin
I know this might sound silly, but have you tried grapes for the constipation? Patient visitors were asked to bring grapes for patients because it was known that those on morphine would get constipated, and the grapes helped with this. Might be worth a try!
Thanks for the suggestion , love grapes but unfortunately they give me really bad stomach bloat and 🌬 🥴 . Dynamite works a treat 🗯 ( only joking )
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