Starter dose of Levo - satisfactory vs. optimum results

[L154C0]

Officially diagnosed with Hashimotos after two consecutive high TSH results (you were right greygoose my endo ignored the TPOab positive result!)

Prescribed starting dose of Accord Levo 50mcg. Latest blood test 6 weeks later:

TSH 2.16 mIU/L (0.3 - 5.0) 39.6%

Free T4 (fT4) 9.6 pmol/L (7.0 - 20.00) 20.0%

Free T3 (fT3) 5.0 pmol/L (3.5 - 5.8) 65.2%

T4:T3 Ratio 1.920 

Folate - Serum 7.6 ug/L (4 - 20) 22.5%

Vitamin B12 522 nmol/L (180 - 900) 47.5%

Ferritin 71 ug/L (15 - 200) 30.3%

Symptom wise, I’m feeling better but not optimum - energy flailing, brain fog, burning joint pains and muscle cramps still an issue.

I’m seeing a new NHS endo tomorrow so do you think the above results warrant an increase in Levo?

Thanks

[greygoose]

A doctor will think that anything within the range is satisfactory, even if it's scraping along the bottom. Only you can know if your results are optimal by the way you feel.

Your FT4 is far too low for good health, as would be expected on only 50 mcg levo. Your FT3 is high-ish because you either having, or have had recently, a Hashi's 'hyper' swing. It's only temporary, the level will eventually go down. But you feel improvements because of your high FT3. Remains to be seen how you feel when the level drops again. But in the meantime, it would be a good idea to get an increase in dose. Your TSH is too high.

[SlowDragon Administrator]

yes definitely ready for next increase in dose to 75mcg daily

If you want to stay on Accord request extra 50mcg tablets and cut in half to get 25mcg

Accord only make 50mcg and 100mcg tablets

Retest in another 6-8 weeks

Meanwhile work on improving low folate

No vitamin D result?

Look at increasing iron rich foods in diet to keep ferritin between 70-100

ALWAYS test 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)

[L154C0 in reply to SlowDragon]

Vitamin D Just came through - 96.1 (50-150). Have been taking cytoplan D3 + K2 100ųg. Am also taking Ingennus B complex but only 1 a day so maybe I should top up with separate folate.

[SlowDragon Administrator in reply to L154C0]

Vitamin D is good

Am also taking Ingennus B complex but only 1 a day so maybe I should top up with separate folate.

Good idea

Always stop B complex 3-5 days before any tests ….then take folate instead

[SlowDragon Administrator]

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)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...