Recent Results - how do they look?

[Sunflower535]

I have been feeling reasonably well in the last months. I have been trying to get my vitamins in order as my GP's back last year didn't want to do anything more with my Thyroid and wouldn't "up" my dose any. I don't have the finance to go private and they won't refer me back to the Endocronologist but he wouldn't be much better anyway so I have been trying to muddle through myself and have been feeling a whole lot better - not the same tiredness. My new results are as follows - can you tell me what you think of them? I'm still on 50 mg on Levothyroxine which I know is the starter dose. When I got the blood test collected I had it done at 9.30 am - that was the earliest time I could get with them. I didn't have my Levothyroxine until after I came out of the appointment so didn't have it for 24 hours before the test.

Ferritin - 115ug/L - range (30 - 332)

CRP HS - 1.06 mg/L (Range <3)

Magnesium - Serum - 0.94 mmol/L (range 0.7 -1)

Folate - Serum - 29.4 nmo/L - medichecks don't give ranges on this one - just between 7 - 13 nmol may indicate a possible deficiency.

B12 Active - 127.0 pmol/L - range >37.5

Vitamin D - 193 nmol/L - range 50 - 250 - I had been taking 4000 IU per day but had stopped this the week before the test as the weather had been sunny and I was getting out more - perhaps I should stop this altogether now for the summer.

TSH - 4.300 mlU/L(range 0.27 - 4.2)

Free T3 - 4.0 pmol (range 3.1 - 6.8)

Free T4 - 17.6 pmol/L (12 - 22)

Do these numbers look okay and is there anything more I can do to improve them? It's been a while since I have been on here so can't remember if the levels I'm at are optimal (apart from the Vitamin D which I believe is better at about 100). Any advice would be much appreciated. I know the Thyroid numbers are probably not good but there's not much I can do about them unless you think otherwise.

I have tried to go Gluten Free so many times but fail. I'm mostly GF (eat GF bread all the time - slip with the cakes occasionally and don't like the GF pasta), but I guess that's not as good as being completely gluten free. When I went GF at the start I did think it helped but then as time went on and I started eating it again I didn't feel any difference - especially as I don't eat much bread anyway.

Thanks in advance.

[SlowDragon Administrator]

See GP for 25mcg dose increase in Levo

TSH is far too high

On levothyroxine TSH should ALWAYS be below 2

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

[Sunflower535 in reply to SlowDragon]

I'm 8 stone 10

[SlowDragon Administrator in reply to Sunflower535]

Just reading previous post

healthunlocked.com/thyroidu...

Weight loss can be hypo issue

Poor gut function and lack of appetite

Gluten and/or dairy intolerance

What’s your ferritin result?

[Sunflower535 in reply to SlowDragon]

Do my vitamins all look in order??

[SlowDragon Administrator in reply to Sunflower535]

You can reduce vitamin D dose a little

B vitamins look good

[Sunflower535 in reply to SlowDragon]

Okay thanks - I have stopped vitamin D altogether as hopefully I will be outside more in the evenings now. I find I don't need it as much in the summer - I try to test twice a year and have yet to be deficient.

[Tina_Maria in reply to Sunflower535]

I would not stop the vitamin D altogether, I would perhaps not supplement for a month or 6 weeks and then perhaps only take 4000IU every other day? If you do not take any for a long while, your levels may drop down too low, which you don't want.

If you do not see any benefits from the gluten free diet, then don't pursue this. Some people find it helps, others do not see a difference - we are all different. I have tried it years ago and I got really bad headaches and my fibre intake was not great either. Now I just try to have as little processed food as possible and I also make my own bread. Not only is it good to know what you put in your bread, it tastes much better too. 😉 If you do a slow rise of the bread in the fridge overnight, the longer fermentation will also make the bread much more digestible and the texture will be great too! I also use a lot of spelt flour, as it is higher in fibre and has a lower gluten content compared to wheat.

Try to get your GP to increase your dose of levothyroxine, as a TSH of 4.3 is too high when on replacement and your T3 is still quite low.

[tattybogle]

GP really should be willing to increase levo dose now, due to TSH being so high ,

inform GP of this latest TSH result and show them some of the references from this post to support request for dose increase ~ they all clearly advise GP's to keep TSH between 0.4/0.5 -2/2.5 in all patients on levo: healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range-

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and assuming you in uk , use nice thyroid treatment guidelines also :

nice.org.uk/guidance/ng145/...

" 1.4 Follow-up and monitoring of primary hypothyroidism

Tests for follow-up and monitoring of primary hypothyroidism

1.4.1

Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis. "

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simple explanation of why TSH in range is not the same as optimal for the individual :

healthunlocked.com/thyroidu... explanation-of-what-*high-tsh-is-telling-us-when-our-ft4-level-is-normal-on-levothyroxine-the-shoe-size-analogy.-*-over-2.5-3-ish

[pennyannie]

Hello Sunflower

Can you please tell us your ferritin reading and range please ?

I know now I need to aim to maintain my ferritin at around 100 - folate around 20 - active B12 around 125 ( serum B12 - 500++ ) and vitamin D at around 125.

[Sunflower535 in reply to pennyannie]

Ferritin - 115ug/L - range (30 - 332)

[pennyannie in reply to Sunflower535]

SlowDragon