Latest results - should I ask for more Levothyroxine or should I try and get onto NDT?

[Woodhouse]

These are my latest results (am on 50mcg of Levothyroxine). TSH 3.8 (0.34-5.5), FT4 9.1 (7.5-19), FT3 4.9 (3.8-6). I have Hashimotos. I was beginning to feel a bit better but seem to be going backwards again - tiredness really coming back, also started gaining weight again. Was wondering if I need more Levothyroxine? And was also wondering if I would be better off going down the NDT route? Any advice welcomed.

[helvella Administrator]

My view is that you should ask for more levothyroxine.

Going down the desiccated thyroid route has so many difficulties - however you do it - that it is to be avoided if not necessary. You might be someone who does OK on levothyroxine. You won't know until you have been on it, at an appropriate dose, for a decent length of time.

But do get the usual vitamin B12, folates, iron/ferritin and vitamin D tested and issues addressed as needed.

Rod

[Edited to correct typo - should have been B12 not B1 as originally!]

[Woodhouse in reply to helvella]

Thanks this is a helpful. I've been on vit D and iron for about a month now. Am being retested for those in a few weeks.

[PinkNinja in reply to helvella]

Although I am someone who takes NDT, I agree with Rod completely! I gave levothyroxine a good go - several years, in fact - but it has never suited me. I was originally on T3 only and was very well on that but times change [sigh].

Most people do very well on levothyroxine once they are on the correct dose. Your TSH is very high for someone on levothyroxine. If you were in the US (and some other countries) you would still be considered hypothyroid.

Dr Toft, former chair of the British Thyroid Association (the only "thyroid body" that the RCP etc seem to have any respect for) states in his book "Understanding Thyroid Disorders" that TSH should be below 1 for most people and for some people it should be suppressed (I am paraphrasing as I don't have the book to hand). It is not an expensive book and is published in association with the BMA so you might want to get a copy (Amazon and larger chemists) so that you can show your GP.

I also agree about the other blood tests. Very important!

Carolyn x

[shaws Administrator]

Your dose of 50mcg is a starting dose and should have been increased by 25mcg about every 6 weeks. Some GP's keep you within the 'normal range' but this is an excerpt of an article in Pulse Online by Dr Toft, ex of the British Thyroid Association: If you want a copy of the whole article to give to your GP before your next appointment, email [e-mail]. It does take time to get to a dose which suits you.

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

[Jackie]

Hi If it was me I would stick with the Levo for now, as you can get that on a script, but have more. I would also take T3, your FT3 is on the low sie, I need mine right at the top of range It also slightly lowers the TSH ( fine for you ) and helps weight etc. That is my endo`s favourite choice, only if that no good does she go down the NDT route.

The other tests, of course, are vital, especially glucose, annually, as hormonal and autoimmune.Also, often at a later date an ultra sound of the thyroid, if you think you need it.

Best wishes,

Jackie