Patient Yousef Saleh 27 M · 94 kg · 175 cm Hashimoto's · thalassemia minor Hypothyroid 10 years · since 2016 Levothyroxine 150 mcg · started Aug 2026 Updated 2 Aug 2026

TSH · Jan 2024 — Jul 2026 · 11 readings

Eleven readings. One in range.

The green band is where my TSH is supposed to sit — 0.25 to 5.4. It has been above it almost the entire time. The first time it landed inside was November 2025, on 100 mcg — then my thyroid kept declining and that dose stopped being enough. Since August 2026 I've been on 150 mcg, and a 29 Aug recheck already landed back inside the band at 3.02 — just four weeks in, earlier than the dose is expected to fully settle, but an encouraging sign.

In range 0.25–5.4 Above range Dose change

Latest TSH

14.1

18 Jul 2026 · 2.6× over

Current dose

150mcg

1.6 mcg per kg · at target

Next TSH test

~Late Sep

6–8 weeks after the change

Time in range

9%

1 of 11 readings

Best result so far

0.855

Nov 2025 · in range

What the line is telling me

A dose that worked, then stopped working

The shape of this chart is the whole diagnosis. It isn't random — it tracks my dose against a gland that keeps losing ground.

2024 · 50 mcg

Too little from the start

TSH swung between 6.45 and 16.8 all year while TPO antibodies sat near 98. Half a dose against an autoimmune gland that was already failing.

2025 · 100 mcg

It actually worked

Doubling the dose brought TSH from 5.95 in July down to 0.855 in November — properly in range. This is the proof the medicine does its job when the dose fits.

2026 · still 100 mcg

Control slipped away

By March, TSH was back at 15–17 on the exact same dose. Two labs two days apart agreed, so it isn't a lab error.

Losing control on a dose that previously worked means one thing: the Hashimoto's has progressed. My gland's own output dropped further, so 100 mcg no longer covers the gap.

Aug 2026 · 150 mcg

Now at a full dose

Full replacement runs about 1.6 mcg per kg. At 94 kg that's roughly 150 mcg — where I started a few days ago. For the first time the dose matches the body it has to cover.

The number to watch is the TSH drawn 6–8 weeks from the change, around late September — a new dose takes that long to fully settle. An early check at four weeks (29 Aug) already came back at 3.02, back inside range. Encouraging, but the September draw is still the one that confirms the dose has settled.

The other numbers

Three markers worth watching

Everything else in my bloodwork is either normal or moving slowly. These three have a pattern.

Vitamin D

Insufficient for 2.1 years despite dosing weekly — then the 29 Aug 2026 draw came back at 54.9, sufficient for the first time. Good news if it holds; recheck to confirm rather than assume it's fixed.

HDL cholesterol

The one weak spot in an otherwise clean lipid panel. Slowly climbing but still under target. Moves with weight, activity and cutting shisha.

Ferritin

Iron stores are full, not low. With thalassemia trait this matters: my small red cells are genetic, so iron supplements are the wrong answer.

TPO antibodies

The autoimmune attack itself. Still far above the cutoff of 34, but slowly drifting down — the antibodies confirm Hashimoto's, they don't guide the dose.

Thyroid ultrasound

2 Aug 2026 — the scan confirms what the bloods say, and finds nothing sinister.

  • Chronic thyroiditis — diffusely enlarged, coarse texture
  • Mild goiter — 21 mL total, isthmus 9 mm
  • Two nodules · TI-RADS 2 — benign, no biopsy
  • Lymph nodes clear — nothing suspicious
  • Follow up: annual ultrasound

The full scan images are stored with the radiology centre. The written report is summarised above.

Open scan images

Imaging · 2 August 2026

The radiologist's report

The full neck and thyroid ultrasound, in the radiologist's own findings. It confirms the diagnosis and rules out anything sinister.

Dr Maryam Hisham · Smart Scan Radiology Center

Neck and thyroid ultrasound

PatientYoussef Saleh Ahmed
Study date02 Aug 2026
Referred byDr Aref Abu Huwaij
Study ID20260802-135626

Clinical indication

27-year-old male patient with long-standing hypothyroidism.

Findings

  • The thyroid gland is diffusely enlarged, with heterogeneous coarse parenchymal echotexture, in keeping with chronic thyroiditis.
  • The isthmus is thickened, measuring approximately 9 mm.
  • Right lobe: 21 × 46 × 22 mm — calculated volume approximately 10.3 mL.
  • Left lobe: 19 × 45 × 26 mm — calculated volume approximately 10.8 mL.
  • Two well-defined, oval, predominantly hyperechoic thyroid nodules are identified:
    • Right nodule — approximately 19 × 12 mm
    • Left nodule — approximately 19 × 18 mm
    • Both show benign sonographic morphology, compatible with ACR TI-RADS 2 (not suspicious)
  • Few subcentimetric benign-appearing cervical lymph nodes. No suspicious cervical lymphadenopathy.
  • Both parotid and submandibular salivary glands are unremarkable.

Impression

  1. Diffuse thyroid enlargement with coarse heterogeneous parenchymal echotexture, consistent with chronic thyroiditis in the appropriate clinical setting.
  2. Bilateral benign-appearing thyroid nodules, ACR TI-RADS 2.
  3. No suspicious cervical lymphadenopathy.
  4. Annual sonographic follow-up is advised.

Radiologist · Dr Maryam Hisham Abdel Salam

Download report (PDF) Open scan images

Original report · 1 page

Why my blood count looks unusual

Thalassemia minor explains the hemoglobin

I carry the beta-thalassemia trait — a carrier, not affected by the disease. It means my body makes red blood cells that are smaller and more numerous than usual. That's genetic and lifelong, not a deficiency and not something going wrong.

It is the reason my MCV keeps reading in the fifties to sixties when the normal floor is 80 — well below normal but stable rather than declining. A blood count that looks alarming at a glance is, for me, just what normal looks like.

The same trait explains the two smaller flags on the Aug 2026 count: an MCHC just under the floor at 31.8 and an MPV of 12.7. Both travel with thalassemia trait, and neither means anything on its own against a normal hemoglobin and a normal platelet count.

It has nothing to do with the thyroid, and it doesn't change the levothyroxine dose. It matters for exactly one reason — the warning below.

Red cell size (MCV)62.1
Red cell count (RBC)7.24
Hemoglobin14.3
Mentzer index~8.6
Cell concentration (MCHC)31.8
Iron stores (ferritin)Full
AnemiaNone

Do not treat this with iron. A Mentzer index under 13 points to thalassemia, not iron deficiency — and my ferritin has run 260 to 428, so my stores are already full. Iron supplements would be the wrong answer and could build up over time. Anyone seeing my low MCV needs to know the trait first.

Ruled out

Eight things this isn't

Chasing a stubborn TSH means checking what else could explain it. All of these came back clear — which is why the remaining answer is simply the dose.

Prolactin

9.2

Pituitary is fine — this is primary thyroid disease

HbA1c

4.4%

Diabetes excluded; glucose normal through Nov 2025

Vitamin B12

516

Normal again on 29 Aug 2026 — not a cause of the hot feet

H. pylori IgG

Negative

Unlikely to be blocking absorption

Kidney

Normal

Urea, creatinine, uric acid, electrolytes

Liver

Normal

ALT 13, AST 12 — comfortably in range

Thyroid nodules

Benign

TI-RADS 2 on ultrasound; annual watch only

Free T4 / T3

Normal

Room to raise the dose without overshooting

Keep an eye on

Five loose threads

Not alarming, but worth a recheck rather than forgetting about.

Hemoglobin
Drifted from 16.1 down to 13.4 between 2024 and late 2025, then recovered to 14.3 on the 29 Aug 2026 repeat count. Direction reversed — considered settled unless it recurs.
Monocytes
Ran high at 12% with a mildly raised white count in Nov 2025. The 29 Aug 2026 repeat came back at 8% with a normal white count — most likely was reactive, as expected. Considered settled unless it recurs.
Zinc
Was 50, the very bottom of the range, in Nov 2025 — up to 76 by 29 Aug 2026, comfortably mid-range. Keep the night-time supplement going.
Lymphocytes
The absolute count is mildly over on 29 Aug 2026 — 3.48 against a ceiling of 3.00 — even though the percentage (40%) and the total white count (8.7) are both normal. Usually nothing at this size, and it replaced a Nov 2025 count where neutrophils and monocytes were the ones over. Worth one mention at the appointment, not a workup.
Hot feet at night
The worrying causes are already excluded — B12 and blood sugar are both normal. Most likely benign warmth. Mention it only if it turns into genuine burning or tingling.

What happens next

The plan, in order

One appointment and one blood draw can start almost all of this.

Dose raised to 150 mcg — done

Started August 2026. This is full weight-based replacement at 1.6 mcg per kg, and the first time the dose has matched what my body needs. Everything now hinges on what the next blood test shows.

Watch for signs of overshooting while it settles: palpitations, tremor, insomnia, feeling wired or unusually hot. If any show up, contact the prescriber rather than adjusting alone.

In progress

Re-test TSH around late September

Six to eight weeks after the increase — that's how long 150 mcg takes to settle. Testing earlier gives a falsely high number and risks a wrong conclusion. Draw the blood before the morning pill, at roughly the same time of day each round.

Needs a prescriber

Vitamin D reached sufficient — confirm it holds

After 2.1 years below sufficient on weekly dosing, the 29 Aug 2026 draw came back at 54.9 — inside the sufficient range for the first time. Keep the current regimen and recheck at the next blood draw rather than assuming it's settled.

Improved — recheck next draw

Get a sleep study

Loud snoring plus waking unrefreshed at BMI 31 points at obstructive sleep apnea. It's treatable, it's probably stealing a chunk of my energy, and left alone it raises blood pressure over time. A home test is enough to start.

Needs a prescriber

Blood count repeated — both resolved

The 29 Aug 2026 draw confirms it: hemoglobin recovered to 14.3 and monocytes are back to 8% — both were a one-off rather than a trend.

Done

Book the annual ultrasound

The nodules are benign, so this is routine monitoring — one scan a year, nothing more.

Needs a prescriber

Only if TSH stays high: screen for celiac

H. pylori is already negative, so celiac is the last absorption cause standing. Blood test is tTG-IgA plus total IgA — and I have to keep eating gluten until it's drawn, or the result is false.

If the dose fix fails

Daily

Rules that keep the number steady

None of these replace the right dose. They stop small things from swinging it around once the dose is right.

Taking the pill

  • One fixed time every day — consistency matters more than which hour.
  • Water only, then wait. My 2–5 hour gap before the cappuccino is already fine.
  • Going back to sleep afterwards doesn't affect absorption.
  • Don't skip doses — missed pills are a real cause of the swings.

Storage in summer

  • Keep tablets sealed, somewhere cool, dark and dry.
  • Not the bathroom. Not a sunny windowsill.
  • Not a parked car. Not near the stove.
  • Heat quietly drains potency — likely part of the May to July climb.

Supplements

  • Zinc at night — keep it, well away from the morning pill.
  • Vitamin D — needs a stronger regimen, not the current weekly one.
  • No iron unless a test proves deficiency. Thalassemia trait plus full stores means iron is the wrong call.
  • If ever on iron or calcium, take them four hours apart from the thyroid pill.

Everything else

  • Cut the shisha — it worsens apnea, drags HDL down, and pushes the white count up.
  • One meal a day helps absorption. Make it nutrient dense.
  • Re-test after any big weight change — losing weight lowers the dose I need.
  • Stop biotin 2–3 days before any thyroid blood test.

Bring this to the appointment

Checklist

Everything a doctor needs to know from 2.5 years of results, on one screen.

Levothyroxine raised to 150 mcg — done, Aug 2026. Controlled on 100 mcg in late 2025 (TSH 0.855), lost control by March 2026 as the gland progressed. Now at full weight-based replacement.
Re-test TSH around late September — 6–8 weeks after the increase. An early check on 29 Aug (4 weeks in) already came back at 3.02, in range — encouraging, but not yet the settled-dose reading.
Vitamin D — reached sufficient, 29 Aug 2026. Now 54.9, after 2.1 years below sufficient on weekly dosing. Recheck next draw to confirm it holds.
Thalassemia minor — do not prescribe iron for the small red cells. They're genetic; ferritin is 350 and stores are full.
Blood count repeated, 29 Aug 2026. Hemoglobin recovered to 14.3 (was 16.1 → 13.4); monocytes back to normal at 8% (was 12%).
Sleep study for suspected obstructive sleep apnea — loud snoring, waking unrefreshed, BMI 31.
Annual thyroid ultrasound to follow the two benign TI-RADS 2 nodules.
Low HDL and mild insulin resistance — anything needed beyond weight loss and exercise?
If TSH stays high on a correct dose taken properly — celiac screen. H. pylori already negative.
Prolactin — done 2 Aug 2026: 9.2, normal. Pituitary clear, no MRI needed.
?
If the September TSH is still high on 150 mcg, what is the next step — raise again, split the dose, or start looking at absorption?
?
What TSH are we actually aiming for? Anywhere under 5.4, or nearer 1–2 where most people feel best?
?
Should Free T4 and Free T3 be drawn alongside TSH each time, rather than only occasionally? TSH alone has been slow to explain how I feel.
?
Is it worth sticking to one lab from now on? Two labs two days apart returned 15.19 and 16.90 — I want to know how much of a change is real before we act on it.
?
How long should I stay on 150 mcg before we call it settled, and what symptoms should make me call sooner rather than wait?
?
Does the ferritin at the top of the range need anything? With thalassemia trait I want to be sure it is not quietly climbing.

Complete record

Every result, 2024 to 2026

The full archive across five labs — One Lab, MegaLabs, BioLine, Jubaiha Medical Laboratories and Smart Scan Radiology. Red is out of range, green is comfortably normal.

Original documents

Download the source reports

The raw PDFs behind the numbers above, straight from the lab — for sharing with a doctor or double-checking a figure.