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 — Aug 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 one time it landed inside was November 2025, on 100 mcg. Then my thyroid kept declining and the same dose stopped being enough. As of August 2026 I'm on 150 mcg — the first time I've been at a full weight-based dose.

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

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. Testing sooner reads falsely high, because a new dose takes that long to settle.

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

Below sufficient for two and a half years, despite dosing weekly. The weekly regimen isn't getting me there — this needs a proper loading dose.

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.

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 reads in the fifties when the normal floor is 80, and why my hemoglobin sits lower than it once did while still holding a normal range. A blood count that looks alarming at a glance is, for me, just what normal looks like.

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)56.1
Red cell count (RBC)7.06
Hemoglobin13.4
Mentzer index~7.9
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

480

Normal — 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

Four 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. Still inside the normal range, but the direction is worth confirming with a repeat blood count.
Monocytes
Ran high at 12% with a mildly raised white count in Nov 2025. Most likely reactive to smoking or low-grade inflammation. One repeat count settles it.
Zinc
Sitting at 50, the very bottom of the range, even while supplementing at night. Worth keeping up, taken well away from the thyroid pill.
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

Fix the vitamin D properly

Weekly dosing has failed for two and a half years running. Ask for a loading regimen rather than repeating what hasn't worked.

Needs a prescriber

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

Repeat the blood count

Confirms whether the hemoglobin drop and the raised monocytes were a one-off. Bundles into the same draw as the TSH recheck.

Needs a prescriber

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 two and a half 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.
Vitamin D loading dose. Insufficient for 2.5 years on weekly dosing — currently 20.9.
Thalassemia minor — do not prescribe iron for the small red cells. They're genetic; ferritin is 350 and stores are full.
Repeat blood count — recheck hemoglobin (16.1 → 13.4) and monocytes at 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.

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.

Thyroid

TSH 0.25–5.4 µIU/mL · Free T4 11.5–21.9 pmol/L · Free T3 3.07–6.76 pmol/L · TPO under 34 IU/mL

DateTSHFree T4Free T3TPO AbDoseLab
27 Jan 20249.14———50 mcgBioLine
02 Jun 20249.53———50 mcgBioLine
09 Jun 2024———98.1050 mcgMegaLabs
23 Oct 202416.80——97.8050 mcgMegaLabs
29 Dec 20246.45———50 mcgMegaLabs
24 Jul 20255.95———100 mcgOne Lab
09 Nov 20250.855———100 mcgOne Lab
15 Mar 202615.1916.244.56—100 mcgMegaLabs
17 Mar 202616.9015.70—90.0100 mcgOne Lab
11 Apr 20267.44———100 mcgOne Lab
17 May 202613.90———100 mcgOne Lab
18 Jul 202614.10———100 mcgOne Lab

Blood count

Hb 13–17 g/dL · MCV 80–101 fL · MCH 27–32 pg · RBC 4.5–5.5 ×10¹²/L · WBC 4–10 ×10⁹/L · Platelets 150–400

DateHbHctRBCMCVMCHRDWWBCMonocytesPlateletsLab
27 Jan 202416.149.28.4058.619.218.210.13%233BioLine
02 Jun 202416.344.28.4252.519.418.69.73%245BioLine
09 Nov 202513.439.67.0656.119.018.511.012%185One Lab

Small cells with a normal hemoglobin and a Mentzer index near 8 (under 13) — beta-thalassemia trait, not iron deficiency. The low MCV and MCH are genetic and expected; iron is not the answer.

Blood sugar and inflammation

Fasting glucose 70–99 mg/dL · HbA1c under 5.7% · Insulin 2.6–24.9 µIU/mL · HOMA-2 at or under 1.8 · CRP up to 5.0 mg/L

DateGlucoseHbA1cInsulinHOMA-2CRPLab
27 Jan 202493.4————BioLine
02 Jun 202477.0 random————BioLine
23 Oct 2024874.4%15.21.93—MegaLabs
09 Nov 202588————One Lab
15 Mar 2026——4.40—5.3MegaLabs

Lipids

Cholesterol under 200 · Triglycerides under 150 · HDL above 40 · LDL under 100 · Cholesterol/HDL under 3.8 — all mg/dL

DateCholesterolTriglyceridesHDLLDLNon-HDLChol/HDLLab
23 Oct 2024152110281061245.4MegaLabs
09 Nov 20251486631103.8——One Lab
15 Mar 202615173331031184.6MegaLabs

Iron, vitamins and minerals

Ferritin 25–350 ng/mL (One Lab prints 25–400) · Iron 59–158 µg/dL · Vitamin D sufficient above 30 ng/mL · B12 200–1100 pg/mL · Zinc 50–120 µg/dL · Magnesium 1.6–2.5 mg/dL

DateFerritinSerum ironVitamin DVitamin B12ZincMagnesiumLab
27 Jan 2024260.2—12.0———BioLine
02 Jun 2024264.7—17.2———BioLine
09 Nov 2025428—26.1480502.5One Lab
15 Mar 202635095.920.9———MegaLabs

Kidney, liver and electrolytes

Urea 10–50 mg/dL · Creatinine 0.6–1.2 mg/dL · Uric acid 3.4–7.7 mg/dL · ALT up to 40 U/L · AST up to 38 U/L · Sodium 135–150 · Potassium 3.6–5.5 mmol/L

DateUreaCreatinineUric acidALTASTSodiumPotassiumChlorideLab
27 Jan 202447.51.09—7.814.1———BioLine
02 Jun 202435.71.024.4216.115.2———BioLine
09 Nov 2025380.84.513121394.4105One Lab

Other

Prolactin 4.1–18.4 ng/mL · H. pylori IgG under 20 IU

DateTestResultReadingLab
02 Jun 2024Blood groupA+—BioLine
09 Nov 2025Helicobacter pylori IgG8.73NegativeOne Lab
02 Aug 2026Prolactin9.2Normal — pituitary clearJubaiha
02 Aug 2026Thyroid ultrasoundTI-RADS 2Benign nodules, chronic thyroiditisSmart Scan

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.

09 Nov 2025 · Jordan 🇯🇴

One Lab

CBC · Fasting glucose · Lipid profile · Ferritin · B12 · Vitamin D · TSH

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15 Mar 2026 · Jordan 🇯🇴

MegaLabs

CRP · Insulin · TSH · Free T3 · Free T4 · Vitamin D · Lipid profile

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17 Mar 2026 · Jordan 🇯🇴

One Lab

Iron · TPO antibodies · Ferritin · Free T4 · TSH

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11 Apr 2026 · Jordan 🇯🇴

One Lab

TSH

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17 May 2026 · Jordan 🇯🇴

One Lab

TSH

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18 Jul 2026 · Jordan 🇯🇴

One Lab

TSH

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02 Aug 2026 · Jordan 🇯🇴

Jubaiha Medical Laboratories

Prolactin

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