New to this - need help understanding these test results, please.

[Andree]

Hi - I'm a 53-year-old female and have recently been diagnosed with underactive thyroid, after complaining of throat problems and general weariness for two years.

Most recent blood resullts: "Free T4 12.9" (?)

and TSH 18.8

Been on Levothyroxine 50mg for 3 weeks but don't feel any better, still feel tired.

Had an ultrasound which confirmed a 1cm cyst on thyroid. Doc said will review in six months..

Would have preferred a biopsy I as have neck pressure, which is worse at night.

Would appreciate any help or advice, thank you

[Hidden]

Six months? Does that include reviewing the amount of medication you're on? He should be reviewing your medication long before that, certainly within 2 months, preferably within 6 weeks. 50mcg is very unlikely to be enough to make you well.

[Andree in reply to Hidden]

Thank you - sorry, have a review scheduled with ENT in September but doc will review meds and bloods every six weeks weeks. Will likely increase the dosage, as you say. Thanks again.

[Ansteynomad]

Your GP should be reviewing your thyroxine dose every six weeks until you hit the right level. The reason you don;t feel any better is that you are still very hypo.

It sounds as if you might need now to get yourself up to speed on all this stuff and educate your GP.

In your position I would push for a biopsy as well.

[Andree in reply to Ansteynomad]

Thank you - doc said she will review meds every six weeks or so. Will push for biopsy, but everything takes months. Discussed biopsy with my doc today but she said it could be a 3-month wait just for an appointment at ENT.

[Clutter]

You should have a follow up blood test 6/8 weeks after starting Levothyroxine. 50mcg is a low dose and it may have been better to start you on 75mcg which is the recommended dose for people under 60 without heart problems. Dose rises are in 25mcg increments. Increase and decrease in medication should be followed by 6/8 week thryoid function tests.

When you are optimally medicated your symptoms including neck pressure should resolve. It may help if you use an extra pillow until then. Fine Needle Aspiration (FNA) is usually only necessary to test for cancerous cells in a single nodule. Watch and wait is the usual procedure for thryoid cysts and multi-nodular goiters.

[Andree in reply to Clutter]

Thanks, doc said she will review bloods and meds every 6/8 weeks, so she will probably up the dose, as you say. Hope you're right about the medication solving the problem, as I can only sleep sitting up these days.

But I've had these symptoms for two years but was getting treated for a hiatus hernia, which I didn't have, as a second endoscopy showed.

It is a relief to be diagnosed, hopefully correctly, but everything I've been reading suggests that a 1cm cyst should be investigated further to rule out cancer. Will keep you informed, thanks again.

[Clutter in reply to Andree]

Andree,

If you're anxious about the cyst push your GP for that biopsy referral.

[jimh111]

The most recent guidance suggests your first dose should be reviewed after 4 weeks in order to get closer to your optimum dosage sooner. Ask your doctor to up your dose to 75 mcg and then review you in a month or so. It is also reasonable to start youngish patients on 100 mcg but your blood test suggests you may not need that much (but you might).

[Andree in reply to jimh111]

Thank you, yes, I'll see the doc every 6/8 weeks. The six-month review was with the ENT.

[Clutter in reply to jimh111]

Jim,

Do you have a link to the new guidance, please? 'Twould be useful for posters whose GPs don't keep up with events.

[jimh111 in reply to Clutter]

Do a search on "following initiation of therapy" in aace.metapress.com/content/... which is on page 16 (1003) . See also Recommendation 13 on page 25 (1012). Note this applies only to initiation of therapy, the usual recommendation is 6 weeks plus after initiation, when they are trying to 'fine tune' the dosage. (This all assumes the blood tests are of use in the particular patient).

[Clutter in reply to jimh111]

Thank you, Jim. 4 weeks to test after initial therapy is much kinder than having to wait 6/8 weeks for an increase.

[jimh111]

Yes, that's right. With a seven day half life the levothyroxine will have reached 90% - 95% of its target level after 4 weeks. It's only when they have arrived close to the patient's ideal dosage that a longer period is needed for more precise tuning. Starting a younger patient off on 100 mcg levothroxine also saves time, provided the patient does not have longstanding severe hypothroidism which needs a more gentle start.

[eeng]

You may like to post your blood test results here each time you get them - your doctor's idea of 'normal' (which will probably be anywhere in the wide reference range) might not leave you feeling well as optimal blood test results would. Also get your doctor to check your iron, ferritin, vitamin B12, folate and Vitamin D, because having optimal levels of these will help your body use the Thyroxine to best effect. Good luck.

[Andree]

Thanks everybody, just called the doc and getting bloods done on Monday, which will be 4 weeks. Will post results, thank you all again.