Hello everyone
I started taking Levothyroxine around 3 weeks ago, I asked the doctor for a blood test after 6 weeks on them and she said No, it has to be 3 months... so I asked for my intital blood results and here they are, I have no clue on how to interpret them, can anyone help? I've attached a photograph of what the doc printed off. Any advice is greatly appreciated.
Thanks (I hope the photo is clear!)
Kateybee,
It isn't possible to interpret thyroid results without the lab ref ranges (figures in brackets after results) but your FT4 result has a minus sign following so I assume that means FT4 8.9 is below range. TSH 16 is high.
6-8 weeks is the usual time to retest thyroid levels after starting Levothyroxine or adjusting dose. The starting dose is usually increased in 25mcg increments every 6-8 weeks until TSH is 1.0 or lower with FT4 in the upper range.
How much Levothyroxine have you been prescribed?
Hi thanks for replying, I've been prescribed 25 micro grams of Levothyroxine, but the doctor will not test me again until May. Do the blood results indicate any other problems? I'm so dumb when it comes to TSH, T4, T3 and I get confused with this so laymens terms for me please! I just don't understand it all, overwhelmed by all the information. Do I need to take any vitamins or extra things to help or is levothyroxine enough for now?
Thanks again 🙂
Kateybee,
TSH 16 is high because FT4 8.9 is low and FT3 although not measured will also be low. Thyroid peroxidase is negative for autoimmune thyroiditis (Hashimoto's) but unfortunately doesn't completely rule it out because some patients are positive for thyroglobulin antibodies which NHS primary care doesn't test.
25mcg is a very conservative dose. Your GP could have prescribed 75-100mcg unless you have heart disease or are elderly. If you feel unwell 6 weeks after starting Levothyroxine go back to your GP and ask for a blood test and dose increase. There is no point waiting 3 months to be told the dose is inadequate.
Hypothyroid patients are often deficient or low in ferritin, vitamin D, B12 and folate. Ask your GP to test. You won't know what or how much to supplement unless you have blood tests.
thyroiduk.org.uk/tuk/diagno...
Next time you get blood results ask for the lab ref ranges as well as the results. If the receptionist doesn't have them write to your GP or practice manager and ask for them. Don't be put off by your GP's disapproval. The Data Protection Act entitles patients to their results and ranges.
ico.org.uk/for_the_public/t...
Thank you so much for this! You are a great help.
You can say you have taken advice from Healthunlocked Thyroiduk. who are the the NHS Choices for information on dysfunctions of the thyroid gland. Many doctors haven't a clue so we have to - read - learn - in order to get better.
I'm so dumb when it comes to TSH, T4, T3 and I get confused with this so laymens terms for me please!
Don't worry, nobody is born knowing this stuff.
This article is worth reading :
health.howstuffworks.com/hu...
The book I used to get up to speed on the basics is this one :
amazon.co.uk/Your-Thyroid-H...
Note, there are lots of entries for this book on Amazon at wildly different prices, so check them all to find the best price. Don't forget you can also buy the kindle version (if relevant) or a used book. If you are prepared to read the kindle version on a PC or Mac you can download the Kindle App for free (search the Amazon website for "Kindle App" and choose the appropriate one for you).
How can I get the lab reference range? The doctor seemed a little put out at my request for blood results and barrage of questions, I'm still non the wiser. 🙁
You could ask the receptionists at your surgery which lab does the surgery's blood tests and ask them for a contact telephone number.
It is possible that the lab posts its reference ranges on the web, although only a few of them do that. If you can't find them on the web give them a ring and ask.
Your doctor is wrong to make you wait 3 months before blood testing.
If you read this link
cks.nice.org.uk/hypothyroid...
Quote
For people who do not need admission or referral, treat overt primary hypothyroidism with levothyroxine (LT4) — do not prescribe combination therapy (LT4 and LT3) in primary care.
See the section on Prescribing information for further information on initiation and titration of LT4.
Review the person every 3–4 weeks after initiation of LT4 and adjust the dose according to clinical and biochemical parameters, aiming to:
Resolve the symptoms and signs of hypothyroidism.
Normalize serum TSH and improve thyroid hormone concentrations to the euthyroid state.
Avoid overtreatment, especially in the elderly.
Once a stable TSH is achieved, TSH can be checked 4–6 monthly and then annually.
End Quote
Note that patients have found that 3 - 4 weeks is too soon. It really needs to be about 6 weeks between changing dose and repeating blood tests.
Thanks for all your help with this, I feel so frustrated that they will not test me after 6 weeks, they said it is Sheffield hospital endocrinology deptartment that decides the time frame. Should I see another GP? It's hard because I don't have one doctor I just get any in a telephone triage and when I asked to speak to a doctor face to face they said there's not a lot to discuss, just take the tablets and wait for a blood test in three months. 😕
I think going to another doctor in the region may well give you the same answer but it may be worth ringing the hospital and asking if this is what there current advice is. It may have changed and your GP has not been kept up to date. May be leave the hospital call for neared 4-5 weeks and say you don't feel waiting another similar time will be possible because of how you are feeling. The real reason is probably down to cost but they won't admit that.
Oh boy! Looks like your doc is following the minimum care standards as I would expect, but at least she took TPO antibody.
The problem with using TSH is that it's a poor method to guide replacement, and there are at least 3 different diagnostic ranges. Your lab is using 0.27-4.2. The AACE (American Association Clinical Endocrinologists) uses 0.3-3.0. Most functional medicine practitioners want to see it in the 1-2 range. From my experience, the corporate lab range is way too broad. You are more likely to feel well if TSH is near the bottom of its range, rather than near the top. But anyone should agree that TSH=16 is WAY too high, and T4=25mcg is unlikely to be your final dose. Of course, it does have to be increased gradually.
I don't know what to say about FT4. We need a lab range to decide, please get that from the lab that did the test, and post it.
The word "normal" is a red herring. A low antibody count over a long period of time will destroy the thyroid just as well as a high antibody count over a short period of time. As in my case. My TPOAb went to zero after I figured out what was causing it. Antibodies are really an issue of environmental health, often related to gut deterioration, and very few doctors know anything about that.
The half-life of T4 (levo) is about one week when one is euthyroid. In your case, the half-life is probably shorter because your body, being hypothyroid, should be using it faster. So in 6 weeks, you should be within 1% of your final result. Your doctor telling you 3 months does nothing but keep you feeling badly for longer. For comparison, my doc's minimum interval between tests, when adjusting T4, is 5 weeks.
Keep in mind that a knowledgeable doc is going to use a full panel for hypothyroidism, which consists of TSH/FT3/FT4/rT3/TPOAb/TGBAb. It's not over till the fat lady sings, and it's not over until the doc has proved that T4->T3 conversion is sufficient (FT3 in upper half of range) and you are not harboring an excessive level of rT3.
It is certainly possible you will end up on full replacement. The big drug companies claim that the full replacement dose for T4-only is 1.5-1.7 mcg/kg body weight. Multiply your weight in kg by 1.5 and see what you get as a full replacement dose.
Heed the advice of posters who will advise you to boost your nutritionals. There is a large set of supplements which will help your body do the T4->T3 conversion. For instance, a small dose of selenium helps because it is a component of the deiodinase enzymes that do conversion.
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