please can you help with my thyroid blood results and more blood test

[1lackingenergy]

Hi

I have asked for my results as you have all suggested and this is what I have been given!

March 2016

Normal TFT with a TSH OF 1.9 and Free T4 of 1.1

September 2016

TSH Suppressed at <0.05 with a Free T4 of 28 indicating hyperthyroidism

November 2016

TSH 5.4, Free T4 of 9 and Free T3 of 3.7 with negative TPO antibodies - slightly hypothyroid

January 2017

Ultra sound - shows a large thyroid encasing the trachea with no discrete nodules. There was some mild increased vascularise. No retrosternal extension and no sinister features.

Bloods - TSH of 5.6, Free T4 of 9.0 lower limit of normal and Free T3 of 3.6 pmol/L 2.60-5.70pmol/L

February 2017

Started 25mcg levothyroxine

March 2017

Bloods - thyroid function normal, TSH 3.2 mlU/L 0.40-5.00mlU/L and Free T4 11 pmol/L 9.00-19.00pmol/L

As I have previously said, I am still having lots of symptoms:

Difficulty swallowing when the thyroid inflames with aching down the neck

Dry throat and mouth

Blurry vision

Gritty eyes

Feel really cold and can't warm up

Feeling over hot, sweating and wanting to pass out or dizzy

Feel like I may be sick

Enlarged tongue when throat plays up

Hair loss

Sweating

Anxiety

Depression

Extreme tiredness and fatigue making it difficult to do anything

Heart palpitations

Weight gain

I have been of work this year as all I do is sleep as small tasks wear me out. I have been sleeping most of the day. As my thyroid is now normal she said I can't be tired and that I must have depression as I has cried as I was fed up of feeling so tired and no energy. She won't sign me off work anymore as fatigue is not a medical condition and my thyroid is normal I have to return to work in a week and have warned work I won't cope and may fall asleep. I am thinking of getting private bloods done as I want to know why I still feel so tired and have no energy to do anything or do something for an hour but then have no energy afterwards for the rest of the day or for a few days.

What do you think from my mixture of results?

[SeasideSusie Remembering]

1lackingenergy Your results can't be interpreted without the reference ranges, can you please add them. You can edit your post by clicking the down arrow V at the bottom, make the changes and click the green button to save the changes.

25mcg Levo is a starting dose and unless you are frail, elderly and have a heart condition you could have been started on 50mcg.

You will need your tests repeated 6-8 weeks after starting Levo. Book that appointment for the earliest one of the morning, fast overnight (you can have water), and leave off Levo for 24 hours. This will give the highest possible TSH which is what we need when looking for an increase in dose or to avoid a reduction. Do this every time you have a test.

You should get an increase of 25mcg after that repeat test, then you'll need another test 6-8 weeks later with another increase, then retesting again after 6-8 weeks, etc, until you feel well and symptoms abate.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well.

There are two types of antibodies, TPO which you have had done (what was the actual result (with range), and TG (thyroglobulin) which the NHS almost never do. You can be negative for TPO but positive for TG so it would be a good idea to push for it to be done or do a private test.

[1lackingenergy in reply to SeasideSusie]

Thank you for your reply. I have added the ranges in March as that is the only blood results they have supplied the ranges for so I will go back to the doctors and ask for them. Especially as I have had to pay £13 for all my results and letters and the important information is missing ☹️ I have no clue why I was started on a low dose. He said he was putting me on medication mainly because of my symptoms as he said my thyroid was almost normal. January I have added my T3 range

The March results are my 6 weeks check and I have been told I shouldn't need any more bloods now until I see the endocrinologist is June/July

[SeasideSusie Remembering in reply to 1lackingenergy]

1lackingenergy

"February 2017

Started 25mcg levothyroxine

March 2017

TSH 3.2 mlU/L (0.40-5.00mlU/L)

Free T4 11 pmol/L (9.00-19.00pmol/L)"

He is going by the fact that your results have now come into range, your TSH has reduced from 5.6 and your FT4 increased from 9. But just because they are within the range doesn't mean that everything is fine. You still have symptoms, your TSH still to high and FT4 still too low.

From ThyroidUK's main website > About the Thyroid > Hypothyroidism - Treatment Options:

'According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

Dr Toft states in Pulse Magazine, "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.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)." '

Dr Toft is past president of The British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing [e-mail] to show your doctor.

**

"The March results are my 6 weeks check and I have been told I shouldn't need any more bloods now until I see the endocrinologist is June/July"

Is this the GP or the endo?

You need retesting every 6-8 weeks with increases in Levo until you reach the dose which brings your test results to a level where you feel well and symptoms abate. See

thyroiduk.org.uk/tuk/diagno...

And scroll down to

"If you are diagnosed:

Once you have been diagnosed, try to see the same GP/endocrinologist every time you make an appointment. It makes it much easier to discuss your progress.

Be aware that if you are diagnosed with hypothyroidism (myxoedema), you are entitled to free prescriptions. Ask your GP or NHS hospital for an FP92A application form. The form tells you what to do. A certificate/card will be sent to you upon receipt of a properly completed application form.

If your doctor diagnoses you with thyroid disease, he will probably start you on treatment. Information on the different treatments is found in our leaflets, Hypothyroidism and Hyperthyroidism. Treatment is usually started with small dosages. You will probably be told to be tested in two or three months and then make another appointment. Your doctor will then look at your test results, discuss your symptoms with you again, especially any improvement, and then make a decision as to whether or not to increase or decrease your dosage.

Your doctor will decide when to keep you on a particular dosage. This is usually decided by looking at the blood tests. However, some people still remain ill at this point. If this happens, we suggest the following:

Hypothyroidism:

etc ....... "

Tell your doctor that your information comes from Thyroid UK which is NHS Choices recommended source of information for thyroid disorders.

It looks like you are going to have to fight your corner if you want to get well.

**

For best absorption of your Levo, take it on an empty stomach, one hour before or two hours after eating, with water only, not tea, coffee, milk, etc. If you take any other medication or supplements, take it two hours away from Levo, and four hours for iron, calcium, Vit D and magnesium.

[1lackingenergy]

Thank you once again. It was the doctor that told me my 6 week tests were normal and I didn't need any more bloods done.

I have email Louise for a copy of the article and I will look at the other document you stated.

[Katepots]

Up your meds, THS needs to be under 1 for us to feel well.

Although you don't have antibodies try cutting gluten out of your diet and see if that makes a difference to how you feel. Casein in milk another biggie but try gluten first.

Some people with Hashimotos don't show antibodies so worth trying to see if symptoms improve.

[1lackingenergy in reply to Katepots]

I know I need to try and change some of my lifestyle as well as medication but it's knowing where to start. I will look up a gluten free diet and try my best as I really want some energy back.

[Katepots in reply to 1lackingenergy]

Gluten and casein free really helped me. I bought a nurti bullet (best thing ever) so start each day off with a smoothie.

Banana,blueberries, green powder or spinach, cinnamon and turmeric (both anti inflammatory) B12 powder, collagen powder. Makes me feel so good quick and easy too. Bung in blend!

Take a good pro biotic, has also really helped me.

Phi naturals 10/30 from Amazon is good.

Cut down caffeine and alcohol 😩

Get your Folate Ferritin b12 and Vit D tested as your likely to be low in some if not all.

A lot of your symptoms sound like B12

Vit D should be around 60

B12 over 600

Under 500 you can start to have neurological changes.

X

[1lackingenergy]

Thank you. The doctor makes me feel like I am a hypercondriac but I know when I really don't feel well. I will have to go back with all this evidence and hope she listens. Apparently I had to pay £10 for their time and 10p a sheet but that doesn't make sense as I only got five sheets! Another thing to moan about when I go back and that they didn't include the full information of my test results. Arrggh