Elevated TSH Levels after 5 weeks on Levothyroxine - Advice Please :)

[CB1990]

Hi everyone,

Had a Medichecks test in Feb after years of being told I was borderline Hypo. I have posted the results as a picture.

I had an appt with my GP on 03/03 and he prescribed 25mg of levothyroxine and an appointment with an Endocrinologist (coming up in May).

I am also receiving B12 injections, and the nurse on Monday told me that I should have another blood test to present the Endo with for comparison. This time all that was tested was:

Free T4 11.6 (Range 10.8-25.5)

TSH 10.1 (Range 0.27-4.20)

So the TSH is the same range as my first test but I have jumped from 6.9 to 10.1 in 5 weeks whilst taking my Levothyroxine. I should add that I had my blood test first thing in the morning before food and before taking Levo. Is this raise normal? The nurse looked fairly confused and told me to discuss it with the Endo in May but if any of you have any insight it would be greatly appreciated. Thank you for taking the time to read my post.

[Clutter]

CB1990,

Your GP needs to increase dose. 25mcg was an insufficient starting dose unless you are frail, elderly or have heart disease. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 1.0 or lower with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Your FT3 was only at it's level in Feb because high TSH is flogging the thyroid and conversion to T3.

Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

I'm struggling to read the B12 and folate results on your Medicheck report but they both look low/deficient. I don't think an endocrinologist has any particular expertise about B12 deficiency. If your GP isn't competent to treat it you should probably be referred to a haematologist. Pop over to healthunlocked.com/pasoc for advice on B12 and folate deficiency.

[CB1990 in reply to Clutter]

Hi Clutter,

I am not frail, elderly or with heart disease - I am a strapping 26 year old woman!

Thank you so very much for your reply, it's really wonderful that you took the time. Is it usual, then, that if the Levo dose is too low it will cause the TSH to rise?

Yes, both b12 and folate were low. B12 especially at 88. The GP advised getting my folate levels up before having B12 jabs. I've since been advised against this by many, doctors included, due to potential nerve damage and folate mimicking/masking B12 levels so I think I was just unlucky with the GP I saw initially!

Thank you so much again for your helpful comments.

[Clutter in reply to CB1990]

CB1990,

No, the Levothyroxine 25mcg hasn't caused your TSH to rise. Your hypothyroidism has gotten worse because 25mcg wasn't enough. Your GP could have started you on 50mcg or 75mcg.

I think PASoc advise B12 jabs 48 hours before starting to supplement folic acid when both are deficient.

[CB1990 in reply to Clutter]

Hi Clutter,

Thank you for clarifying.

Thank you also re: B12 and Folic Acid - I will seek advice from the PASoc.

All the best.

[shaws Administrator in reply to CB1990]

with a B12 of 88 did your doctor take an antrinsic test to see if you have pernicious anaemia?

[CB1990 in reply to shaws]

Hi Shaws, thank you for this. It's only thanks to my Medichecks test that I knew I needed one so I did push the GP on this, results expected next week. Thank you again.