Please help me understand my blood test results

[sam8de]

Hi there. Not been on here for a while. My initial TSH level results in June were:

6.51 mu/L (0.27 - 4.20) and was given a very low dose of levo (25mc). I had another blood test a week and a half ago. Results were: free T4 level 14.8 pmol/L (10.8 - 25.5) TSH level 5 mu/L (0.27 - 4.20).

My gp rang a few days ago and said that I need to up the levothyroxine to 75mc and that it may be a too high a dose, but at least I'd lose weight (ha!). He also said that I wouldn't need another blood test until January 2018 - that's 4 months away, yet the levo leaflet says that you should have your blood checked every 3 or 4 weeks until the correct dosage is found. I'm so confused. Through your experiences, with my results, do you think 75mc is adequate? Any info would be very much appreciated. Thanks.

[spongecat]

Hi there

I think doc is maybe jumping the gun a little. It is normal to increase (or decrease) levothyroxine in 25mcg steps. He has started you on a very low dose normally for the elderly or people with heart conditions.

He should up your dose to 50mcg and then redo the blood test in 6-8 weeks time to see how things are getting on and how you feel in regards to symptoms. Upping immediately to 75mcg may be too much at once for your body to cope with comfortably and he has admitted as such! Repeating the blood tests too early will not give a chance for the levo to have done its T4 to T3 thing and percolate through the body. His suggestion of waiting until January is far too long, especially if you are feeling lousy. As I said the test during the dosage titration period should be retest at 6-8 weeks every time there is a dosage change.

Losing weight is really only feasible once you are on the correct dosage and even then you need to be aware that it can be a marathon, not a sprint. Extreme dieting can cause even more problems and extreme exercising at this time can leave you completely exhausted until you find out how your conversion ability is doing.

Usual protocols (which your GP is probably not aware of)....book blood draw for before 9am and fast overnight, drinking water is OK and leave 24 hours between your levo dose. So if you take levo in the morning don't take it on the morning of the blood draw, take it afterwards. Always take levo on an empty stomach with a glass of water and nothing to drink like tea or coffee or food until 1 hour later.

It also would be a good idea to test your B12, Vitamin D, ferritin and folate levels as well.

[sam8de in reply to spongecat]

Spongecat, thank you so much for your advice! I will take it all on board. However, with the risk of sounding thick, I still do not understand my results. Am I subclinical? Have I hypothyroidism? All I can tell you is that I struggle so hard to get through each day. I'm self-employed, so have to force myself to get up each morning and get through each day and flop whenever I can. It's Friday evening now, and am looking forward to spending the whole weekend in bed - no work, no boyfriend, no friends, no anyone - just me and bed. I used to be so sociable, so I KNOW this isn't me.

[spongecat in reply to sam8de]

Hi sam8de

Don't worry, you are not being thick. It's hard to take in stuff like this when you are not well. Well you will gain knowledge, probably more than your GP! Have a good look around our parent sight thyroiduk.org/ for lots of imformation. Also Dr Peatfield has written a book that explains ...Your Thyroid and How to Keep it Healthy (available as book, kindle etc.)

Knowledge is power with this condition! Sorry, I digress.......

Now your results in June were a TSH 6.51 (0.27-4.20) ....you are outside the reference levels and are hypothyroid, you haven't given a T4 for then but never mind it was probably on the low side. It is good that your doctor started you on Levo because some GP's follow the notion that treatment shouldn't begin until TSH is 10 and the poor patient can be feeling very ropey indeed, they don't seem to care! It is those doctors who would describe you as possibly "subclinical". On here we say no to that, you are hypothyroid and should be treated.

Now your latest bloods show that the TSH has dropped to 5. (you are still outside reference range) It is no wonder that you are still feeling bad because most of us hypos do not feel better until the TSH is 1 and less.....that is the goal. So you need that raise of Levo and then the 6-8 week blood test to see if the TSH has dropped again.

Did your doctor test for antibodies? (TPO and TGab) Sometimes they do sometimes they don't. If either or both of these are positive then this is called Hashimoto's disease or autoimmune thyroiditis and is the most common form of hypothyroidism. This cannot be "cured" as such and the antibodies slowly destroy the thyroid hence our need to replace the hormones. We can help diminish the severity of the attacks and many of us get positive results by adopting a gluten-free diet, sometimes dairy free too.

When you have a blood test ask for the results and reference ranges. You are legally allowed this information under the Data Protection Act. In this way you can keep track of things. Some of us opt to have our bloods done privately too as the NHS only does tests which reveal half the story, so to speak. Thyroid UK has details on labs who do this. Your GP may or may not accept the results but we do it for our own peace of mind and is essential for those of us who have opted to self-treat.

How you feel now physically and mentally is the disease, it's horrid. I didn't leave the house for a year, very rarely I would venture out until I was diagnosed and had an inkling of what was going on. In fact I really couldn't be arsed to do anything. I would think about doing something and want to do it but I just couldn't. My GP tried me on anti-depressents which I didn't need and resulted in even more weirdness in my head! It was only when the Practice Nurse thought I had a gouty toe ( Yes another hypo symptom!) and ordered a full blood panel that the TSH of 27 came back...ooops! you have a dicky thyroid my dear!.......Little by little I got my life back. Be kind to yourself. Sometimes our friends can find it hard to understand why we are shutting ourselves away, this will not last, you will improve.

You will get your vim back but it takes a little time and then one day you wake up and actually feel some beans inside you.

I think that is probably enough for you to take in now.

Keep posting on here, ask questions, have a rant. There are sympathetic people here who totally understand.

[sam8de in reply to spongecat]

Oh my gosh, I'm so sorry. I've only just seen your reply! Thank you so much for all your wisdom and experience. I've had a shitty couple of weeks. Huge fall out with my boyfriend of almost 8 years. He really doesn't understand and thinks that I 'choose' to be this way. That I am lazy to want to spend every spare second of the day in bed, curtains closed, on my own and shutting the world out. Everything, big or small, is such an effort; getting out of bed, brushing my teeth, washing my hair etc. You really touched a nerve when you said about thinking about doing something, wanting to do it, but just couldn't. That is me all over! The simplest of tasks seem so mammoth to me. I used to be so energetic, so out-going and sociable. Now I just want to be on my own 24/7.

[sam8de]

Sorry, just to add that they didn't test for antibodies and that I started a gluten-free diet yesterday (so expensive!!). xx