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Help with test results and what to do...........

Apologies in advance as this may seem a long post. Below are my three recent sets of test results - following the March 2017 results my GP placed me on a low dose (25mg) of Levothyroxine. Following the June results, I saw my GP as I was experiencing dizzy spells and tiredness, which were new symptoms. He said my test results were normal and that I probably did not need to be on any medication and that the Levothyroxine could be the cause of the dizziness, but to keep on those until the re-tests in September.

Following the September results (again "normal") I have decided to come off the medication. Does this seem a reasonable approach?

Many thanks in advance for any advice.

TEST RESULTS:

Specimen Type: Serum

Specimen Reference#: 1

Received: 16 Mar 2017

Pathology Investigations

Thyroid function test

Serum TSH level 7.77 mU/L [0.35 - 5.5]

Above high reference limit

Serum free T4 level 13.7 pmol/L [10.0 - 19.8]

-----------------------------------------------------------

Specimen Type: Serum

Specimen Reference#: 1

Received: 21 Jun 2017

Pathology Investigations

THYROID PEROXIDASE ANTIBODY

Serum thyroid peroxidase antibody concentration 81 iu/ml [0.0 - 60.0]

Above high reference limit

Thyroid function test

Serum TSH level 4.88 mU/L [0.35 - 5.5]

Serum free T4 level 14.8 pmol/L [10.0 - 19.8]

-------------------------------------------------------------------

Specimen Type: Multiple

Specimen Reference#: 1

Received: 27 Sep 2017

Pathology Investigations

ESR

Erythrocyte sedimentation rate 6 mm [2.0 - 10.0]

FREE T3

Serum free triiodothyronine level 4.7 pmol/L [3.5 - 6.5]

Full blood count

Total white blood count 8.0 10*9/L [3.9 - 10.2]

Red blood cell count 4.90 10*12/L [4.3 - 5.75]

Haemoglobin concentration 142 g/L [135.0 - 172.0]

Haematocrit 0.425 L/L [0.395 - 0.505]

Mean cell volume 87.4 fL [80.0 - 99.0]

Mean cell haemoglobin level 29.3 pg [27.0 - 33.5]

Red blood cell distribution width 13.1 % [11.0 - 16.0]

Platelet count - observation 314 10*9/L [150.0 - 370.0]

Plateletcrit 0.260

Mean platelet volume 8.3 fL

Neutrophil count 4.18 10*9/L [1.5 - 7.7]

Lymphocyte count 2.83 10*9/L [1.1 - 4.5]

Monocyte count - observation 0.62 10*9/L [0.1 - 0.9]

Eosinophil count - observation 0.16 10*9/L [0.02 - 0.5]

Basophil count 0.07 10*9/L [0.0 - 0.2]

Liver function tests

Serum albumin level 36 g/L [35.0 - 50.0]

Serum total bilirubin level 6 umol/L [0.0 - 20.0]

Serum alkaline phosphatase level 94 U/L [30.0 - 130.0]

Serum alanine aminotransferase level 20 U/L [7.0 - 40.0]

Urea and electrolytes

Serum sodium level 140 mmol/L [133.0 - 146.0]

Serum potassium level 4.0 mmol/L [3.5 - 5.3]

Serum creatinine level 74 umol/L [62.0 - 115.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres ≥ 90 mL/min/1.73m*2

Please note change in eGFR equation to CKD-EPI.

eGFR calculation assumes Caucasian origin.

VITAMIN B12

Serum vitamin B12 level 400.0 ng/L [211.0 - 911.0]

FOLATE (SERUM)

Serum folate level 5.88 ug/L [> 5.38]

Serum Folate Reference Range = Greater than 5.38 ug/L If the patient

cannot be fasted be aware that a folate rich meal, eaten less than 3

hours prior to venesection, may increase serum folate concentrations.

Thyroid function test

Serum TSH level 3.89 mU/L [0.35 - 5.5]

Serum free T4 level 15.0 pmol/L [10.0 - 19.8]

3 Replies
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No you actually need a dose increase, not stop it. Retesting again after further 6-8 weeks

Your blood test in June shows high thyroid peroxidase antibodies - 81 i.e. Over top of range of 60

So you definitely have Hashimoto's or autoimmune thyroid disease

The aim of thyroid replacement is to bring the TSH down near one. Not just anywhere in range TSH in last test at 3.89'is far too high indicating you need dose increase

FT4 should be near top of range - around 17-19

copy of Dr Toft's article from Pulse online

Dr Toft was president of BTF ( British Thyroid Foundation)

What is the correct dose of thyroxine

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.

Also ask GP to test vitamin D, extremely common for this to be too low

hypothyroidmom.com/92-of-ha...

Hashimoto's very often affects the gut, leading to low stomach acid, low vitamin levels and leaky gut

WithHashimoto's is that very likely hidden food intolerances can be causing issues, most common by far is gluten.

Changing to a strictly gluten free diet may help reduce symptoms. Very, very many of us here find it really helps and can slowly lower antibodies.

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/why-changi...

scdlifestyle.com/2014/08/th...

Low vitamins that affect thyroid are vitamin D, folate, ferritin and B12. If they are too low they stop Thyroid hormones working.

Your vitamin B12 and folate are not brilliant. You need to keep an eye on this and may need to supplement

See SeasideSusie excellent detailed vitamin advice

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

All thyroid tests should be done as early as possible in morning and fasting and if taking Levo don't take it in the 24 hours prior to test, delay and take straight after

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I agree with SlowDragon. You have Hashi's, so things are going to get worse, not better. Your doctor started you on too low a dose of levo, so it's going to take quite a few six weekly increases before you bring your TSH down to zero - where it needs to be when you have Hashi's - and your FT4/FT3 up to a level that will make you well.

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Ok, the latest Serum TSH test showed a level of 10.8 - this followed the period of coming off the meds as advised by GP. I now have an appointment with the GP tomorrow where I suspect he will reinstate the medication.

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