Advice please on blood results

Hello!

As you may already know to your cost, sometimes GP's advice is grounded solely in blood work ranges rather than paying attention to how a hypothyroid patient is feeling or responding to treatment. The experience of members here is that there needs to be a watchful eye on the levels of thyroid hormones and vitamin and mineral levels because there's a difference between something being within a reference range and being in a part of the range that is optimal for effective use of thyroid hormones (whether our own or supplemented/prescribed ones).

An appropriately-medicated hypo patient tends to find that the TSH is suppressed to <1 as that is typical for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo. So, yes, the TSH might be a little lower than the reference range but the other levels tend to be more related to how someone feels.

If you have the results of your recent blood work (TSH, FT4, FT3, thyroid antibodies, etc. plus any vitamins and minerals like iron, ferritin, folate, vitamins B12 and D), please post them, along with their reference ranges, as it will help members to comment. I know that you mention your FBC - is there a ferritin level? It will be easier to comment about whether OTC supplementation might be useful if members can have a fuller picture of your blood work.

Musculoskeletal pain is quite common when people are vitamin D deficient so I'm wondering if you know your level for that.

If you don't have your full results, please obtain a copy by contacting your GP's reception, and then post them, with details of your levo. etc. and that might allow members to make helpful observations or suggestions.

Oh dear. Same old same old from the medical profession...

Once you start taking thyroid hormone replacement the TSH becomes irrelevant, because you have effectively broken the body's feedback loop between thyroid-pituitary-hypothalamus. Don't be concerned about below range TSH.

Did your GP do FT4 and FT3 tests? It's difficult to know what's going on without these.

Your FBC is below the botton of a large lab reference range. It needs addressing, but did the GP do any other bloods?

Do you have Hashimoto's disease aka autoimmune hypothyroidism? In that case, a so called "normal" TSH can perpetuate the autoimmune attack. My doctor says most Hashimoto's sufferers feel best when their TSH is somewhere between 0.05 and 0.1, sometimes even lower than 0.05. If your free Ts (the actual thyroid hormone levels) look good and you have no symptoms of being either under- nor overmedicated, the TSH should not matter.

Would not reduce your dose until you have had full Thyroid blood test. Just TSH tells you virtually nothing when on Levothyroxine (sounds like your GP does not understand Thyroid)

You need FT3 and FT4 testing. As long as FT4 is within range, towards top of range and FT3 at least half way in range but not over range, regardless of TSH you are not over treated

NHS unlikely to test FT4 and almost never tests FT3

Insomnia and leg pain could be low vitamin D, which is extremely common when hypo

drgominak.com/sleep/vitamin...

Also good idea to test B12 and folate

Yes it definitely does matter that your Anaemic, you can't use thyroid hormones if ferritin is too low

healthunlocked.com/thyroidu...

Lastly it's essential to know if your have high thyroid antibodies, this gives diagnosis of why you are hypo. If high this is autoimmune thyroid disease also called Hashimoto's. Highly likely to have poor gut function leading to low vitamins

If you can't get full thyroid and vitamin testing from GP, then like hundreds on here you will need private tests

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.