Hello it's been a long road trying to get Levo prescribed, even after a result of nearly 3000 peroxidase antibodies I was refused medication til Tsh out of range, but eventually it happened and I thought I might get somewhere but I have hit a brick wall again. I was initially prescribed 25mg ( even tho under 50) after i said I felt no change doc increased to 50mg which I have been taking for approx 5months, now u have had another blood test which I had to ask for because I still don't feel any different and the result is thus
Serum TSH level 2.98 mU/L [0.35 - 5.5]
Serum free T4 level 14.4 pmol/L [10.0 - 19.8]
Well now the doctor won't increase Levo because everything is within range ! He is particulary focusing on T4, mentioned the previos test when Tsh was over range but T4 was in range at 12.2 and says it's fine again so no increase.
I followed the process for blood test, had it at 8am didn't take levo, was 25hrs since precious tab, didn't eat etc til after, so what is the circadian rhythm for T4 and what time should I have test if it is this he focuses on ,? Or is it not my thyroid which is the problem and why I feel like an elderly person who needs to nap and hibernate ?
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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 articles from Thyroid UK email dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.
For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested
See if you can get FT3 and vitamin testing from GP. Unlikely to get FT3 but it's the most important
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, lowest FT4 and most consistent results
As you have Hashimoto's you are very likely to have low vitamin levels and low vitamins stop thyroid hormones working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Despite what your GP thinks you are undermedicated to have TSH 2.98 despite it being within range. FT4 14.4 is still low in range, a dose increase would raise it higher which is desirable.
The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.35 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.
If you haven't done so already it would be a good idea to ask GP to check ferritin, vitamin D, B12 and folate which are commonly low/deficient in hypothyroid patients and cause symptoms similar to hypothyroid symptoms.
You have another poorly trained doctor and we, the patient, suffers. Thankfully we have the internet so we have to read, learn and we will recover our health. When blood tests for thyroid hormones are due, it has to be the very earliest appointment, fasting (you can drink water) and allow a gap of 24 hours between last dose of levothyroxine and the test and take afterwards.
Ask GP to also test B12, Vit D, iron, ferritin and folate. Deficiences can also cause clinical symptoms.
Thank you for your replies, as I had stated I had the test, at 8am the first possible one, of the day, I had 2bk this many many wks b4 as they get bkd first, I put in a request a wk before test for doc to add Vit d & Ferratin but it didn't get authorised, my vit B when last tested was fine as I take the vit B tabs most days & it was quite high in range, I have been tested for celiac and allergy tested both of which are neg as I have allergic rhynitus which is not helped by nasal sprays or anything I have tried thus far, It has been getting considerably worse so have been trying to get to the bottom of that too. 're the doc toft info I tried to use that in previous yrs with a previous doctor when my Tpo antibodies came back very high but I was told that they at the surgery had to go by ranges only,( ie anywhere within range ok thats why there is a range!) anything else had to be sanctioned by endocrinologist, (I've previously posted on the appts I've had with them useless people!) Anyhow I did look at getting private blood test for ft3 and well it's not exactly cheap especially at this time of yr but chances are it will come back within range! The only way the ft3 is measured at surgery is when one of the others are out of range which happened once when Tsh was 0.05 and ft3 came back in range. So I'm not sure how this will help my cause but will cost me? Basically I wanted to know if there is a better time of day to measure T4, is it lower at any time? As this seems my only way of convincing doc for an increase?
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