Increase T4?

[stillhopeful]

Would like some advice as have a doctors apt today at 5.10 and could ask her to increase my T4 (Levothyroxine)or refer to endocrinologist or both?

I asked for advice about a year ago and was and am very grateful for the help given then and from Thyroid UK in general . I dont know how I would have managed without you and am a member and made our case in the government survey reT3.

Then my TSH was 36.3 (0.35 -3.95). In Nov 17 it was 0.85 same range.

It has taken a year to get from 50mcgT4 to 87.5mcg which is my present dose as I get a bad reaction every time I change dose. The GP said she would refer me to the endo if I was still symptomatic after 2 months under 1 TSH which is now the situation. Should I risk a further increase in T4 if she will let me or ask for a referral now?

By the way my Vit D was 20.1 (80-150nmol/L) a year ago but got it up to 100 at the end of Feb 2017. My folate and Vit B12 were average and Ferritin was on the low side but not out of scale so I have been taking supplements for these but have not been tested recently.

[SlowDragon Administrator]

What are you actual TSH, FT4 and FT3 results and ranges?

It would be good idea to retest all vitamins. It's some time since they were tested

Vitamin D, folate, ferritin and B12

Did you carry on taking maintenance dose of vitamin D?

Never established in previous post if you have high thyroid antibodies. You do need to know. If high then you might consider gluten free diet

Suggest you ask GP to test both TPO and TG antibodies (or explain previous result)

[stillhopeful in reply to SlowDragon]

Do not have recent FT3 or FT4 as GP/NHS Lab do not want to test for these.

June 17

Ferritin 54 ng/ml (20-204)

FT4 16.1pmol/L (9.1-19.05)

Have been on iron bisglycinate 20mg a day since then with Vit C.

yes I did carry on with Vit D taking on average 1500 iu a day.

As far as I can make out I was tested for Anti Thyroid Microsomal Ab twice

20 Dec 16 Anti-Thyroid Microsomal Ab 0.6 no range given.

6 June 17 Anti- Thyroid Microsomal Ab 0.5 no range given

The title of this test is ANTI-THYROID PEROXIDASE.

I think it must be TPO AB.

I will ask for the other test which I think is Antithyroglobin Antibody TG AB

I have been stricter with my gluten free diet for a year. Ever since I had CFS I have found that gluten tends to give me arthritic symptoms.

Should I get private tests before either increasing my T4 or referral to endo?

[SlowDragon Administrator in reply to stillhopeful]

Personally I would get full private testing.

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

Private tests are available

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, lowest FT4 and most consistent results

Link about antibodies

thyroiduk.org.uk/tuk/about_...

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

[stillhopeful in reply to SlowDragon]

Thanks for the advice. Doctor will test for folate and B 12 given my symptoms. She does not want to increase my levothyroxine and will refer me to an endo after results of blood tests if within range.

Asked for other hashi test. She tried on the computer but lab does not do them. She is also going to try to order free T4 free T3 test but says lab unlikely to do them. Get the feeling she is frustrated with sit also.

Need to go private for other tests and investigate endos.

Thanks for all the links!