Help with old results, was I showing signs of thyroid problem?

[rosserk]

Hi can anyone help interrupt the results above from a test I had done June 2017. I’ve just come across it and it appears my thyroid function was tested before and is slightly lower than my current results after being prescribed levothyroxine. My symptoms have been the same since March 2015.

[shaws Administrator]

Your TSH result if it was after you began levothyroxine is too high. The aim is a TSH of 1 or lower if on levothyroxine. Others will respond to some of your results.

The fact that your symptoms have remained the same for three years says it all.

You should have no symptoms if you were on an optimum dose but sometimes we need to add some T3 to T4. Many do fine on T4 alone (levothyroxine) but it has to be at an optimum which means a TSH of 1 or lower and Free T4 and Free T3 in the upper part of the range.

There is a Special Offer this week with Medichecks which you might like to take advantage of.

thyroiduk.org.uk/index.html

All blood tests have to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours from your last dose of levo and the test and take afterwards.

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

[rosserk in reply to shaws]

Hi this was my blood results when doctors said they couldn’t find a problem for my symptoms. I wasn’t given levothyroxine until 2 months ago after a second test. Which showed the following results

TSH LEVEL 13.1

T4 LEVEL 8.8

My last test after levothyrixine has brought my TSH level down to 2.63 which is higher than when I was tested in 2015 when they said I was fine.

[SeasideSusie Remembering in reply to rosserk]

Your result was "fine" back in 2017. No-one really knows their "normal" TSH when fully well because we are not tested. Back in 2017 your TSH was well within the normal range and they didn't test FT4 or FT3 or antibodies, so to all intents and purposes there was no indication of thyroid disease.

The fact that your TSH now is higher than 2017 is because you did eventually develop full blown hypothyroidism with an over range TSH. You are now on Levo and it is doing it's job of bringing down your TSH. You know from replies to your threads of the previous couple of days that:

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

You know you need an increase in Levo and you've been given a link to the Pulse article by Dr Toft in support of this.

All this information is in replies to your previous 2 threads.

[rosserk in reply to SeasideSusie]

Sorry SeaSideSusie

I’m not trying to be a nuisance I was told to post additional questions in a new thread but I think that’s confused things with different people giving me the same advice.

I realise some of my questions are a bit daft but I’ve been ill for so long I’m desperate. Apologies if I caused anyone offence

Kindest regards ..

[amasufindme in reply to rosserk]

Sending you a big hug

[rosserk in reply to amasufindme]

Thank you.....

right back at you!

Kindest regards 😜

[shaws Administrator in reply to rosserk]

When you give your results, it is helpful to also give the ranges. The reason being that labs differ in their machines and so do ranges. Nothing is easy is it

A TSH of 2.63 - nearer 3 is too high and the aim is a TSH of 1 or lower. Unfortunately our doctors seem to have been trained exactly the same and only think that if the TSH reaches 'somewhere' in the range, ie up to 5 is fine if we're on levo. Not so, the aim is a TSH of 1 or lower so you need an increase in dose.

Request a blood test for six weeks after your increase and see what it is after your increase. The aim is 1 or lower so if it is higher than 1 ask GP for an increase in levo. Make the appointment in advance so you get the earliest test possible and allow a gap of 24 hours between your last dose of levo and the test and take afterwards. This gives us the best results.

[SlowDragon Administrator]

You folate was below range and B12 on low side. Typical of being under medicated on Levothyroxine

CRP above range as well

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 print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

[rosserk in reply to SlowDragon]

So was my level of 2 showing a problem in 2017? Or am I confused?

[shaws Administrator in reply to rosserk]

Your doctor may not have thought a TSH of 2 was high because in the UK, the diagnosis of hypo is when the TSH reaches 10 and in other countries people are diagnosed if it goes above 3 and I doubt if doctors now know that it should be 1 or lower.

[SlowDragon Administrator in reply to rosserk]

Were you on Levothyroxine when this test was done?

[rosserk in reply to SlowDragon]

No I only went on levothyroxine when result came back

TSH LEVEL 13.1

T4 LEVEL 8.8

Two months ago

Just had re-test after levithyroxine for 8 weeks and TSH is now 2.63

[SlowDragon Administrator in reply to rosserk]

Well at least with TSH of 13.1 you got problem regognised

So you are on 50mcg presumably

You need FT4 and FT3 tested too

You will need dose increased, by 25mcg hopefully GP agrees.

TSH over 2 is too high on Levothyroxine

Ask for vitamin D, folate, ferritin and B12 to be tested, plus thyroid antibodies too

[rosserk in reply to SlowDragon]

Nope I’m still on 25mg doctor said I’m back in normal range so no change to medication required. Haven’t seen a doctor all information has been relayed to me by receptionist. I have appointment in two weeks so will be asking for an increase but not sure doctor will agree.

[SlowDragon Administrator in reply to rosserk]

Not acceptable at all.

NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...

If GP won't increase or run all tests you will need to get private testing done

[rosserk in reply to SlowDragon]

I’m hoping to use the guidelines in my argument for an increase. 😊

[Clutter in reply to rosserk]

Rosserk,

TSH >2.0 indicates thyroid was beginning to struggle but 2.0 is within normal range and NHS won't diagnose hypothyroidism until TSH is over range or FT4 below range.

[rosserk in reply to Clutter]

My symptoms were the same at that time perhaps if I’d had a fasting test it may have showed a problem who knows. In any event I now know there’s a problem which is better than having no reason for my symptoms. I wished I’d known to have a fasting test and not to take levothyroxine for 24 hours before my most recent test then perhaps the results would have been different and my doctor may have increased the dose.

I specifically asked if I should fast, my test was also at 4pm not first thing. Next time I will insist on a test in the morning.

Kindest regards and thanks for your continued responses 😊

[Clutter in reply to rosserk]

Rosserk,

TSH wouldn't have been abnormal even with a fasting test. Symptoms can precede abnormal bloods by months.

Why don't you ring your GP and ask for dose to be increased? TSH would have been higher had you had an early and fasting test but TSH 2.63 indicates undermedication when taking Levothyroxine.

[rosserk in reply to Clutter]

Sorry I meant the most recent test on Monday this week the one that returned result 2.63 which doctor said was normal and no increase needed. I asked the receptionist if I could speak with the doctor but she said no! She could arrange a telephone appointment for the 15th but I have appointment on the 14th. I will ask for increase then.

[Clutter in reply to rosserk]

Rosserk,

Is there no duty doctor you can speak to when your appointment is weeks away?

[Angel_of_the_North in reply to rosserk]

Most healthy people have a TSH around 1.2. The number declines sharply after about 1.75 see ncbi.nlm.nih.gov/pmc/articl... , so statistically a TSH of 2, although in normal range is less likely to be healthy that a TSH of 0.9, but quite a lot of people are perfectly healthy with a TSH of 2 - that's why you also need to test thyroid hormones. Also look at hindawi.com/journals/jtr/20... (Thanks Diogenes) on the problems with TSH testing.

[rosserk in reply to Angel_of_the_North]

I think had they tested T4 they may have found a particularly when I had so many other suggestive symptoms. I don’t suppose it matters now as long as I can now get the appropriate treatment.

[rosserk in reply to SlowDragon]

Thank you I’ve requested the article but haven’t received a reply yet ..

[RedApple Administrator in reply to rosserk]

There might not be anyone in the office at the moment. Lots of people haven't been able to get to work due to the weather. We're not just snowed in, but iced in where I live. No-one in our road has been able to go to work and schools are closed!

[Angel_of_the_North]

Your TSH appeared fine, but there was no actual thyroid test (free T4 and freeT3). Your B12 was too low and your folate under range, which should have been treated. Your C reactive protein was high, suggesting inflammation.

[rosserk in reply to Angel_of_the_North]

Thank you for taking the time to respond. I’m getting a bit confused with the different numbers for each component. It just occurred to me when I saw thyroid at the bottom of the test and it was only 2.00 that there may have been a problem then that was missed. Think I understand it now 😜