Thyroid UK

Advice requested on latest bloods

I’d be grateful for advice on my latest blood tests please. All blood tests shown below, since Aug 17, with the latest ones at the end. (The first three lots done on the NHS, the last lot via Medichecks. Just waiting now for results of separate Vit D test. First lot of tests wasn’t fasting; others were; latest lot at 8.30am which is about an hour earlier than the previous ones.)

31 Aug 17 – pre diagnosis, not on medication

Serum TSH 6.89mi/L [0.27-4.2]

Serum free T4 11.1pmo/L [12.0-22.0]

Thyroid peroxidase antibody level 220 U/mL [>34 = positive]

Serum vitamin B12 503pg/mL [197.0-771.0]

Serum ferritin level 22ng/mL [13-150ng/mL]

Serum folate level 7.1ng/mL [3.9-26.8 ng/mL]

Serum 25-Hydroxy vitamin D3 level 58.4nmol/L [50-75nmol/L is adequate]

30 Oct 17 – on 25mcg Levothyroxine

Serum TSH 3.58mi/L [0.27-4.2]

Serum free T4 14.3pmo/L [12.0-22.0]

13 Jan 2018 – on 50mcg Levothyroxine

Serum TSH 0.65 miu/L (0.27-4.2)

Serum free T4 17.7 pmol/L (12.0-22.0)

1 Mar 2018 – on 50mcg Levothyroxine

TSH 3.17 mIU/L (0.27-4.2)

Free T4 13.4 pmol/L (12.00-22.00)

Total T4 73.4 nmol/L (59.00-154.00)

Free T3 3.91 pmol/L (3.1-6.8)

Thyroglobulin antibody 366 IU/mL (0-115)

Thyroid Peroxidase Antibodies 366 IU/mL (0-34)

Active B12 108 pmol/L (25.1-165)

Folate 19.98 ug/L (2.91-50)

Ferritin 61.1 ug/L (13-150)

I’m still experiencing symptoms but given my previous bloods were looking fairly good, and that my GP has not been very helpful so far, I didn’t think they would retest at this stage plus I also wanted to get T3 done and vits and mins checked. I’m pleased that the latter are improving as I’m supplementing with folic acid and also ferrous sulphate, and a Vit B complex. But I’m surprised that my TSH and Free T4 are so much worse than last time – could the hour’s time difference in testing make that much difference, or will there be another reason? Is it because my antibodies have gone up? I’m disappointed by the antibodies increasing as I’ve been gluten free for five months now, taking probiotics (kefir), and trying to reduce stress levels, so I’d hoped the antibodies would at least have stayed the same… :-(

Still, the good news is that these results make sense of why I’m still experiencing symptoms, and they give me a basis for asking my GP for a dose increase.

Would welcome any advice please!

Edited to add - I am a numpty and have just remembered, I accidentally glutened myself (just a tiny bit but I did react to it) a week before these tests, so would that be why my antibodies have shot up higher than at the start of all this? And would that be enough to change TSH and T4 so much? If so, have I just wasted a load of money on tests that don't reflect my usual situation?! Kicking myself if I've been that silly!! Hangs head in despair at self...!

4 Replies
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50mcg is only a starter dose. Your results show you need next dose increase.

Ask GP for 25mcg dose increase.

Improving vitamins and gluten free will have been helping too.

Getting glutened might be a cause of antibodies going up, but the fact TSH has risen may have also caused antibodies to rise

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...

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...

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Thanks, SlowDragon. Those links will be useful with the GP I hope. So is it quite normal for TSH to vary that much? Both TSH and T4 are now at similar levels again to when I was on just 25mcg levo; initially they improved on 50mcg but have now got worse again. Is that sort of variation to be expected with Hashi's?

Reply

By time we get diagnosed, metabolism has often already slowed down significantly. As we start on Levothyroxine and improve vitamins and gut begins to heal on gluten free diet then metabolism starts to improve. Then you need more Levothyroxine.

We can't start on high dose, but slowly work up towards required level. Increase in 25mcg step, wait and retest after 6-8 weeks.

Repeat this increase in 25mcg steps giving slow climb up until TSH is around one (or slightly less) and FT4 towards top of range

Once you get to that point, if after few months FT3 remains low then, like many of us with Hashimoto's, you may need addition of small dose of T3.

But you can't rush and increase to much or too fast.

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)."

No point showing your GP this yet as your TSH is still high, but you might need it in future

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

tukadmin@thyroiduk.org

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

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

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Ah, that makes sense. So, if I've got it right, as our metabolism picks up our bodies start to use more thyroid hormone as our various systems kick back into gear, so then we need an increased level of hormone replacement because we are able to use more of it. And that means our test results can seem to look worse again even though overall things are improving.

That fits with the fact that after 8 weeks on 50mcg, my TSH and T4 looked pretty good, but another six weeks on, with my gut hopefully healing more and vits and mins improving, T4 has decreased and TSH has increased.

So glad I found this forum otherwise I'd have been stuck on 50mcg until the GP retested in a year's time! Thanks for your help.

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