New and question concerning medicine

[icehenge]

Hi,

I'm new here and it looks like a helpful community.

I'm a male in my mid 30's.

Could someone help me read my thyroid test results from 3 separate dates?

I was able to see a endocrinologist recently. She diagnosed me with hypothyroidism based on her review of my medical information. She started me on a low dose of Levoxyl 25mcg once a day and a blood follow up test in 6 weeks with a re-visit with her. I was happy to have some diagnosis after suffering low energy, brain fog, always cold, etc for many years. I've been on the medicine for 1 week, day 1-4 i felt fine (maybe better than normal), day 4-7 i'm so tired and irritable. Is there an adjustment period?

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Test results:

Normal range values listed in brackets [ ] to the right of the test values.

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March 2016

TSH 1.250 uIU/ml Normal Range [ 0.450-4.500]

Triiodothyroine (T3), Free 3.3 pg,mL [2.0-4.4]

T4, Free(direct) 1.05 ng/dL [0.82-1.77]

Thyrogolobulin anitbody <1.0 IU/mL [0.0-0.9]

Thyroid Peroxidase (TPO) Ab <6 IU/mL [0-34]

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Dec 2016

TSH 0.8 mcIU/mL normal range [0.40-4.50 ]

Free FT3 3.1 pg/mL [2.3-4.2]

Free FT4 0.71 ng/dL [0.8-1.8]

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January 2018

TSH 1.10 mcIU/mL normal range [0.40-4.50 ]

Free FT3 3.5 pg/mL [2.3-4.2]

Free FT4 0.7 ng/dL [0.8-1.8]

[SeasideSusie Remembering]

Icehenge

As reference ranges vary from a lab to lab, we need the ranges from your lab to interpret your results. Can you please edit your post and add them. You can edit by clicking on the down arrow V below your message, choose EDIT, make changes then click on the green EDIT RESPONSE button.

[icehenge in reply to SeasideSusie]

Thank you for the heads up. I will add them right now to the original post.

[Neverending63]

Can you add the ranges for the results as they can vary. I’m sure others will ask otherwise.

[diogenes Remembering]

The trouble with 25 ug starting doses in younger people is that they can have exactly the opposite result required. That is, they can actually partially suppress the conversion of T4 into the essential hormone T3 by the body. Much better to start with a 50 ug dose, where this temporary suppression is often not so evident.

[icehenge in reply to diogenes]

Hi Diogenes, I checked and I think my March 2016 test has those results. Do you think I should test again?

Should i wait out this dose then if I think it might be to low or contact the doctor for a possible increase in dose? Will the 25 ug stabilize?

[diogenes Remembering in reply to icehenge]

I would not wait if you are getting no benefit from 25 ug. 50 ug is the best starting dose at your age.

[icehenge in reply to diogenes]

Thanks. I'm gonna give it another day or two see how i feel and then call the doctor if no improvement.

[Marz]

Maybe have the Thyroid anti-bodies - TPO & Tg tested to rule out Hashimotos Also test B12 - Folate - Ferritin - VitD - in case your symptoms are lined to LOW nutrients - as often happens here on the Forum with many members ....

[icehenge in reply to Marz]

I will get those areas tested. thank you. Do deficiencies in those vitamins once corrected eliminate the need for thyroid medicines?

[Marz in reply to icehenge]

When optimal you will feel better and your Levo will work better too ...

[icehenge in reply to Marz]

Great thank you

[SlowDragon Administrator]

As diogenes says, starting on just 25mcg can be enough to shut your own thyroid down, but is too small a dose to replace.

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...

Your bloods should be retested 6-8 weeks after each dose increase

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies, FT3 and FT4, plus vitamins

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

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 ideally be done as early as possible in morning and fasting.

If on Levothyroxine, don't take in the 24 hours prior to test delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances too, especially gluten. So it's important to get tested.

[icehenge in reply to SlowDragon]

Hi SlowDragon,

Thank you for the tips and details on the test to get done. I'm going to look them up and look to have some of those done on my own like you suggested. As Diogenes mentioned if this is to low a starting dose can i wait it out or will i feel like crap till the up dose to 50mcg? Would this 25mcg eventually equalize and i'd feel somewhat normal till the next 6 week checkup is what i wonder?

[SlowDragon Administrator in reply to icehenge]

See how you get on, if it's unbearable, then see GP and insist on dose increase. You may be fine

Also what brand of Levothyroxine are you started on? Many people don't get on well with Teva brand.

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out especially for brand change when dose is increased

[icehenge in reply to SlowDragon]

Hi. It looks like my brand is made by Pfizer. The pill box says Levoxyl. I will keep you updated.

I do take it in the morning and wait 1 hour before eating and have moved my multivitamin time to later in the day.

[SlowDragon Administrator in reply to icehenge]

Usually not recommended on here to take a multivitamin. They contain too little of what we do need and stuff we don't want too. Like iodine. If you have Hashimoto's you don't want extra iodine

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

Without testing you can take Vitamin C, this will support adrenals and selenium supplement can help improve conversion of T4 to T3

Always advised to get Vitamin D, folate, ferritin and B12 levels tested and supplement if necessary

[icehenge in reply to SlowDragon]

Ok on multivitamins. Mine looks to be iodine free. I used to get sick very often. I Still get sick but the multivitamin helped so i continued. I have selenium on hand and will take that now that i know it helps. Looks like I'll have to look into scheduling a blood test to check those values though. Appreciate your help.

[icehenge]

Thank you for the previous help everyone.

Here are my blood results after 8 weeks on Levoxyl 25ug.

I tested in morning, no medicine before (usually take Levoxyl in AM), and fasted.

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TSH

0.57 uIU/mL,

Range [0.34 - 5.00 uIU/mL]

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FT4 - Free Thyroxine

0.81 ng/dL,

Range[ 0.60 - 1.80 ng/dL]

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Thyroid Peroxidase Auto Antibody

<10 kIU/L,

Range[ 0 - 35 kIU/L]

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Vitamin D (25 OH)

110 nmol/L

Range [Sufficient > 100 nmol/L]

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Symptoms same about the same and sometimes no better off i'd guess.

The endo said she thought it might be Hashimotos but the Peroxidase test seems negative?

She increased my dose from 25ug to 50 ug of Levoxyl.

And I know …I said I’d test the folate, ferritin and B12 levels but I have to pay out of pocket and time was an issue. I now have the time next week and will have those test done.

I wanted to do an update though on the bloods and hear if others think my treatment sounds right?

[SlowDragon Administrator in reply to icehenge]

You need to also test TG antibodies. NHS only test TG if TPO are raised. But you can have high TG and low TPO.

healthline.com/health/antit...

Also just to confuse matters you can have Hashimoto's and never have raised antibodies. Diagnosis can be from ultrasound of thyroid then, Thyroid appears granular if it's Hashimoto's

thyroidpharmacist.com/artic...

Your FT4 is low, very good dose has been increased to 50mcg. Perhaps ask GP to test folate, B12 and ferritin at next Thyroid test.

Considering how low your FT4 is, your TSH should be higher

Likely to need several more dose increases in Levo. It should never be increased by more than 25mcg at a time. Retesting 8 weeks later approx after each dose increase.

NHS guidelines saying standard starter dose is 50mcgs and that majority of patients eventually need between 100mcg and 200mcg Levothyroxine

beta.nhs.uk/medicines/levot...

Vitamin D is good

[icehenge in reply to SlowDragon]

Thank you for taking the time to reply to this individually for me.

There is a lot to read on and learn on this subject. Thank you for your wealth of information.

I'm going to test for folate, B12 and ferritin this Monday morning and will find results.

My Thyroglobulin antibody was tested in March of 2106 and appears low, or normal.

March 2016

TSH 1.250 uIU/ml Normal Range [ 0.450-4.500]

Triiodothyroine (T3), Free 3.3 pg,mL [2.0-4.4]

T4, Free(direct) 1.05 ng/dL [0.82-1.77]

Thyroglobulin antibody <1.0 IU/mL [0.0-0.9]

Thyroid Peroxidase (TPO) Ab <6 IU/mL [0-34]

I was wondering if I might have central hypothyroidism? This is a uneducated hypothesis though based on my low TSH and low FT4.

[SlowDragon Administrator in reply to icehenge]

Your FT3 and FT4 were not very low in March 2016 and TSH not very high either.

[icehenge in reply to SlowDragon]

Forgive me but does that mean central hypothyroidism isn't a factor?

[SlowDragon Administrator in reply to icehenge]

Seems unlikely

Why not start a new post and ask other opinions

[icehenge in reply to SlowDragon]

Sounds good. Thank you. I'll get that additional bloods test done and see the results. I'll post then what appears in one new message. Thanks for the help.

[icehenge]

Any feedback?