I know I have read the answer to my question a million times, but my futile searches haven't returned me anything very specific, so I'll put my tin hat on and ask anyway.
Having just been stated on Levothyroxine I'm going for my first pre-titration blood test tomorrow.
Am I correct thinking I should not take my medication tomorrow morning, and remain fasted until I have the blood drawn? As I can go anytime, any day from 08:00, that's not a challenge, but I just want an optimal result from the test. Like so many at this stage, I need an increased dose, so don't want to do anything to mess it up.
Thanks in anticipation.
Written by
MMaud
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Yes, don't take your levo for the day until you have had your blooddraw; that is the standard protocol. You don't want to make your results look TOO good for the doctor. Fasting isn't necessary for thyroid testing.
Do not take your levothyroxine that morning (f you take it in the morning) or the night before (if you take at bed-time).
Fasting is something that is sometimes claimed as important, sometimes not. My view? Fast - if in future you have a test of something else that must be fasting, any thyroid testing done at the same time wouldn't be on a different basis. If you see what I mean! I suspect that the impact of fasting on thyroid tests is small - but it might depend not just on when you ate, but also on what you ate. Avoid the possibility of that impact.
Take your tablet with you and take it straight after the blood has been drawn. Don't panic about drink/food too soon after - yes, it makes a difference, but this is a "special occasion".
To get as accurate a result as possible, take your medication the day before your planned day of testing, but do not take it the morning of your lab tests. This will mean that you are fasting for over 24 hours.
I typically fast my meds 26-30 hours for my labs. A recent lab test was unplanned for that day, and I'd taken my meds 6 hours before. Over the years, this is not the first time I've tested only 6 hours after meds. Not ideal, but sometimes that's your only option due to work and life schedules and being able to get to the laboratory.
My results between fasting and NOT fasting:--------The difference between by fasting meds labs and labs 6 hours past meds on my last blood test was that my FT3 was .4 higher, than while fasting 30 hours. Interestingly, with only a 6 hour fast, my FT4 was .05 lower than while fasting 30 hours. T4 is slower acting to reach full therapeutic level than T3, no idea if that was why and it just hadn't reached it's full level yet after 6 hours, or what. I had also fasted food and coffee besides my medication for 6 hours, too.
I think ShootingStars means not taking meds for over 24 hours, not fasting as in not eating, which is what we mean in the UK. So. no levo for 24 hours, no breakfast - nothing except water on morning of test and earliest possible blood draw appointment.
We don't advise such a long fasting time. Usually it is fasting before the early a.m. blood test. We do advise allowing a gap of 24 hours between the last dose of levothyroxine (or whatever thyroid hormones we take) and taking it afterwards.
Fortunately, I have access to a walk in testing centre, where they open at 8am, so that's where and when I have any bloods taken. To be honest, it so much easier to park going for 8am, than later anyway.
Fasting for an extra few hours isn't an issue for me, and I will take my tablet with me to have as soon as I'm done.
I just want the tests to show I need a decent titration. After a week or so of feeling much better on meds, I feel like I'm back to the beginning. I now understand this isn't uncommon where a titration is required. It's almost like my body is putting a thumb to the nose to the meds.
I rather enjoyed the few days of being marginally warmer with some clarity of thought.
It is definitely common to feel this way, you may even find your results have worsened slightly and find the GP questioning if you are taking it properly! The best analogy I heard was that your pituitary has been screaming for extra thyroid production for so long that your thyroid has a bit of a holiday in surprise at finally getting some help.
I felt improvement for the first couple of weeks each dose raise but then a backsliding until the next one. One word of caution, retests should be every 6-8 weeks when titrating but many GPs have a nasty habit of trying to leave it 3 months. Be insistent, it clearly states it in the levo instruction leaflet. In the early days I didnt know better and it took way too long to get me titrates properly and my results were way oit again bu the time they did test. Also try and insist on an appt to discuss results otherwise you will just get the dreaded ‘normal’ etc off the receptionist instead of being able to fight your own corner.
If you dont have your electronic records turned on i recommend doing so, again it stops you having to fight with receptionist to get the numbers rather than empty platitudes you are legally entitled to them and need to keep a record so you can learn at what levels you feel best.
If you book GP appt for about a week after the test it gives you time to get the results back and post on here for advice, we can then give you an indication of what GP is likely to be thinking and advice on how to try and counter any misguided ideas they may be having
I'm content that my GP is very switched on, even if thyroid issues aren't her special interest. We have a very good working relationship.
This time I had only been taking the Levo around 5 weeks. She said I could go for my retest any time after 4 weeks. She was quite direct that I shouldn't go before 4, but not to wait too long as the starting does almost certainly wouldn't be right.
I have another condition where I have regular bloods drawn, and I take a new set of blood papers as soon as one lot is in, so I control when I have them done. She then calls me if there is anything to discuss in the results, but I will always have seen them by then, as I have online access to them.
I'm not a frequent flyer at the Doc's, thankfully, but I'm organised and so is she. If she ends up scratching her head on this, I'll ask for a referral back to the Endo, and do my battles there, if necessary.
My thyroid knowledge is miniscule at the moment, and my learning curve will be steep, but I can climb metaphoric hills.
Of course, it's early days in all of this, but I'll get on with it. I just can't quite believe I'm looking forward to an increase in medication. That's plain bonkers, but hey ho. That's life.
Yes, you're correct. Allow a gap of 24hous from your last dose of levo and the earliest blood test and take levo afterwards. Fasting is advised as taking food before the test can reduce the TSH and may result in an adjustment to lower your dose. Excerpt:
Results:
TSH was suppressed in all subjects after food irrespective of the fasting levels. Free T4 values did not change significantly.
Thanks shaws - Bearing in mind I was started on 25mcgr, there's not a lot of "down" to go!
Thankfully, my GP jumped for joy, almost as much as me when my last function test breached the upper "normal" range, after over 2 years of being constantly frozen. She didn't wait for a second breached test, but also warn me the starting dose was unlikely to do too much for me.
Sometimes I feel the medics are just as frustrated by the apparent rigidity of the guidelines as we are. It must be absolutely dreadful to have had all that education and intellect and for some conditions be diagnosing by what appears to be a flawed decision tree.
I doubt there is any 'in depth' training - even in endocrinology - about the importance of a healthy thyroid gland.
They have absolutely no knowledge about any other 'choices' (NDT or T3) as these were withdrawn, gradually, leaving many patients who were well to become unwell or sourcing their own hormones if they had the werewithal.
It seems to me that it is something like taking a temperature. We can see on a thermometer whether the temp is high/low and can confirm if we feel or unwell. If high we take a paracetamol to lower temp.
So, as far as I can undersand, so do the 'professionals'. They look at the result of a blood test on a piece of paper and assume, if it is somewhere in range, to pronounce we don't need an increase in dose whilst also ignoring our disabling symptoms and don't ensure our TSH is 1 or lower. They may give another prescription for the symptom. They still insist any symptoms are not due to the lack of thyroid hromones as the blood test is 'in range'. We hear that phrase often. In the UK a person has to wait until TSH is 10 before being diagnosed. In other countries it is if it is above 3.
Rarely is the FT4 and FT3 checked. Prescriptions for the 'symptoms' may be prescribed but we are not now allowed to add T3 to T4 if patients is not improving on T4 at all. The suffering continues and at the extreme end suicide - one who also wrote a letter for the Coroner of why she did so. I doubt much notice was taken of it and would probably state 'while the balance of mind was disturbed'.
I understand exactly what you are saying. Sadly thyroid issues aren't the only conditions being viewed and treated in a blunt if x, then y way.
Fortunately, I have lived a healthy life, but for the two conditions I have been diagnosed with in the last few years, I have been atypical. Atypical doesn't fit an basic decision tree, so we have to do our own learning, then encourage our Docs to learn with us. I'm very much at the bottom of my steep thyroid learning curve, but if taking on the learning curve means I don't have to dress like Nanook of the North in all weathers, I'll be happy to do it.
It's only by advice - long before this forum began - by Thyroiduk.org.uk it led me slowly to good health. There was still a couple of 'old - school doctors' around who were trained in the basic symptoms and could diagnose someone due to symptoms. Both came under the 'gaze of the professionals' and complaints were made about the way they diagnosed/treated and appeared before the GMC.
Neither were found to have done anything wrong but the strain is just too much after you've been treating patients for years. One resigned due to the strain and one died due to a stroke, and his patients and his staff believe due to investigations for doing something he was taught and stated 'we' the patients were put in a parlous state due to the adherence to blood results whilst ignoring symptoms.
Well my results are in (taken yesterday 08:00), with a message "satisfactory to call the surgery", so I'm in the phone queue now. I was notified by an SMS at 09:30. I'm impressed by that part!
TSH now 4.5 from 5.6 (range 0.5-5)
FT4 now 12 from 13 (range 10 - 25)
I'm just hoping the suggestion will not be steady state - test again in a month or so. However, mustn't jump to conclusions.
Needless to say, if that's the messaging via the receptionist, I'll be asking for a call back.
Fingers cross whilst I listen to the plinky-plonky musak.
Well, my results are considered "Satisfactory", with a telcon appointment booked for the 2nd May.
I may be doing the Doc a disservice, but if there is no plan to up the dose, I will self-medicate. Enough is enough. I simply can't face another summer of looking like the mad woman, all wrapped up like the Michelin man - especially having had a few days of feeling better.
It's all been a bit like I've had the sizzle, but there's no sausage in prospect.
My next query is likely to be asking where I can buy reliable Levothyroxine.
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