Hi all (sorry about profile pic and no idea how that got there).
Well, you recommended Medichecks and asked me to post results. I did as you advised and left off Levothyroxine for 24 hours before the test.
So I was shocked to read that the comment was 'You are currently taking levothyroxine and this will affect your thyroid tests so we will be unable to diagnose any issues with your thyroid from this set of results.'
One wonders why the company did not tell me to come off the med for longer. But I did as advised on this site.
'Your TSH is in the upper half of the normal range and you have normal thyroxine and freeT3 which suggests that your levothyroxine dose is too low.'
Everything else tested was fine but folate seems low to me at 7.61 though at bottom ed of normal range.
Anyway, thyoid results and reference ranges were:
TSH 3 (0.27-4.20)
Free thyroxine 15 (12-22)
T4 88.6 (59-154)
Free T3 3.72 (3.10-6.80)
Throglobulin antibody <10 (0-115)
Thyroid peroxidase antibodies <9.0 (0-34)
End.
My pre-med general blood test had shown TSH 7.7. and T4 12.
I am now at the end of my two-month trial of the thyro med. I don't know what to say to my GP. Should I ask for a re-test? But the NHS level for meds is 10 for TSH. I think she will think I am fine on 3. And probably won't continue me on levothyroxine.
Symptoms: in the two-month trial, and I understand it can take at least that to change, first half I slept immensely better; middle bit affected by husband's op and aftermath; lately not been sleeping well again. I lose less hair in a hair wash than before - hardly an issue. I think I feel less cold. I still find it hard to lose the small amount of weight above my top BMI and have put on a little.
I need the benefit of your wisdom and experience please!
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How much T4 are you taking in your trial? From the results, it seems to have had some effect, but has by no means reached a satisfactory level vis a vis your rather elevated TSH (even if it is within the so called reference range). Both FT3 and FT4 are rather low in their ranges, so this too suggests you could take a little more T4 to advantage.
Levothyroxine is T4. I would see if you could raise another 25 to 75mcg and see how things turn out. Thyroid hormone therapy can never be just a story of take the tablets at this or that strength and all will be well for ever. Your health is a moving feast with age and continual attention has to be paid from your health perspective as to whether your dose is right or it ought to be changed.
I don't ask for comments from Medichecks because I can interpret my own results, but I do sometimes wonder about their comments when members post what they have said.
'You are currently taking levothyroxine and this will affect your thyroid tests so we will be unable to diagnose any issues with your thyroid from this set of results.'
I assume you weren't asking for a diagnosis, you already have one from your GP. Or did you ask for a diagnosis?
You did not need to come off Levo for longer than the 24 hours. Once you've been diagnosed and prescribed Levo that's it, you don't come off it, you continue taking it, but you just leave off for 24 hours before a test - in fact you're not leaving it off at all, you're delaying taking that dose until after the blood draw because if you took your Levo before the blood draw it would give you a false high FT4, it would be measuring what you've just taken rather than what is normally circulating in the blood.
If you do any private tests again, don't bother asking for their comments, just post on the forum for interpretation.
'Your TSH is in the upper half of the normal range and you have normal thyroxine and freeT3 which suggests that your levothyroxine dose is too low.'
This is correct and what you were told in your previous thread. You are at the start of your thyroid journey and it was explained that you will need retesting every 6 weeks with increases in Levo of 25mcg each time until your levels are where they need to be for you to feel well, which for most of us is a ~TSH of 1 or below with FT4 and FT3 in the upper part of their reference ranges.
My pre-med general blood test had shown TSH 7.7. and T4 12.
I am now at the end of my two-month trial of the thyro med. I don't know what to say to my GP. Should I ask for a re-test? But the NHS level for meds is 10 for TSH. I think she will think I am fine on 3. And probably won't continue me on levothyroxine.
So everything is going the way it should. Your TSH has lowered from well over range and your FT4 has increased, exactly what taking Levo should do.
It takes months to feel the full benefit of an optimal dose of Levo, it's too early for all your symptoms to have disappeared and you feel well. You need to continue with the testing/increasing dose every 6 weeks until you do feel well.
Your GP should retest you as a matter of course after your 2 month trial so if she doesn't want to accept your Medichecks results (and she'll probably ask you why you've had them done if you show them to her) then she can do her own. Or just book it anyway, or if you have to see your GP as a follow up then say "I believe you should now retest my levels to see how I'm doing on the Levo" or some such thing.
You need an increase in dose and to support your request for this use the following information from thyroiduk.org/tuk/about_the... > Treatment Options:
According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.
The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Available on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.
Also -
Dr Toft 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 article by emailing Dionne at tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.
Your antibodies are nice and low so no sign of autoimmune thyroid disease (Hashimoto's) there.
Did you do the UltraVit test as recommended? If so post the results of the vitamins and minerals for comment.
What a knockout reply, SeasideSusie. I am indebted to you. My mind was already following the thought that I just might not say I had a private test. The original test was a full blood test but the thyroid element was just TSH and Free T4. I asked for a specific thyroid test and my GP said that was it - I had had one. So I think I will stay mum and get to see her - my last tablet is today and see if she does the expected retest order.
Yes: I did the vits.
Active B12: 126 (25.1-165)
Folate: 7.61 (2.91-50
25 OH Vit D: 75 (50-200)
Biochemistry:
CRP - High Sensitivity: 0.96 (0-5)
Ferritin: 106 (13-150)
No I didn't ask for a diagnosis but one would still have helped. My GP had Abnormal blood test result but said it was just subclinical and was not initially inclined to say it needed treating at all but eventually conceded the med trial.
I will follow up your links and see the GP. I will arm myself with the info from the links,. What I do if she says I don't need more levo heaven knows.
This is a nice result, if you're supplementing then it's at the right level, if you're not supplementing then this is good.
Folate: 7.61 (2.91-50)
You already know from your last thread that your folate level is too low, it should be at least half way through it's range so I would get that B Complex and start supplementing. Look at Thorne Basic B, that raised my level from vey bottom to very top of range in 2.5 months taking 1 a day. Another decent one is Igennus Super B.
25 OH Vit D: 75 (50-200)
Not quite reached the level recommended by the Vit D Council, which is 100-150nmol/L. Lots of sunshine on bare skin (no sunscreen) for around half an hour a day (more if dark skinned) helps in the summer for some people, others can't make it naturally and need to supplement. You could possibly do with a winter maintenance dose of something like 2000iu daily but you should nudge it up to lthe recommended level first. Have a look at D3 softgels by Doctor's Best of Now Foods which are very cheap.
When taking D3 we need to retest twice a year to keep within the recommended range. City Assays (an NHS lab) offer a home fingerprick blood spot test to the public
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
This is an inflammation marker, nice and low so no problems there.
Ferritin: 106 (13-150)
Nice result. Ferritin needs to be at least 70 for thyroid hormone to work (our own or replacement) and I've seen it said that for females 100-130 is best.
No I didn't ask for a diagnosis but one would still have helped.
They couldn't have given you one as you were already taking Levo but you didn't need one anyway, you knew you were Hypo because of your over range TSH. They reported on the results and gave you correct information about your dose of Levo being too low.
I have folate just started to take. Metafolin at 400ug once daily. Do I still need the B Complex instead? I take magnesium as malate too and it has stopped my very painful leg cramps.
Sole remaining obstacle is the thorny problem of not appearing to be telling my GP her job. It's the original issue: if NHS level for TSH is 10, why is she not going to say I am fine. She is by nature very sweet but is a new doctor for me and already showed a slight impatience when I asked for th thyroid figures originally.
Anyway, will let you all know. Briliant analysis. Eternally grateful.
It's the original issue: if NHS level for TSH is 10, why is she not going to say I am fine
This is where you talk about subclinical hypothyroidism (has that been mentioned, I thought I read that your GP mentioned subclinical but I may be mixing you up with someone else).
Subclinical hypothyroidism is where the TSH is between 4 and 10, FT4 is within range, and the patient is symptomatic.
If TSH is between 4 and 10 mU/L and FT4 is within the normal range
◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.
◾In older people (especially those aged over 80 years), follow a 'watch and wait' strategy, generally avoiding hormonal treatment. If a decision is made to treat, prescribe LT4 and recheck TSH two months after starting and adjust the dose accordingly.
◾In asymptomatic people, observe and repeat thyroid function tests (TFTs) in 6 months.
◦ Follow up of people with SCH who are started on LT4
◾Reassess symptoms on treatment. If symptoms have improved, lifelong treatment may be considered. If symptoms have not improved or if adverse effects are reported, stop LT4 after a 3–6 month trial.
◾Once TSH has normalized, TFTs should be measured at least annually thereafter.
......
"My pre-med general blood test had shown TSH 7.7. and T4 12.
So those original results puts you as Subclinical and a trial of Levo was the correct thing to do. You now need that trial continued for the recommended 3-4 months, noting the part about retesting after 2 months and adjusting dose accordingly so she has to retest now. [And of course, push for you not being in the older people category, you are nearer 65 than 80]
If you do decide to share your Medichecks results then you can show how your TSH has reduced and your FT4 increased so she was right to give you the Levo, but it might be better for her to do her own test. Now you just need to get the levels in the right place for you, details given in previous reply.
**
Is the Metafolin prescribed or do you buy it yourself? If you buy it yourself when you next need some I would change to a B Complex, it's a good thyroid and adrenal support and keeps all B vitamins in balance.
My GP rang as requested and was going to send me for a blood test, at which point I confessed to the Medicheck one and she asked to see it as it may be sufficient and I do not need a duplicated NHS one.
On the main Thyroid UK site, under Thyroid Blood Tests (TFT THyroid Function Test) it gives a figure for TSH normality of approx. 0.4 to 4.5.
So, I am according to that, not needing an increase in meds, yet everyone in this forum says it ought to be below 1. and Medicheck says I need more.
What a conflicting view. I suppose it goes by how you feel in the end.
Doc will decide tomorrow after reding Medicheck results.
On the main Thyroid UK site, under Thyroid Blood Tests (TFT THyroid Function Test) it gives a figure for TSH normality of approx. 0.4 to 4.5.
So, I am according to that, not needing an increase in meds, yet everyone in this forum says it ought to be below 1. and Medicheck says I need more.
It doesn't say that is where TSH should be for a treated Hypo patient. It says that is the approximatereference range, and reference ranges vary from lab to lab (which is why it's important to have ranges from the lab that does your tests). We don't know what your NHS reference range is for the TSH of 7.7 but we do know that you were above the upper limit therefore hypothyroid, and the Medichecks range is 0.27-4.20 for your TSH of 3.
TSH = THYROID STIMULATING HORMONE
This hormone comes from the pituitary to stimulate the thyroid gland into making more hormone. TSH rises when the thyroid is struggling.
The approx. reference range for this test is 0.4 to 4.5.
Please do not hand on a plate reasons for your GP not to increase your Levo, or to take it away, which is what you will do if you quote any of what you have written here.
You have all the information you need in the replies you have already had about where your test results should be if that is where you feel well, and Medichecks has also confirmed you need an increase in dose.
I haven't handed these queries on a plate to GP; I am just seeking to anticipate her response. I said in a covering letter the meds are going the right way (as you said) but I undertood from this site that it ought to have a TSH of less than 1. I also copied the letter from Medichecks and included in my own letter that the recommendation was an increase of levothyroxine. I said I was not going to use the letter to tell her my response to the meds as it was not the occasion ( I want a longer period and to meet her face to face).
I didn't say you had, I was cautioning against giving her reason to take you off Levo or not increase it.
You have Dr Toft's article that clearly states where the TSH, FT4 and FT3 can be if that is where the patient feels well.
Also, you can say you have taken advice from NHS Choice's source of information for thyroid disorders, which is the charity Thyroid UK. Don't mention the internet or forums, that is like a red rag to a bull where doctors are concerned and their cue to ridicule all the information you give.
Right - printing out all relevent official stuff. Expect I will just get the ok about that blood test or be given another to do, and she knows I had my last med last night. Reading my letter to GP through, I referred only to 'informed sources'. If I have to refer to them it will be Tofts, endocrinologist, as source. My previous doctor was all for patients informing themselves as they don't have time to do so and are by their nature, generalists. You just have to be tactful and not be seen to be unduly arguing. Nor mentioning blogs: I quite agree. I would feel undermined if I were a GP with years of training and experience to be told by some upstart patient how things should be.
I do have form on this: I have an unusual genetic form of epilepsy which in the end I diagnosed myself, pre-internet, and now they all accept it. It was a critical diagnosis as what I had been prescribed would have made it worse. There was no red rag to a bull response: doctors have only about 5 hours training on these things.
Please be careful to avoid making it look as if there are formal NICE GUidelines for hypothyroidism and hyperthyroidism.
I know the distinction is not obvious and might appear subtle. Below is a quote from Lyn Mynott posted earlier:
Unfortunately, it's a common misconception that NICE have issued guidance because the Clinical Knowledge Summary for hypothyroidism is on the NICE website.
Hello all. GPO has Medicheck results and responded very well. My levothyroxine has been raised from 50 to 75 and a blood test to be done after 8 weeks, but it is now accepted that this is a life condition. Subject to the 8-week test to establish the levels are correct. I am very relieved that my GP responded so well to the test report and results. Thank you all. She didn't say but as I am on thyroid treatment for life I guess that is accepting I am hypo not borderline. Thank you for all your help.
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