Yesterday my GP agreed to titrate my Levo upwards from 25mcgr to 50 mcgr. Her reluctance was because my TSH has fallen back from 5.8 to 4.5 and my FT4 had dropped from 13 to 12, and therefor had come back into range.
On explaining that my symptoms had not materially improved, and pointing out the proximity of both those figures to the margins of the ranges, she relented, although her initial preference was to increase from 25 to 37 mcgr. Only my explanation that the Wockert tablets are the size of a Sweetex deflected her from that rationale.
Having agree to increase my dose, she now wants me to have another blood test in 2 weeks, "just in case I start to go the other way, to hyperthyroidism".
I have the paperwork for my bloods, but would like to understand if anyone knows of any real downside to the test being so soon after titration? I have also promised to be vigilent for any symptoms relating to over-medication.
Many thanks in anticipation yet again. I really do appreciate your feedback. One day, hopefully I'll be able to be helpful too.
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MMaud
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I understand that a test after two weeks is a waste of your time and nhs resources. Most likely the lab will not test the sample anyway, because it’s too soon. In my area they will only test after three months
If you feel ok on increased dose, (and two weeks may be too soon for you to know), then I think I’d forget (oops).
Don’t forget that it’s best to have the test as early as possible, don’t eat before test, and don’t take Levo until after test. This will give you results that can be compared as you can do the same for future tests.
The issue I would have with "forgetting" is that my repeat hasn't been modified, as I have agreed to use up the 35mcgr tablets by taking two per day, as opposed to the one. Any forgetfulness would quickly come to light by me trying to buck the repeat system.
I was retested 6 weeks after starting, so my area are clearly OK with under three months, but who knows about the two weeks.
Thanks for the heads-up about the fasting test, and no Levo on the day. I'm already onto that. I'm fortunate that I can go to the hospital walk-in blood centre for them opening at 8am, so that's what I do for consistency.
It would help if you included the reference ranges when posting test results, we can understand the TSH but where in range is the FT4? We often see ranges of 7-17, 9-19, 12-22, so it's not possible to interpret your result.
Your TSH has lowered, which is what is supposed to happen when started on Levo. However it is still far too high.
Your FT4 has also lowered, which is not supposed to happen. FT4 should rise as TSH lowers.
The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 are in the upper part of their ranges, if that is where you feel well.
With a TSH of 4.5 you are a very, very long way from being properly medicated.
25 mcg Levo is a very small starter dose, usually reserved for children, the elderly or those with a heart condition. It's usual to start with 50mcg. Increasing your dose of Levo should lower your TSH and hopefully your FT4 will now start to rise.
It takes 6 weeks for the full effects of a dose change to be felt, testing after 2 weeks may not show much difference and there's no real point in doing it at that time.
Noooooooooooo! I just typed a very long reply to you and greygoose, only to somehow lose it, so I'll try to precise it here.
I was possibly a bit sneaky yesterday, in that I indulged my GP quite a bit, with the dual objectives of an upward titration and learning more about where her level of knowledge baselined. I guess, on that basis, I achieved both objectives, albeit the latter being particularly disappointing.
My apologies to all, for not expressing my blood results too well. My TSH had gone from 5.8 > 4.5 (range 0.5-5), and my FT4 from 12>13 (range 10-25), so to my GP, I am now in range.
If I apply a very blunt logic, and refer back to my TSH testing, which only begins when I first presenting with symptoms, I need to be TSH under 2, as at 2 I was already experiencing significant temperature regulation issues. Anyone knows whether my symptoms will accommodate that blunt logic (never mind any concept of euthyroid)
I am not at all keen to change GP as I find her easy to get along with. She is candid, and I can work with that, and bearing in mind I have already been referred to and discharged by the locally rated Endo who declared my bloods to be fine at a TSH of 3.4, irrespective of my symptoms. I worry that the grass may not be any greener locally, so am, for now at least, reconciled to educating myself and trying to take my GP along the learning journey with me. I have done it before for another condition, so I know she is open-minded at least.
I'm aware that "going the other way" can't happen, but at that point, I had achieved a titration and didn't want to do anything to undermine that decision or to embed that I might be a smarty-pants by correcting her - yesterday at least.
Of course, it’s all very frustrating, but knowledge is power, and I think I now understand what I an dealing with with my GP, so now I know I MUST upskill myself on the condition and go from there.
I’m over 50, so I guess she complied with the NICE guidelines for starter doses.
I keep my Levo on my bedside table and generally take it immediately I wake, then snooze for a short while to give it the 30-60 minutes prior to my morning tea.
When I hear more of this 'nonsense' the medical profession had decided to visit upon us poor hormone challenged souls - it's hard not to despair!
I would recommend that they all read the book... 'Tears Behind Closed Doors: Failure to Diagnose a Thyroid Condition'
by Diana Holmes.
It's an account of her long and frightful journey to get correctly diagnosed - which most of us can relate to. Years after I first read it - I heard her talking about her experiences in a youtube interview, and was astounded to hear that when finally diagnosed correctly, and put on a course of levo. - her TSH was only 1.9. So much for their 'gold standard' blood tests and inacurate and misleading reference ranges.
The website I like to copy info from - gets right to the point I think.
You are hardly likely to be over-medicated - you can't 'go hyper', that's physically impossible - on a 25 mcg increase if your TSH is 4.5. With a TSH of 4.5, you are still hypo. Your doctor really doesn't know anything about thyroid, does she.
my FT4 had dropped from 13 to 12, and therefor had come back into range.
I don't understand that. Your FT4 range ended at 13? Can you tell us the exact range, please?
If she wants to waste NHS money on testing after two weeks, why not. She'll probably get her knuckles rapped by the practice manager though! The levels probably won't have changed at all in two weeks - especially on such a small dose.
I really think you should think about changing your doctor, because this one just doesn't know enough to make you well.
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 for brand change when dose is increased
All thyroid tests should be done as early as possible in morning and fasting and don't take Levo 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)
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