Trying to make sense of my blood test results

[RaymondTurner]

SeasideSusie Here are my blood test results. I had a chat with my Dr. this morning and she wants to test me for sleep apnoea (as my main complaint is tiredness) and if that doesn't bear fruit she says she will increase my levothyroxine dose a little but she thinks around 2.5 is what they aim for so she doesn't want to increase it too much. I hope you can read this. I notice that my "Serum urea level" is outside the normal range (by their calculations) but i don't know what this is. Do you have any idea? Thanks for all your help. Ray

[Judithdalston]

I had an endocrinologist who ignored my private blood tests, which demonstrated I needed more T4/T3 medication, and suggested being tested for sleep apnoea ( which surprise surprise was negative)- it's not uncommon. Looks to me like you would benefit from more levothyroxin, so you should increase your dose by 25 mcg to start with. Have you managed to sort out when you take your levothyroxin away from food/ drink( except water); I was never told this either and for 12 years must have had a reduced absorption as the T4 was bound with calcium in breakfast milk- it certainly made a difference when I started dosing at 4-6 am instead. I wonder why your doctor has decided the TSH should be 2.5, and not at 0.57, so therefore ignoring the T4 and T3 levels? Have you ever had blood tests for Vit D, B12, folate or ferritin- they are particularly vital for good thyroid health, but also general health- poor levels of these can make you very tired? We need them at the upper end of the test ranges, 'normal/within range' may be far too low. Look at SeasideSusie's various posts on good vitamin/ mineral levels and protocol. If your doctor is reluctant to do more tests you might consider having private ones such as Medichecks, who often have 20% off a range of tests on Thursdays ( you just order the kit then, you can keep it for weeks/ months till needed).

[RaymondTurner in reply to Judithdalston]

Thank you for this. I don't remember if the dr advised me to take my tablets with only water or anything like that but whatever she advised for years, I have been taking them first thing in the morning and washing them down with a cup of tea and then straight away eating breakfast. Mornings tend to be utterly manic with getting the kids to school and so I couldn't wait an hour before eating and drinking anything but I have started having my tablets at mid day (since being advised by SeasideSusie last week) and not eating anything after 10am and not drinking tea for an hour each side of taking them but I have been away and so routines have been disrupted etc. so not always 100% obeying this rule. however i am now back at home and am starting to implement a stricter regime on myself. I have felt slight benefits but its hard to say for sure because I was on holiday so lots more resting than usual anyway. i will gauge it in the coming weeks. I don't think my B12, Vit D, Folate or Ferritin levels have been checked before. I spoke to the dr this morning and she has arranged my sleep apnoea test and says if it comes back negative she will increase my levo dose a little. I will talk to her about testing these things. Generally she is very good at trying stuff to see if it will work and I do feel she listens to me, even if she doesn't always act on what I say, at least she didn't suggest anti-depressants like the other dr i saw. If I get to an impasse with my dr I may look into getting a private test. Once again thank you for taking the time to reply.

[SeasideSusie Remembering]

Raymond

I did comment on these results in your previous post so those comments still stand.

However, your GP needs to learn more about treating hypothyroidism. The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. You need an increase in your dose of Levo and to support this you should show your GP the following information from

thyroiduk.org.uk/tuk/about_... > Treatment Options

"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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

Print the article, highlight question 6 to show your GP.

Also, get your GP to look at

pathology.leedsth.nhs.uk/pa...

Where it says

"Thyroxine Replacement Therapy in Primary Hypothyroidism

0.2 - 2.0 miu/L Sufficient Replacement

> 2.0 miu/L Likely under Replacement"

So keeping at 2.5 means you are undermedicated.

Tell your GP that you have taken advice from NHS Choices recommended source of information about thyroid disorders, which is the charity ThyroidUK. Don't mention the Internet or forums, they don't like that.

I can't help with the raised serum Urea but you can check that here

labtestsonline.org.uk/tests...

If not already mentioned by your GP, your HbA1c results need discussing.

[RaymondTurner in reply to SeasideSusie]

Thank you for all the information, SeasideSusie. I haven't had a chance to read it all yet but I will and its good to have something to take to the Dr with me to try to covince her that i am not feeling too well. I did tell her i had been in touch with Thyroid UK and was told my TSH should be around 1 but she answered that at her surgery they usually want it to be around 2.5. The reason I was initially diagnosed with hypothyroidism was because I was worried I was diabetic because i am overweight and always sleepy. My blood sugar was slightly higher then but in the pre-diabetic range. The levels have dropped into the normal range but they are obviously at the top end. I have questioned if this is okay but as it is in the normal rage no body seems too worried.

Thanks again for all the advice and help.

[Judithdalston]

Yes your HbA1c results are on the high side- these are diabetic tests to show average blood sugar etc in previous 6 weeks, but if you have been on holiday you might have eaten/ drunk differently from normal. Also if you have disturbed sleep patterns your blood sugar levels can be raised. Improved thyroid health is supposed to improve this too.

[RaymondTurner]

Hi, Thanks for answering. My blood sugar has come down a bit in the last few years (I was in the pre diabetic range but not actually diabetic which was anything over 6.5 if I remember right). I had this test before i went on holiday and so this is based on my normal diet which is very very low in sugar. I eat hardly any carbs or gluten at all but do drink (lactose free) milk and alcohol (with gluten). I eat cheese which has some lactose and occasionally eat things like sweet chillie sauce on food or gluten free sausages which have rice flour in (but go for the really high meat content ones so it has less carbs) and vegetables which may be a bit starchy but I never eat bread, pasta, potatoes, rice, sugar or anything like that (I've been doing this for about two years now. In the past low carb diets have worked and I've lost lots of weight but this time i'm not being quite as strict as I used to be because it's really not sustainable. So far i have lost no weight. I weigh around 20 stone). My blood sugar dropped when I started on the levo and over time has dropped slightly more but it is never dropping much and has been at this level for a few years now.

[Judithdalston in reply to RaymondTurner]

I am diabetic as well as hypothyroid so know what it's like!

[RaymondTurner in reply to Judithdalston]

What sort of diet are you on? Do you find anything helps lower blood sugar?

[Judithdalston in reply to RaymondTurner]

No specific diet just careful ( re insulin dependent diabetes) last full thyroid tests showed no/ few antibodies though have had Hashimoto's for 12 years. When I have indirectly gone gluten free with low carb diets to loose weight never noticed any improvements re Hashimoto's. Do struggle to loose weight, until this winter, walked 10,000/day but was diagnosed with painful fibromyalgia a year ago. Now after research going down Dr John Lowe's route to 'cure' fibromyalgia as he believed it was caused by poorly medicated thyroid problems, so recently added T3. It's certainly improved by walking ability, so back to 10,000 steps /day, but still got some aches/ tiredness...in theory when I get to the right dose I should loose weight too!

[humanbean]

Regarding your TSH and your doctor saying they aim for 2.5...

For a long time the top of the reference range for TSH was around 5 - maybe a bit less, maybe a bit more. Many doctors decided that the ideal level was around half that, presumably because they thought that was similar to the TSH that healthy people had. But it isn't true. The bulk of healthy people have a TSH substantially lower than that.

I notice that the top of the reference range for your TSH test is now 3.6, which is the lowest I've ever seen in the UK. This is a good move, but if doctors are going to stick to believing "2.5 is healthy" then we are no better off.

For more info on the TSH of healthy people, see this post :

healthunlocked.com/thyroidu...

[RaymondTurner in reply to humanbean]

I'm collecting a load of things to read at some point. I don' think it will be today though as I'm really busy. I will probably read everything tomorrow. thanks for sharing this. I am finding all this onfo useful even if its just to make sense of how I have been feeling. At some point I will be able to put all this to some sort of practical use (in fact my Dr has already agreed that she may increase my dose of levo if the sleep apnoea test doesn't reveal anything.).

[SlowDragon Administrator]

You could try taking Levothyroxine at bedtime

Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

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 for brand change when dose is increased

Do you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?

If not had antibodies tested ask GP to do so

[RaymondTurner in reply to SlowDragon]

Hi, I did get the brand changed once for 100 micrograms of my tablets but it stayed the same for the other 50mg. I'm not sure if it made a difference. I am taking my tablets at about mid day which works for me as I can then eat breakfast by 10am and have tea until 11am and then only have water until 1pm. I often drink alcohol at night (and wouldn't want to stop) so that isn't going to work too well. Thanks for the advice about brands though. i may look into this.