Help interpreting results

[AnneGood]

Hi, I'd appreciate some help interpreting my latest results:

Serum TSH level (XaELV): 6.58 mIU/L

Serum free T4 level (XaERr) : 14.8 pmol/L

My last set of results were 'acceptable' so I remained on 50m of levothyroxine. My GP wants to discuss the results on Friday. I'm worried he may take me off my medication, and I'm just about getting by as it is.

Thanks in advance!

Anne

[SlowDragon Administrator]

Are these the results from when taking 50mcg Levothyroxine?

They show you are very under medicated. When on Levothyroxine TSH should be around or just under one and FT4 towards top of range and FT3 at least half way in range

You need a 25mch dose increase in Levothyroxine and bloods retested in futher 6-8 weeks

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

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

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies.

Plus very important to test vitamin D, folate, ferritin and B12

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. When 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 are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

[AnneGood in reply to SlowDragon]

Wow thanks, SlowDragon. Such a comprehensive reply!

This is only the second test I've had done since being diagnosed with an underactive thyroid. I didn't know (no one told me) that it should be done fasting, so the results were low end of normal last time. This time I fasted - well just skipped breakfast really - and got these results. I'm trying to follow a gluten free diet, with varying degree of success, as I travel a lot for work and sometimes find it hard to avoid. It's done wonders for my IBS though!

I found your comment on vitamins interesting. Throughout my life, I've always taken multi vitamin/mineral supplements but stopped when I started on the levothyroxine as I was concerned about interactions. I think I need to start taking something again.

I have a telephone consultation with my GP on Fri. I can ask him about the T3 test then, and see what he says.

Thanks again. I'll follow the link you supplied as well before then so I'm better informed.

Anne

[SlowDragon Administrator in reply to AnneGood]

Don't take a multivitamin - too little of what we do need and stuff we don't want at all eg iodine best avoided completely

Test the vitamins listed. If these are low then we need to supplement these individually

Most NHS labs refuse to test FT3 even if GP request (too expensive at 92pence!)

[AnneGood in reply to SlowDragon]

Thanks again. I'll see what my GP says/offers on Friday in the way of additional tests etc. If I'm dissatisfied with the response, I'll get a +11 test privately and see what that says.

Anne

[SlowDragon Administrator in reply to AnneGood]

Assuming you get 25mcg increase in dose, then don't retest until 6-8 weeks after this

you can order +11 test ahead of when you want it, so keep an eye out on "Thyroid Thursdays" from Medichecks for it being on offer

[AnneGood in reply to SlowDragon]

Thanks! I'll do just that, although knowing my doctor he'll probably suggest retesting in another 3 months. It took forever to get diagnosed.

Anne

[SlowDragon Administrator]

Also see you have atrial fibrillation. It's extremely important to test your FT3 levels

Poor conversion of FT4 to FT3 can lead to low FT3

Low vitamins can affect conversion

Link about A Fib and hypothyroid

stopthethyroidmadness.com/a...

Research suggests low FT3 is possible cause

academic.oup.com/ejcts/arti...

circep.ahajournals.org/cont...