I had Graves disease and after 6 months on medication my liver function tests went through the roof, I was having palpitations and was generally exhausted. I was then given radio-iodine treatment and as warned became hypothyroid - my liver function tests also immediately returned to normal. This was all diagnosed and treated while working abroad. For the past 13 years I have been treated back in Uk but have never had a T3 test as the doctor says it isn't required. However, at practically every 6 monthly blood test my dosage is changed - usually between 75 and 100 mg. I am now on a 75mg dose but have put myself back up to 100mg as I was feeling awful on 75mg. I have never been referred to an endocrinologist in this country - should I be asking to see one - perhaps privately - or carry on this see saw.
Hypothyroid tests: I had Graves disease and after... - Thyroid UK
First step is to get full testing done
What supplements do you take?
For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies and also 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
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)
Come back with new post once you have test results and members can advise on next step
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take early morning on waking, but it may be more convenient and possibly more effective taken at bedtime
Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, it is best to make sure to only get that one at each prescription.
You still need to test vitamin D. £29
In part because we tend to be too clean and likely wash off vitamin D
Also because when have Thyroid problems we need or use more than average person
As to testing advice.
There is currently ridiculous over reliance on many medics wanting TSH within range, (virtually impossible if on adequate Thyroid replacement) so anything that keeps TSH as high as possible when testing is advised
There is pronounced diurnal variation in TSH, so testing as early as possible in morning gives highest TSH. There is some controversy as to wether fasting or not increases TSH, but having delayed taking Levo until immediately after test, you need empty stomach for taking Levo anyway.
Graph showing TSH daily variation
No Levo in 24 hours prior to test gives lowest FT4. If you normally take Levo in morning just delay until immediately after test. If normally take Levo at bedtime, still delay until after test. You can still take next dose that evening.
If you are supplementing B12 you may benefit from a good quality daily vitamin B complex. One with folate in. This helps keep all B vitamins in balance
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results
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
Professor Toft recent article saying, T3 may be necessary for many, especially after RAI.
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)
Thyroxine replacement in primary hypothyroidism
Would suggest you just test vitamin D now - extremely easy - just four spots of blood on a card. Can do at any time of day, pop in post and they email you the results
Getting vitamins optimal through summer
Vitamin D need some to be at least 80nmol. Many find around 100nmol is better
Then do full thyroid and vitamin check in 6-8 weeks after improving vitamins
Remember to stop taking any supplements with biotin in 3-5 days prior any blood tests
I am only now getting round to trying to organise a full private thyroid test - my results this week were
Serum TSH level 0.08 mU/L (range 0.27-4.20) Low
Serum free T4 level 24.4 pmol?L (11.0 - 25.0)
Nothing else was tested. To get a private one I am confused by the various tests on offer - what is recommended I should have. My Vit D has been tested and is good.