Lab results

[Mummychicken]

Please link to earlier post. Doctor at medicheck said all ok, no problem with my medication

[shaws Administrator]

Did they really say all is "O.K."?

Or did they say 'normal' range.

Yes they are in the normal range but the bottom of them except for TSH which should be 1 or lower.

The aim for FT4 and FT3 is towards the upper part of the range so you need an increase in dose. Usually an increase of 25mcg every six weeks after a blood test to bring the frees towards the upper part of the range.

Blood tests have to be at the earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose and the test an take afterwards.

[Mummychicken in reply to shaws]

This is what it said

“Your TSH is in the optimal range which suggests your Levothyroxine dose is correct.

Your thyroxine and FT3are also within the normal healthy range.

Your thyroid antibodies reveal no evidence of autoimmune thyroid disease”

[SlowDragon Administrator]

Well the results are within range but they are not optimal

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)

Is this how you did the test?

TSH is likely a bit high.

FT4 is definitely too low - should be at least over 18

FT3 too low. Most patients need it over 5 or 5.5

Ask GP for 25mcg dose increase in Levothyroxine

Would suspect you also have low vitamin levels. Great pity you didn't get vitamin D, folate, ferritin and B12 tested too. Ask GP to test or get them tested when get full Thyroid retested privately 6-8 weeks after dose increase

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]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3. Note especially his comments on current inadequate treatment following thyroidectomy or RAI

rcpe.ac.uk/sites/default/fi...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine and FT4 should be higher in range (at least 17)

(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...

[Mummychicken in reply to SlowDragon]

I did the test exactly as you describe. 6.00am and no meds for 36 hours.

[SeasideSusie Remembering in reply to Mummychicken]

Mummychicken

no meds for 36 hours.

You have a false low FT4. You should leave off Levo for 24 hours, any more gives a false low, taking it too close to blood draw gives a false high.

I would increase Levo as suggested by SlowDragon and retest in 6-8 weeks leaving off Levo for 24 hours. If FT4 has risen and FT3 remains low it may point to a conversion problem and the need for adding T3 to your Levo. To know if you convert well at that time, divide FT4 result by FT3 result, eg FT4 = 20, FT3 = 4, 20/4 = 5. Good conversion takes place when the FT4:FT3 ratio is between 3:1 and 4:1. If your is over 4:1 it would show poor conversion.

[Mummychicken in reply to SeasideSusie]

I take my meds at night. Did blood test Monday morning. Took last meds Saturday night

[SeasideSusie Remembering in reply to Mummychicken]

Mummychicken

So, like me, you need to change the time of your Levo the day before the test, it's only for one day.

[Mummychicken in reply to SeasideSusie]

Will do.