Test results: Hi I posted last week after being... - Thyroid UK

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Test results

Sarbie
Sarbie

Hi I posted last week after being put onto 20mg Levo after having blood tests. I’ve also been put on replacement Vit D. I was advised to post my results:

Serum vit B12 level (xe2pf) 373ng/L (180.0-914.0)

Serum folate level (42U5) 5.5ug/L (3.0-20.0)

Serum ferritin level (XE24r) 194ug/L (10.0-307.0)

Serum total 25-hydroxy vit D level (Xabo0) 50.0 nmol/L <30 nmol/L 30-50 nonlinear/L vit D insufficiency consider replacement

Serum TSH level (XaELV) above range 4.8 my/L (0.27-4.2) outside range reference

Serum T4 level (XaERr) 16.5 pmol/L (12.0-22.0)

Think this included everything. I was suffering with extreme fatigue, nausea and aching joints. I found it hard to concentrate but the fatigue and nausea was the most debilitating. I have been on 25mg of levo now for 10 days and have felt a difference although I still get tired but nowhere near the amount I was before. Please could anybody advise if I need to do anything else? Has my doc given correct treatment? Should I ask for anything else?

Thank you

14 Replies
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SlowDragon
SlowDragonAdministrator

Good that you are noticing improvements already

Thyroid levels will need retesting after 6-8 weeks on starter dose

Likely to need further dose increases. Standard starter dose is 50mcgs (unless over 50 years old)

Dose is increased in 25mcg steps, retesting 6-8 weeks later each time

This continues until TSH is around one and FT4 towards top of range and FT3 at least half way in range

What dose of vitamin D has GP prescribed?

B12 and folate are on low side. But not low enough for GP to prescribe. You might benefit from a daily good quality vitamin B complex, one with folate in not folic acid. Eg Igennus Super B complex or Jarrow B right

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

But don't start that yet. Leave it until after first Thyroid blood test

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)

Did you have thyroid antibodies tested? If not ask GP to test both TPO and TG antibodies at next blood test

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

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 .

Sarbie
Sarbie
in reply to SlowDragon

Thank you for such a quick response. So all in all my doc was correct to prescribe levo?

My vit D dose is 3 InVita D3 soin 25000u/1ml amps - I have to take 2 ampoules once a week for 6 weeks.

SlowDragon
SlowDragonAdministrator
in reply to Sarbie

Sounds good. Your GP seems on the ball.

Come back on a new post with your test results and ranges after 6-8 weeks on Levothyroxine

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

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 or at repeat prescription

Sarbie
Sarbie
in reply to SlowDragon

Thank you so much I will take all this advice. Have been taking levo first thing in the morning as I don’t eat breakfast. But I will do whatever it takes to get the best results I just don’t want to go back to feeling so poorly!!

SlowDragon
SlowDragonAdministrator
in reply to Sarbie

Some try taking at bedtime and don't get on with it. We are all different

Must be 2-3 hours after eating dinner. Longer if huge meal. Some people take dose in middle of night

But even NHS site advise no calcium rich food within 4 hours of Levothyroxine. Most of us have milk etc for breakfast

See

"Is there any food I need to avoid"

beta.nhs.uk/medicines/levot...

Sarbie
Sarbie
in reply to SlowDragon

Sorry just to clarify- will the levo start to bring my TSH level down? Is that what I’m aiming for?

SlowDragon
SlowDragonAdministrator
in reply to Sarbie

Yes

Aiming to bring TSH down to around one and FT4 towards top of range and FT3 at least half way in range

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

tukadmin@thyroiduk.org

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...

Far too many medics only test TSH. The most important results are FT4 and FT3 levels

Sarbie
Sarbie
in reply to SlowDragon

Ok thank you. I don’t think they’ve tested my T3 but I will ask at my next apt. Thank you so much I feel like I am beginning to understand. Great to have articles to relate to too.

SlowDragon
SlowDragonAdministrator
in reply to Sarbie

NHS is extremely reluctant to test FT3.

Says it's irrelevant or too expensive to test (costs 92pence)

Literally thousands on here forced to test privately

About 15-20% of thyroid patients are poor converters of FT4 to FT3. This is why it's essential to test FT4 and Ft3 , not just TSH

A naturally working thyroid does not only produces T4 but also produces about 10% T3.

Hi Sarbie

I was finally started on 25 mcg of Levothyroxine at the beginning of June. Like you, I began to feel better quite soon, though still not enough.

However, after 2-3 weeks symptoms started getting a bit worse again, though not as bad as before treatment. This was discouraging, until the good folks on here said this was usual - just a sign I needed an increase. Which I had nearly a week ago, after another blood test showed my TSH was still high. I'm still very up and down in how I feel, and will quite likely need another increase in a couple of months.

So if this happens to you don't worry. Hopefully we will get there in the end!

Sarbie
Sarbie
in reply to Jnetti

Thank you so much. It’s goid to know what to expect.

Jnetti
Jnetti
in reply to Sarbie

Well we're both newbies at this hypothyroid stuff so gotta stick together! ;-)

Sarbie
Sarbie
in reply to Jnetti

👍🏻💪

Sarbie
Sarbie
in reply to Sarbie

Hi I was just wondering how you were getting on. I feel so much better and have had my dose upped to 50mc but I have to say my weight gain has been rather extreme and is really worrying me. I have looked at other sites and forums and this seems to be really common on this medication. I couldn’t bare my weight to get out of control as I exercise hard and eat smart already! Has anybody got any advice or should I come off this medication?

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