I'm new here although i have been treated for underactive thyroid for years. I'm 61 years old. My current dose of Levothyroxine is 75mg. My starting dose was 50mcg which my GP kept me on for several years despite still having symptoms of underactivity.
My current blood test results via bluehorizon medicals are as follows;
TSH 3.19
T4 total 86.9
Free T4 16.00
Free T3 4.23
Vitamin D 68
Vitamin B12 385
Serum Folate 20.90
My symptoms (no doubt familiar to many of you) are:
Weight gain (though i honestly have a healthy diet and supplement with unprescribed folic acid, selenium and vitamin D). I also have a Vitamin B12 injection every 3 months at the surgery. Admittedly i don't exercise much due to fatigue and aching legs/painful knees.
Excessive hair loss (over 30 years)
Depression (prescribed Fluoxetine)
Swollen legs and ankles
Excessive fatigue
Painful knees and legs
High cholesterol (prescribed Simvastatin)
I had a partial thyroidectomy about 20 years ago due to a nodule.
My Levothyroxine dose was increased to 100 mg approximately a year ago but this was then reduced to 75 mg as the Practice Nurse said I was hyperthyroid following the increase.
These symptoms have increased over the years (I had an early menopause, in my 30s following fertility problems and I feel like in hindsight, my thyroid problem began after i had my son, 35 years ago).
I'd be so grateful for advice on my results, as all the GP has told me in the past is that my previous results are "normal" and I don't have any confidence in getting him to consider my symptoms, regardless of what these latest results may or may not indicate.
Thanks again.
Written by
nark
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First thing is, do you have blood test results including ranges
if not got ranges you will need to find them out. You are legally entitled to printed copies of your blood test results and ranges
UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need enhanced access to see blood results.
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results including ranges. Allow couple of days and then go and pick up. They can no longer charge for printing out, rules changed after May 25th 2018
There is currently ridiculous obsession with getting/keeping TSH within range. Many patients find TSH easily becomes suppressed. The most important tests are FT4 and especially FT3
Most patients in Levothyroxine need TSH under one and FT4 towards top of range and FT3 at least half way in range
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
Low vitamin levels are extremely common
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins
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 .
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?
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)
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
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
So when on Levothyroxine most patients need TSH around, or just under, one. FT4 towards top of range of around 20, total T4 at least 100-120, and most important of all, need FT3 at least above 5 or even 5.5.
The most important thing to consider is the FT4 and especially the FT3
Your vitamins are likely low because you are under medicated.
Vitamin D is too low. Dose needs increasing. Aiming to improve to around 100nmol. Vitamin D mouth spray by Better You is good as avoids poor gut function.
Suggest you increase your supplement for 2-3 months and retest. It's trial and error what dose each person needs.
Once you Improve level, very likely you will need on going maintenance dose to keep it there. Retesting twice yearly via vitamindtest.org.uk
Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D
When on B12 injections you may benefit from adding a good quality daily vitamin B complex, one with folate in. This would also keep B12 levels higher between injections. 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
Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only ever get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription
Forgot to say ......your antibodies are low so you don't appear to have Hashimoto's (autoimmune thyroid disease) but if you were ever tested in past and antibodies ever were high, then regardless of other negative testing it means it is Hashimoto's
Also 10-20% of Hashimoto's patients never have raised antibodies..
So you might want to consider at some point in future, trying strictly gluten free diet
But getting dose increase in Levothyroxine is most important, vitamin supplements second
Sorry, we absolutely need the ranges with those results. They differ from lab to lab, so we need the ranges used by the lab where your blood was tested.
Hi nark...ranges and units please - make it easier , and makes sure forum members interpret your results properly. Fortunately I think, tho check I'm right if mention them, that I have recorded some of the ranges a few months ago, probably not changed as they did that earlier ? this year. Your doctors should not have reduced your levothyroxin dose judging from these results, but increased it by 25 mcg, waited 6-8 weeks for further testing, and raised it again etc. You should be aiming at a TSH of 1 or under, and FT3 of above halfway , say 5-6, to see if you feel better. Heavens knows what the nurse thought suggested you were hyperthyroid - have you got results for the 100 mcg dose? Have you ever been tested for the 2 thyroid autoimmune antibodies tests ( TPO and Tg Ab) to show if you have Hashimoto's disease- the vast majority of hypothyroids have it? It is characterised by poor gut absorption from low stomach acid and thus important VitD, b12, folate and ferritin levels can be low. Sufferers find a gluten free diet helps limit the antibodies. I am not 100 % sure I know the ranges or units of your BH results, so check them, but I suspect Vit D is lowish, better 100-150; folate should be halfway thru the range( suspect yours is a bit less than this); ferritin no result posted, again should be halfway plus thru range at over 70; B12 should be near top of range say 550 plus.
In theory your cholesterol should reduce if you are adequately dose for hypothyroidism. I see you are on statins - I came off them about 2 years ago, my Gp put me on them despite not having raised cholesterol levels automatically as I was diagnosed diabetic 12 years earlier, and my hips, knees and lower legs had become so painful at times I had difficulty walking. Various scans, blood tests, physiotherapy, acupuncture etc produced no diagnosis so I suggested statins might have been the culprit...amazing how quickly ' intolerant to statins' appeared on my medical notes! So your painful knees may be statin related. As I've got older my hypothyroid symptoms have got worse, and now also diagnosed as having fibromyalgia ( probably undertreated hypothyroidism), so started to become more proactive re. my thyroid health in general, and realised how poorly most of my chronic disease have been treated and maintained. I have gone DIY with private tests and buying T3 from overseas, so if you don't feel confident with your own Gp you will have many advisors and supporters here.
Thanks for the reply, please find below the test results and normal ranges given by Blue Horion Medicals for me. Any comments or advice is appreciated.
Your TSH is far too high it needs to be between 0.25 and 0.5 where most people feel well, free t3 (5.56 minimum according to my calculations) and free t4 (18.6 minimum by my calculation) should be in the top third of the range at minimum, according to Dr Toft a highly respected Endocrinologist who is physician to the Queen when she goes to Scotland. You are not properly optimised. Vitamins etc are not something I know much about.
In a nutshell you are undermedicated and still hypothyroid and need a dose increase of Levothyroxine. 75mcg is a very low dose 125 is a maintenance dose (ie adequate for those with little or no thyroid function, which given your history sounds an appropriate descriptor In your case. 125mcg is the bottom maintainance dose, most will need more like 150, 175 or sometimes even more.
Get a print out of the supposed “hyperthyroid” results (they mean over medicated) with ranges and post for comments I find it hard to believe a dose of 100mcg would be excessive in your case. I’m afraid a lot of rubbish is spouted by supposed experts in the medical profession on thyroid problems and correct dosage. You need to be optimised not somewhere in the range (often far away from the optimal values) but in the areas Dr Toft recommends.
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help needed...........blood test results back from Blue Horizon
Help with Blood Test Results
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Please help with blood test results. 
