Advice on test results and next steps? NDT? - Thyroid UK

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Advice on test results and next steps? NDT?

Mogget profile image
5 Replies

Hi all,

I was diagnosed hypo 10 years ago and despite feeling generally unwell since I haven't done a whole lot about it (though I did dabble with T3 once). I'm on 50mcg levothyroxine. My asthma worsened in May this year and still hasn't returned to the mild asthma it was previously (despite throwing all sorts of asthma medication at it). I've found some studies which link hypothyroidism with lung inflammation, so I figured it's time to start looking into treating my thyroid problems.

Would it be worth trying NDT?

My most recent test results are from 3rd May 2018:

TSH 2.6 (ref range 0.4-4.9)

T3 3.9 (ref range 2.6-5.7)

They didn't test T4, annoyingly. I asked the nurse to write on the form that T3 should be tested and clearly the lab decided to test that INSTEAD of T4...

Any advice on my next steps is gratefully received!

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Mogget profile image
Mogget
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5 Replies
greygoose profile image
greygoose

Well, you are clearly under-medicated on levo. 50 mcg is just a starter dose. It should have been increased after six weeks. Your TSH is much too high, it should be one or under, and your FT3 is too low, it's under mid-range. Have you tried asking your doctor for an increase in dose?

I'm afraid we can't say anything about your conversion and need for T3 without an FT4 result.

Mogget profile image
Mogget in reply to greygoose

Hi greygoose, thanks for the reply and advice. I haven't asked for a dose increase - I'm seeing my GP on Tuesday so will discuss this then. I imagine I'll have to make a good case though as my numbers are all in range..! I'll also ask for repeat testing to include T4, TPO antibodies and vitamins. Fingers crossed.

greygoose profile image
greygoose in reply to Mogget

Yes, it is difficult when doctors don't understand blood test results. :( Just because it's in-range, doesn't mean it's the right level for you.

SlowDragon profile image
SlowDragonAdministrator

The aim of Levothyroxine is to increase dose slowly in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Very important to know if you have high thyroid antibodies and to get vitamin levels tested

For full Thyroid evaluation you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

See what you can persuade GP to test

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

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 test. 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?

NHS guidelines saying standard starter dose is 50mcgs. Note most patients eventually need somewhere between 100mcg and 200mcg

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

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...

Ask GP for 25mcg dose increase in Levothyroxine and to get vitamin levels tested and thyroid antibodies if these have never been tested

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 .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

Mogget profile image
Mogget in reply to SlowDragon

Thank you SlowDragon - incredibly helpful information. I feel more confident about tackling all this now!

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