Hi. Could someone please explain my mums test results please. She is currently being treated for an under active thyroid. She is on 100mg levothyroxine. She is also experiencing weight gain and extreme tiredness. I’d appreciate any advice for her please. Thankyou x
Serum TSH level 5.39 (0.30-5.00)
Serum free T4 level 13.7 (11.0-22.0)
Serum vit B12 238ng (181-910)
Serum folate 4.9 (>5.4)
Serum ferritin 86ug (10-291)
AJhawkes214
Serum TSH level 5.39 (0.30-5.00)
Far too high for a treated hypo patient, it's over range.
Serum free T4 level 13.7 (11.0-22.0)
Far too low for a hypo patient.
She is undermedicated and as such has symptoms of hypothyroidism. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.
Your mum needs to make an appointment with her GP and ask for an increase in her dose of Levo, 25mcg immediately, retest in 6 weeks, another increase of 25mcg, retest 6 weeks later, repeat until levels are where they need to be for her to feel well.
Dr Toft (leading endocrinologist and past president of the British Thyroid Association) 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 article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 for your mum to show her doctor.
Also, from pathology.leedsth.nhs.uk/pa... she can show her GP
Scroll down to Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH level
0.2 - 2.0 miu/L indicates Sufficient Replacement
> 2.0 miu/L indicates Likely under Replacement
Serum vit B12 238ng (181-910)
Low. Does she have any signs of B12 deficiency - check here b12deficiency.info/signs-an... If so she should list them and discuss with GP, ask for testing for B12 deficiency/Pernicious Anaemia.
Serum folate 4.9 (>5.4)
Below range. Folate deficiency. Speak to GP. Should be prescribed folic acid. Don't start until further investigation into B12 has been made as folic acid masks signs of B12 deficiency.
Serum ferritin 86ug (10-291)
That's not bad. Recommended is supposed to be half way through range.
Absolutely fantastic information. Thankyou. I have printed it off for her to have a good read through and she is going to contact her GP first thing tomorrow x
Could it be an absorption issue ? How does your Mum take her Levo ? Any other medication that could be affecting uptake ? Gut issues ? So much to consider when taking thyroid meds.
B12 & Folate work together in the body so both need to be optimal. B12 when low can be a cause of fatigue too. Does your Mum have Hashimotos ? - if so it may help being gluten free ...
Thankyou for your reply. Funnily enough a customer of hers had suggested hashimotos too. I think this is something she needs to suggest to her GP x
Ask GP to test both TPO and TG thyroid antibodies for autoimmune thyroid disease (Hashimoto's)
Also need to test vitamin D. Very often too low when hypothyroid especially with Hashimoto's
Does your mum have any gut symptoms?
She's taking a fair dose of Levothyroxine. Yet her results don't reflect this
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.
Other medication at least 2 hours away, some like HRT, iron, vitamin D or magnesium at least four hours away from Levothyroxine
verywell.com/should-i-take-...
Many people find Levothyroxine brands are not interchangeable. Once we find a brand that suits, 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. Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
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 your Mum did the test?
Sadly a GP rarely pays attention to Hashimotos and anti-bodies. Docs have no cure - it's mostly a self-help journey to wellness. Private Testing is available through Thyroid UK - see link below and Click onto ABOUT TESTING. Test kits sent to your home and results by e-mail. Its the only way to get all the important tests needed and which the NHS seem loathe to carry out. Used by 1000's on this forum for diagnosis and for monitoring progress.
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