Advice on blood tests very welcome please

[Edison13]

Previous results in May were TSH 5.6 (not sure about T4 told it was fine) I felt dreadful and had all the symptoms of hypothyroid. Told policy is to recheck in 6 months as could be a one off result.

05/10/18 at GP's

TSH 4.2 and T4 11.9.

Vit D 69 so given Hux D3.

Calcium Serum adjusted calcium concentrate 2.36 (2.2 - 2.6)

Serum albumin level 36 (35.0 - 50.0)

Initially told thyroid tests fine but when I said it can't possibly be as I was very symptomatic I was started on 50mcg levothyroxine and told I would be rechecked in 3 months.

Medichecks blood tests 17/10/18 10 days after starting levothyroxine but first thing in the morning.

TSH 2.84 (0.27 - 4.20)

Free thyroxine 17.000 (12.00 - 22.00)

Free T3 4.23 (3.10 - 6.80

Thyroglobulin antibody 11.600 (0.00 - 115.00

Thyroid Peroxidase antibodies 11.4 (0 - 34.00)

Cortisol 510.000 (166.00 - 507.00)

Shortly after taking the test (and tablet I had a "funny do" at work and ended up in A + E. Visual disturbances, felt like a brain spasm and tingling in left side of face, arm and toes. Told ? migraine or neuro or ?minor stroke (TIA).

Not sure of hospital blood tests (told all were okay) but cholesterol was 8 and ESR was lightly elevated but "normal.

Doctor confirmed diagnosis of hypothyroid ( I was told that to have trial of levo to see if symptoms settle but that not definite diagnosis and might not have hypothyroid).

22/10/18 Serum adjusted calcium concentrate 2.8

Serum albumin 38

Cholesterol 7.0 (8.0 in A+E)

Serum HDL 2.4

Serum triglyceride 0.6

Serum LDL 4.3

serum non density lipoprotein 4.6

serum cholesterol/HDL level 2.9

Serum thyroid peroxidase antibody concentration <28

Serum vitamin B12 472 (211.0 - 911.0)

Folate 13.7 (5.4 - 24.0)

[greygoose]

Well, you are hypo. Your conversion doesn't look bad, and your antibodies are not showing signs of Hashi's, but you are under-medicated.

Three months is too long to leave until the next GP test, try going back after two months. 50 mcg is just a starter dose, you're bound to need an increase.

Your cholesterol is high because your FT3 is low, so don't let them fob you off with statins!

Your folate is ok, but B12 could be higher. You now need your vit D and ferritin tested.

[Edison13 in reply to greygoose]

Thank you very much Greygoose

Vit D was 69 (75.0 - 250.0) (after 9 days lying horizontal in Turkey!) Started on HuxD3 20,000. Ferritin was normal but don't have the results. Not anaemic either.

How do I increase my Vitamin B12?

[greygoose in reply to Edison13]

Normal means nothing, just means somewhere

in range. But that doesn't mean that you're not deficient. You need to get the numbers.

Try taking a B complex containing methylcobalamin and methylfolate to raise B12.

[Edison13 in reply to greygoose]

Thank you very much 😊 X

[greygoose in reply to Edison13]

You're welcome.

[shaws]

Blood tests should be every six weeks as two weeks isn't a sufficient time lapse. All blood tests for thyroid hormones have to be at the very earliest (even if you've to make the appointment well ahead) and fasting (you can drink water). You should allow a gap of 24 hours between last dose of hormones and the test and take afterwards.

This helps to keep the TSH at its highest as doctors are apt to judge our dosage by the TSH and most of them tend to think that if it is 'somewhere' in the range - even upper part - that we're on a sufficient dose. Not so - the aim is TSH of 1 or lower with FT4 and FT3 towards the upper part of the ranges. (the latter two are not always tested and we may have to get a private test). TUK have recommended labs.

Levo should be taken usually first thing with one full glass of water and wait an hour before eating as food and coffee interfere with the uptake of the hormones.

You can, if you prefer, take a bedtime dose and, if so, you have to leave about 3 hours food gap if you've had a meal previously. You miss this dose if having an early a.m. blood test and take it afterwards and night dose as usual.

A blood test should be every six weeks with a 25mcg increment of T4 (levo) until TSH is 1 or lower. Some doctors believe that a TSH of 1 is too low and some constantly adjust dose to 'fit' into a range.

Also ask for B12, Vit D, iron, ferritin and folate.

I will also state I am not medically qualified but had undiagnosed hypothyoirdism despite many visits to doctors who obviously do not know any clinical symptoms these 'modern' days.

[Edison13 in reply to shaws]

Thank you very much for the advice. I am really grateful. 😊 X

[SlowDragon Administrator]

B12 on the low side. Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial. B vitamins best taken in the morning after breakfast. Can make you feel a bit wired for first few days.

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...

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-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

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.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

50mcg is only a standard starter dose. Bloods should be retested 6-8 weeks after each dose change. Dose is increased slowly in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...

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...

Getting vitamins optimal is essential too

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

High cholesterol is linked to being hypothyroid and will improve once you are on the correct level of Levothyroxine

nhs.uk/conditions/statins/c...