Advice for my sister

[Simplyred57]

My sister is taking 75 mcg , after talking to her recently she told me she has always taken her thyroxine with a cup of tea in the morning ? I’ve told her about taking it with water then nothing else for an hour, and trying to get her to this, she is due for her yearly blood test TSH only, and was wondering if she changes her way of taking it will it make a difference to her results ? She is due to have bloods at the end of the month they have made it for an afternoon appointment, I’ve told her to change it as it would be a waste of time am I correct ?

[RedApple Administrator]

Simplyred57, You don't mention how your sister is feeling? Is she feeling fine at the moment? If yes, then it may be best to carry on the way she is. Consistency is always an important factor. Changing the way she takes her thyroid hormone may mean she absorbs more of it which could affect how she feels as well as her test results.

[Neverending63]

Basically yes you are. Blood tests should be as early as possible in the morning, fasting, other than water and don’t take levothyroxine for that morning until after the test. Otherwise it will affect the results. I believe TSH lowers as the day goes on so she wants it at its highest for the blood test.

As for taking it I have always been told on an empty stomach with water and nothing to eat or drink for an hour. That includes other tablets and 4 hours between Levo and calcium supplements. I’m sure those with more knowledge will be along and explain it all to you better than I can.

[MissGrace in reply to Neverending63]

Can anyone confirm that TSH is at its lowest first thing as Neverending63 says? I would want my TSH at its highest when I get the blood test first thing in the morning, not it’s lowest - at its lowest it might mean a doctor will try to reduce my dose. I thought the hope was that by testing early and not taking Levo until after the test, that would also help to increase TSH and make it higher. There are so many people on here fighting dose reductions imposed because of low TSH tests. I know there are some real self taught experts out that - can you clarify please?

[Simplyred57 in reply to MissGrace]

That’s really interesting as my last 2 tests have shown suppressed tsh and I’ve had to fight to keep on my present dose, before then I’d always took my thyroxine before and not fasted ?

[SeasideSusie Remembering in reply to MissGrace]

MissGrace

Neverending63 has got it the wrong way round. TSH is actually highest around midnight and lowers throughout the day. As we can't get blood drawn at the surgery at that time, we need the earliest possible blood draw to get the highest possible TSH.

See graphs of daily rhythms of thyroid hormones and TSH here, the top one is TSH and 9am looks to have the highest TSH for a blood draw at the surgery

healthunlocked.com/thyroidu...

[Simplyred57 in reply to SeasideSusie]

So if I take my thyroxine before my next test do you think that might make tsh in the range and not suppressed- that would make my struggle with my GP easier ?

[SeasideSusie Remembering in reply to Simplyred57]

Simplyred

No. It takes a long time for a suppressed TSH to come back into range. You'd have to leave off Levo for some time.

Taking thyroxine before a test will show in a higher than normal FT4 result because that test measures the amount of thyroid hormone circulating, and you will have just taken synthetic hormone so it will measure that dose. This is why it's generally suggested here to leave off Levo for 24 hours, that gives a FT4 result of a more normal circulating hormone amount.

[Simplyred57 in reply to SeasideSusie]

Thanks for that , my sister has changed her blood test to an early one - now she’s undecided whether to take her thyroxine before what would be your advice ? She normally does take it before.

[SeasideSusie Remembering in reply to Simplyred57]

As I said, taking Levo before a blood test will give a false high FT4. If she has a low TSH and a high (over range) FT4 her doctor is likely to reduce her dose of Levo.

Re-read the first reply by RedApple. Then your sister will have to decide whether she wishes to continue as she has always done, or follow the general advice here to have an early morning blood draw, fast overnight with water only and leaving off Levo for 24 hours.

[MaisieGray]

I took my Levothyroxine for the first 30 yrs of being hypothyroid, always with my coffee, and mostly with my breakfast, and if I'd forgotten, would take it whenever I remembered, and never felt better. If she's feeling well, her dose will have been reached in a way that accommodates her tablet-taking behaviour, as it did mine (and I suspect most people whose Levo-taking predates the Internet explaining how we "should" do many things. )

[MaisieGray]

Is having bloods drawn in the afternoon having taken Levothyroxine a waste of time? Not at all, if what your sister wants to know is the level of her serum hormones under that set of conditions. If however, she's always had blood drawn under a different set of conditions eg early am, fasting, and without that day's levo, then for consistency she should do the same this time; especially, if her Levo has been dosed against the resulting blood results rather than symptoms.

[Simplyred57 in reply to MaisieGray]

Thank you I will pass all this on to her she says she feels ok ? But she never looks really well in my opinion - I guess I can only give her the information and let her decide x

[Neverending63]

Sorry yes meant highest and lowers as day goes on. I will edit original post. Was distracted when I was writing this sorry xx

[SlowDragon Administrator]

Consistency of timing is important

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)

Just testing TSH and FT4 is completely inadequate

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

Low vitamin levels are EXTREMELY common, and tend to lower TSH and raise FT4

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.