Wife’s Test Results.

[flfair]

Hi All

My wife had a blood TFT in September, she is on 100mcg Levothyroxine a day,

Test results TSH 2.25 mu/L (0.35 - 5.5) T4 14 pmoI/L (9.0 - 23.0)

She is tired out all the time, and has no energy, she does take magnesium and other vitamins, can anybody help her.

Thanks

Peter

[SeasideSusie Remembering]

flfair

TSH 2.25 mu/L (0.35 - 5.5)

FT4 14 pmoI/L (9.0 - 23.0)

Your wife is undermedicated and needs an increase in her dose of Levo.

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.

Her FT4 is only 36% through it's range.

She should ask her GP to raise her Levo by 25mcg now, retest in 6 weeks. If she is still symptomatic then she should have another 25mcg Levo increase and retest 6 weeks later, etc, until she feels well.

To support her request for increase use the following information:

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 article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

Also refer to NHS Leeds Teaching Hospitals pathology.leedsth.nhs.uk/pa...

Scroll down to the box which says

Thyroxine Replacement Therapy in Primary Hypothyroidism

TSH Level ...... This Indicates

0.2 - 2.0 miu/L ...... Sufficient Replacement

> 2.0 miu/L ...... Likely under Replacement

[flfair in reply to SeasideSusie]

Thanks for the advice, FT3 was not tested.

Peter

[SeasideSusie Remembering in reply to flfair]

My information was to let you know that your wife is undermedicated, I just gave the general information about where test results should be for an optimally medicated patient.

FT3 isn't normally tested in primary care but it's something to note for the future. With a low FT4 like your wife's, FT3 is going to be low anyway. But sometimes, when T4 to T3 conversion is poor, FT4 will go high and if the patient is still symptomatic it's often because of low FT3 and that's when it's important to test that. Hundreds of us here have to do our own private tests when we want to know our FT3 level, then it's important to test FT4 and FT3 at the same time to see how well we convert or not.

[SlowDragon Administrator]

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)

Is this how she did the test?

Which vitamins exactly is she taking and have they been tested since started supplementing? Can you add actual results and ranges if you have them

TSH is likely too high. FT4 definitely too low, should be near top of range

No FT3 result, which is extremely important.

She needs to see GP and request 25mcg dose increase in Levothyroxine

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

[e-mail]

If after getting TSH under one and FT4 towards top of range, if FT3 remains low then look at getting T3 prescribed via endocrinologist

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

rcpe.ac.uk/sites/default/fi...

Might consider getting DIO2 gene test, this can help in getting T3 prescribed

DIO2 gene test article

thyroiduk.org.uk/tuk/testin...

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

[flfair in reply to SlowDragon]

Thanks for the reply, FT3 was not tested, she has not been tested for vitamins, she take magnesium, vit C , vit D, she has a lot of stress and anxiety, and is not sleeping very well, she is aged 67.

Thanks

Peter

[SlowDragon Administrator in reply to flfair]

So you can either see GP now and push for 25mcg dose increase in Levothyroxine

Or get full private blood test including vitamins FIRST

I see from your other posts you are well aware of the importance of magnesium 😀

Important vitamin D and magnesium are taken at least 4 hours away from Levo

Testing B12 and folate are important too, as is ferritin level

Improving vitamin D can increase need for B vitamins

drgominak.com/sleep/vitamin...

Low FT3 is often linked to poor sleep too

Low vitamins are extremely common and often need regular or continual supplementing to maintain levels

Anxiety is a typical hypothyroid symptom

On Levothyroxine many of us need TSH well under one, FT4 towards top of range and always essential to test FT3.

Do you know if your wife has autoimmune thyroid disease also called Hashimoto's diagnosed by high thyroid antibodies?

If not had antibodies tested this should be done. Hashimoto's often is linked to gluten intolerance or coeliac

Sadly NHS is currently useless at offering adequate testing. You will almost certainly need to test FT3 and both TPO and TG antibodies privately .....but ask GP to do them

You more likely to persuade GP to test B12, folate and ferritin. Ask for coeliac blood test at same time

[SeasideSusie Remembering in reply to flfair]

flfair

If vitamins haven't been tested, how do you know she is taking an appropriate dose of Vit D? It's very important with Vit D to take the correct amount. Too much will get stored and can reach toxicity level. So testing and dosing accordingly is essential. And when supplementing, it's recommended to test twice a year to ensure we maintain the correct level.

If GP wont test Vit D then it can be done with an easy fingerprick blood spot test from City Assays vitamindtest.org.uk/

[shaws Administrator]

Alwasys get a print-out of results with the ranges for your own records and can post them for comments. Ranges are important as labs differ and it makes it easier to comment.

This is a list of symptoms and thankfully we don't get all but it doesn't matter how many we can be miserable. Thyroid hormones enable our whole body to function from head to toe and heart and brain need the most T3 in order for us to function normally.

thyroiduk.org.uk/tuk/about_the_thyroid/hypothyroidism_signs_symptoms.html

We are prescribed levothyroxine which is T4 and it has to convert to T3. T4 is also called levothyroxine and T3 liothyronine. T3 is the Active hormone without which we cannot function optimally.

[flfair in reply to shaws]

Thanks for the advice.

Peter