Help with results please

[earthmutha]

I’ve had most of my thyroid removed in 1996 on thyroxine which has been reduced to 75 Mcg a few years ago

My most recent results are

TSH - 2.4

T4 - 15.8

I am in pain in my upper body arms, neck and shoulders

I’m sleeping a lot

GP hasn’t tested T3 —-I don’t know why!!

GP said no further action as all in normal range but wants to see me again as cholesterol is 5.2

I don’t feel normal I feel awful

I’ve lost both my parents within 5 months and have been taking mirtazapine

Any advice appreciated I e another appointment for 21st November

I think I want to take T3 to see if it helps.

[SeasideSusie Remembering]

earthmutha

We need the reference ranges for your results please to be able to interpret them. Ranges vary from lab to lab so we need the ranges from the lab which did your tests.

For a treated hypo patient your TSH is too high. 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. So that already tells us that you are probably undermedicated which is why you don't feel well.

As far as T3 goes, it's far too early to know if you need it. You need your TSH down to 1 or lower, then FT4 and FT3 tested at the same time as the TSH. That then tells us whether you convert T4 to T3 well enough. If your conversion is poor then T3 may help. It's usually the lab that makes the decision to test FT3 even when a GP requests it, and it's not normally done unless TSH is below range. This is why your FT3 hasn't been tested.

But for any thyroid hormone to work properly, optimal nutrient levels are necessary:

Vit D

B12

Folate

Ferritin

So I would ask for those to be tested, then post results/ranges on here for comment.

Are you taking your Levo correctly? On an empty stomach, one hour before food or two hours after, at least 2 hours away from other medication and any supplements (some need at least 4 hours).

Always advised here, when booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lower after eating and coffee also affects TSH. Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test. These are patient to patient tips which we don't discuss with doctors or phlebotomists.

[earthmutha in reply to SeasideSusie]

Thank you for your reply

I do try and take my thyroxine as advised sometimes it’s difficult as I can’t get up early enough to take them

Need to maybe set my alarm earlier and go back to sleep or start taking them at night.

I don’t know what’s going on as I’m full blown menopausal too

I will ask when I go back on the 21st for all ranges and post them again

[SlowDragon Administrator]

If taking Levothyroxine in morning is difficult, it may suit you better to take at bedtime....it may be more effective too

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

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

75mcg is very low dose for someone after thyroidectomy

Your GP is wrong to say TSH of 2.4 is fine. It's far too high for someone with no thyroid

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...

See a different GP and request 25mcg dose increase in Levothyroxine and bloods retested 6-8 weeks later, including vitamin D, folate, ferritin and B12

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24hours prior to test, delay and take immediately after blood draw. This gives highest TSH and lowest FT4. (Patient to patient tip, best not mentioned to GP or phlebotomist)

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

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

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

List of hypothyroid symptoms

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

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...