Under active thyroid

[Nik27]

Hi all I’ve been diagnosed under active thyroid now my GP wants to up my dose from 25mg Levothyroxine to 75mg can anyone explain these numbers as I feel my GP doesn’t explain things fully.

[SeasideSusie Remembering]

Nik27

As you can see from your result sheet TSH has a "value" of 4.24. That is the result of your test. It shows the reference range for that test which is 0.40-4.50nmol/L. So your result is

TSH: 4.24 (range 0.40-4.50)

When we are first diagnosed and prescribed Levo, the aim is to bring TSH back into range (it would have been over range when you were diagnosed). Retesting/increases in dose should be done every 6 weeks until levels are where they need to be for you to feel well.

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 your GP is increasing your dose because your TSH is still very high in it's range.

However, increases should be in 25mcg increments, these are hormones we are taking and we should increase gradually. You might want to consider increasing to 50mcg for now, then 75mcg in a few weeks.

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.

TSH doesn't give the full picture because it's not a thyroid hormone, it's a signal from the pituitary to the thyroid to produce hormone when it detects there isn't enough. You're not taking enough Levo yet, so the pituitary is sending the signal - hence the high TSH.

FT4 and FT3 measure the hormones. FT3 isn't normally done at GP level but FT4 can be and would be useful to include this as you continue to increase your Levo.

[Nik27 in reply to SeasideSusie]

Thank you SeasideSusie I really appreciate all your information, I also get blood tests every 3 months to check Antibodies, I have joined a group on Facebook Thyroid Uk, I feel from these groups I get so much more advice and understand things much more, my GP doesn’t go into much detail.

[SeasideSusie Remembering in reply to Nik27]

I have joined a group on Facebook Thyroid Uk

This forum is from the same people - ThyroidUK's online forum (hosted by HealthUnlocked who provide a platform for hundreds of charities' forums).

[Nik27 in reply to SeasideSusie]

Oh I didn’t know that thank you again x

[Peanut31]

Hi

For us thyroid patients to feel well our TSH should be 1 or below.

Your lucky that your GP has already started you on Levothyroxine, as normally the NHS will not treat patients until there TSH reaches 10 or above.

What your GP has not done is test T3 & T4 as well as TSH. You need all three testing.

Another thing, with increases you normally go up by 25mcg of Levothyroxine.

You have mentioned that he wants to increase it by 50mcg, this is too high, too soon.

Take an increase of 25mcg, keep at this for 6 weeks then have another blood test after the 6 weeks, book the blood test as early in the morning as possible, and don’t take Levothyroxine that morning.

25mcg is a starter dosage that the elderly or patients with heart conditions start on.

You normally start on 50mcg.

What symptoms have you got?.

Best wishes

Peanut31

[Nik27 in reply to Peanut31]

Hi Peanut31, I was diagnosed 3 months ago aswell as low B12 which I get injections every 3 months, now they want to check for Coeliac as I have really bad pain & bloating stomach, my symptoms are hair loss, constantly forgetting things, insomnia & a lot of joint pain, is this all normal?

[Peanut31 in reply to Nik27]

Hi Nik27

Yes your symptoms are “normal” thyroid symptoms.

Can I suggest even if you fail the Coeliac test, to give going gluten free a try.

I had trouble tummy cramps, wind, it was awful. Anyway since going gluten free (September 2017) I no longer have problems.

You have to be strictly gluten, at first it’s a pain as I brought everything gluten free and some of the bread was dry and awful. Now I stick to freshly prepared foods and bread I like Schar.

Joint pain I suffer a lot and still do, hair loss a lot better and my memory is a lot better too.

Best Wishes

Peanut31

[Nik27 in reply to Peanut31]

Thank you so much Peanut31 I really appreciate all your advice x