Hashimotos - What to do before having blood tests, and what blood tests to have?

[cat_alli]

I am so confused by my doctor. In my last appointment I mentioned blood tests should be fasting and with levo stopped for 24 hours, but she said not. Please can you advise me what the protocol really should be before having my tests done, and the reasons why so I can explain to my GP. I’m just going through a massive depressive slump after a couple of years feeling okay, so I’m very keen that my blood tests later this week are taken with me doing the appropriate preparation beforehand. I’ve never had my blood tests done with me fasting or having stopped levo beforehand, because my doctor never mentioned this. I’ve only read about it on this forum recently.

Please could you also list out all the tests I should have done.

I have Hashimotos & am on 100mcg Levothyroxine a day which I take in the morning, plus recently started HRT & I take the progesterone at night.

Thank you so much.

[MaisieGray]

Having early morning blood draws, fasting, and leaving 24 hrs since the last Levo dose is a "patient thing". Those Drs who are aware that's what we do, tend to think either that it has no merit and is pointless; or that we are trying to manipulate the results in our favour - which of course, is true. Like many things thyroid, there's no need really, to ever discuss it with them if you chose to follow that informal protocol. Basically, what we are trying to do is ensure the TSH is as high as it can be during working hours; and that the thyroid levels aren't misleadingly high from just having taken our Levothyroxine, in order to optimise our dosing. Really, it's all a bit of a game; and if you have always done your tests in the same way, which has led you to being medicated at a dose that keeps you euthyroid, then there's no reason to change the status quo. However, if it hasn't worked in your favour and got you the treatment that does keep you well, then you have the option to do it differently if you wish.

HRT can interfere negatively, with thyroid levels.

[SlowDragon Administrator]

All thyroid blood tests should ideally be done as early as possible in morning and fasting.

Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw.

As you normally take Levo in morning, this is easy. Just delay until after blood test is done

This gives highest TSH, lowest FT4 and most consistent results.

This advice is a Patient to patient tip, best not mentioned to GP or phlebotomist (who as you discovered either have no idea, or deny it's relevant)

Some specialist endocrinologists do advise this to their patients

In part, this patient tip is due to an incorrect over reliance on TSH, over and above symptoms

HRT is likely to mean you need higher dose of Levothyroxine

As you have Hashimoto's it's essential to regularly test vitamin D, folate, B12 and ferritin

Many need to supplement these regularly to maintain optimal levels

Are you on strictly gluten free diet

[humanbean]

Please can you advise me what the protocol really should be before having my tests done, and the reasons why so I can explain to my GP.

Read my response on the subject in this post :

healthunlocked.com/thyroidu...

It's the response that begins "It's the time of day that blood is taken that affects the TSH levels,".

It is always suggested that we don't discuss timing and fasting with doctors because the subject doesn't come up in guidelines. If it doesn't come up in guidelines then it isn't important (to them).

Some years ago I tried desperately hard to get an early blood draw for a thyroid blood test from my surgery. I was asked what I was getting tested for and I said I was getting a thyroid function test. The receptionist informed me that thyroid function tests didn't need to be tested first thing in the morning and I could only have an afternoon appointment.

A few months ago I was at the surgery with my husband. He was told he needed a blood test and when he went to the receptionist and asked for a blood test, she smiled sweetly and said "Is 8.30am alright for you?" Aaaaaagh!

I am actually of the opinion that many GP receptionists are malicious when it comes to getting early morning appointments for anything. The more you want one the more determined they are not to give you one.

[humanbean in reply to humanbean]

You might find these threads useful too, despite being old :

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[Bailey147miller]

I live in Spain and there are two blood withdrawal days at the clinic. There are literally 100+ people attending at 8 am and it's like a conveyor belt with one nurse taking urine samples and labelling them. We are given two tubes for the blood which are labelled and 4 nursees sat at tables Everyone is done within an hour. I know as I was last once lol My doctor says fasting not necessary but from info on this group I did actually fast at the last test and wI'll continue rmto do so .