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Thyroid UK
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advise please New test restults from the gp

Hi all. Ok gp test results. I cant seem to put up more than one page on here.the highest part of from a test dated 5/1/18 ( the tyroid uk i have written is old.it was used incase the gp wasnt going to help. It was for my personal notes)and other 2parts are now....im on 50mcg a day at present....ihave other results of serum lipids 7.2 which has come down slightly.....hba1c no action needed....and fbc no action needed .

I have the print outs if needed..

Im waiting on medicheck results in the next day or so..hope you can see the results

Thanks every one for your help

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I just wanted to make a small comment on the fact that you have written ThyroidUK reference ranges against those for your FT3/4 results. Thyroid UK may have written those on its website, only as a general indication of what ranges "might" look like, but they have no relevance or value at all, to those used by the lab that assayed your blood. You cannot make direct comparisons with other ranges or other results in other ranges , as individual laboratories may each have their own test population that created "their" reference range, as the name implies. If your result is say, at 75% of your lab's range and someone else's result is also at 75% of their lab's different range, the number will be different as a result.

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Don't worry that was for my gp at the time as i didnt think he was going to help... Its old. But thanks Maisie Gray

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HI Dave

First thing to say, I notice on your first page that you have given the ThyroidUK reference range beside your NHS reference range. The range TUK give says "The approx. reference range for this test is .... ". You can't use these ranges, they are given as an illustration only, you can only use the range from the lab that does your test, so you ignore anybody else's range and only use the range given with your test result.

Your TSH has come down nicely from January to December, although there is still a way to go. Your FT4 has increased a bit but has a long way to go. 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 you need an increase in your dose of Levo, 25mcg now, followed by retesting in 6-8 weeks, and if necessary another increase depending on the result of that test, followed again by retesting 6-8 weeks later.

Your Serum B12 at 263ng/L is quite low. Do you have any signs/symptoms of B12 deficiency - you can check here b12deficiency.info/signs-an...

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

So if you do have any signs or symptoms then list them and discuss with your GP and ask for further testing for B12 Deficiency/Pernicious Anaemia. They should take more notice of symptoms than numbers. Many people with a level in the 300s have been started on B12 injections.

If you don't have any signs or symptoms then the following applies:

An extract from the book, "Could it be B12?" by Sally M. Pacholok states:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

So you could help raise your level by supplementing with sublingual methylcobalamin lozenges along with a good B Complex to balance all the B vitamins.

Your folate is pretty good, it should be at least half way through range and yours is exactly 50%.

Did they not do Vit D and that's why you're doing it with Medichecks?

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Hi susie. Yes the vit d is at the bittom. .. i think its 25.oh ..

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Dave

25-OH Vit D is the name of the test. The result doesn't appear to be there. Maybe ring the surgery and ask if it wasn't done. Or just wait for your Medichecks result.

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U are right. Grrrrrrr.. i spoke to them and the lab want to know more details before they test for vit d... Unreal.. im seeing the doc on Friday.. grrrrrr

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I don't understand why the lab has to question what the doctor requests. Many GPs wont do Vit D test as they say it is expensive, but for the GP to request it and the lab question it is undermining the doctor in my eyes.

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I totally agree... I dout he will be happy... Its anoying ..im seeing him on Friday..

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As to vit b12 yes i do have some symtoms. Trouble is them sysmtoms are symtoms of so many other things..

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Yes, symptoms of B12 and hypothyroidism can overlap. I think it's still worth a discussion with your GP though as your level is far from ideal according to Sally Pacholok's book which is apparently highly regarded.

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Brilliant i will mention this to the gp and hopefully he might look into it for me.. ... So do you think he will wwnt to up my levo 25 mcg?? As you said ... Im better in the way i feel but i do have moments i seem to dip and sleep all evening on the settee and anxiety starts.. and also the mood changing.. then other times im ok.. im definitely better in the morning compared to the evening..

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Make sure to point out your FT4 is still right at bottom of the range.

When adequately treated FT4 should be near the top of the range

GP should increase dose of Levothyroxine by 25mcg. (Make sure to stick to same brand of Levothyroxine at each prescription)

You also need ferritin tested as well as vitamin D

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Hi slow dragon... Cheers... Yep I'm waiting on medicheck results.they might be in tomorrow...but my vit d test will be separate.so them results will prob be the end of the week .. im doing the test for vit d separate.. i picked up a new prescription today and it was the same make.. i hope the gp will be happy to up the dose..

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Yep will tale with him about the ranges... I hope to be qble to chat to you giys about my medicheck results before i go to gp to talk them over aswell

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Dave

Tick off any signs/symptoms of hypothyroidism that you are experiencing from this list

thyroiduk.org/tuk/about_the... so that you can tell your GP.

Point out that your FT4 is so low in range and refer to the article by Dr Toft (past President of the British Thyroid Association and leading endocrinologist, who stated in Pulse magazine (the magazine for doctors):

"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)."

He confirmed in a recent public talk that this applies to FT3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.

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Thank you Susie..very interesting... I have my medicheck in now so will put that up.. antibodies are up..

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