Not understanding blood results

[Libra77]

Hi guys/ladies wondering if you could help, I've just got my latest results from my doc and noticed over the past few months I keep yo-yoing I'm currently on 75 mg levo. I'm not as tired but am having issues with anxiety/racing heart does my dose need lowering, doc has gave me sertraline for anxiety

[greygoose]

I don't call that 'yo-yoing'. The FT4 was coming up nicely in the first three tests. Then went down in the last one. Were all these tests done under the same conditions - early morning, fasting? Do you have Hashi's?

But your dose certainly doesn't want lowering. If anything, it wants raising. Anxiety can be a symptom of under-medication. If your doctor knew anything about thyroid, he wouldn't need to give you sertraline. But, we have to bear in mind that there are financial incentives for prescribing antidepressants, and none for levo!

[Libra77 in reply to greygoose]

I always go at 9 after dropping kids at school, I don't take my levo before that and I don't eat, nothing has been said about hashis just I tested positive for antibodies, thanks for the response

[greygoose in reply to Libra77]

If you have high antibodies, then you have Hashi's - although your doctor probably calls it 'Autoimmune Thyroiditis'. The Hashi's could be responsible for your FT4 dropping.

But, even so, you need an increase in dose, and you did even before the FT4 dropped.

[SlowDragon Administrator]

When was dose last increased?

You test positive for high TPO antibodies. This confirms cause of your hypothyroidism is due to autoimmune thyroid disease

And lastly, when were vitamin D, folate, ferritin and B12 last tested. Can you add results and ranges on these if you have them

Low vitamin levels are extremely common with Hashimoto's

The aim of Levothyroxine is to increase the dose slowly, in 25mcg steps upwards, retesting 6-8 weeks after each dose increase

This continues until TSH is between 0.4-1.5

Your most recent blood test results show you need dose increase

TSH is too high

FT4 is too low, this should be in top third of range - eg around 14-15

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. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you did the last test?

See GP and request 25mcg dose increase in Levothyroxine

Anxiety and racing heart is usually due to being under medicated

Low vitamin levels are common when under treated too

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...

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 to be adequately treated on just Levothyroxine

Also on page 13 - Box 1 - 4th column - Nutrional

Lists vitamins that need testing

sps.nhs.uk/wp-content/uploa...

[Libra77 in reply to SlowDragon]

The last increase was around sept/Oct due to cramps in legs doc thought a slight increase would help, turns out I have plantar fasciitis,

[SlowDragon Administrator in reply to Libra77]

Plantar fasciitis is very common when hypothyroid

Linked to low vitamin D and/or low FT3

Getting vitamins tested and dose increase in Levothyroxine is next step

Come back with new post once you get results and ranges

Very likely to need supplements to improve vitamin levels

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

[Libra77 in reply to SlowDragon]

Thank you, will see gp again in 2/3 weeks a d ask for some bloods to be done my last full bloods was feb18 not sure how to load the pic of them.

[SlowDragon Administrator in reply to Libra77]

You can only add one photo at start of post

Feb 18 is long time ago

You need vitamin D, folate, ferritin and B12 tested

[Libra77 in reply to SlowDragon]

Thanks will try and get it sorted

[MaisieGray]

Your results are definitely not yo-yoing. The first three results were proving that your medication is doing exactly what it is supposed to achieve - lower your TSH and increase your FT4. That the fourth set showed a slight deterioration could be down to a number of things such as different blood draw conditions, your Hashimoto's, deterioration in your nutrition ... So now you may need an increase in your meds, as well as investigating/treating the latter.

[Libra77 in reply to MaisieGray]

Sorry to clafiry I meant symptoms not blood results,