Evening ladies and gents. I wonder if I could pick your brains again. Hopefully, this could be a simple one for you experts.
As you can see from the image attached, I have been slowly, very slowly having my levothyroxine levels titrated. My GP is very nervy of thyroid issues which is unfortunate, but prior to my last titration I had written to her telling her my feeling was that the then current titration steps didn't feel to be keeping pace with the deterioration in my thyroid function.
By the time she and I spoke, she had spoken to the local Endo (whom I had seen in the past) who agreed I should be titrating in 25mcgr steps until I either felt well or the TSH fell below 1. Ignoring any reference (or lack of it) to T4/T3 levels, that felt like at least a step in the right direction.
Fast forward to today. I had my blood done yesterday and still the 25mcgr hasn't stemmed the TSH rise.
My straightforward question is: Do I need to just sit it out, titrating every few weeks, until the TSH starts dropping back again?
I have a telephone consultation with the GP booked for Wednesday to discuss next steps, which will obviously be a further titration.
Anything else I should be doing meantime?
Written by
MMaud
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Thank you for responding SeasideSusie - Yes, I am careful to control my test conditions and comply with all of the above. In rder to comply (i.e. get an 8am test), I go to the walk in phlebotomy clinic at the hospital about 15 miles away.
Yes, those are the extent of my tests. I have had wider panels doen in the past, including vitamins etc., but those are my full record of thyroid tests.
So if test conditions are the same every time, there must be a reason for the large discrepancy in TSH - I'm looking at the difference between 1.7 and 5.8, although you have the same FT4 result for those results.
What about the TPO antibody range. There's quite a difference between <60 and <20 unless they've changed the range.
I was wondering about Hashi's, but there's no major difference in your FT4 level which I would have expected to see with the difference in your TSH results mentioned above.
Why is TSH only done sometimes, and other times FT4 and once FT3?
I think if this was me I'd do the full thyroid/vitamin panel with either Medichecks (UltraVit) or Blue Horizon (Plus Eleven) to get a better picture.
Thanks Susie - The TPO assay is <60 and my test result was <20. Am I missing something on that point?
The TSH of 5.8 was the point at which my GP agreed to do a trial on Levothyroxine - Hurrah!
Getting the lab to test anything other than TSH is a nightmare. The GP always asks, but more often than not, the lab ignores the request now, even when her wording is very,........ erm,........ stern - likely because the TSH is in range. The one time the T3 was tested we both nearly fell off our chairs!
I'm about to head off to SE Asia for a couple of months in a couple of weeks, but my plan when I come back is to have both the standard NHS tests done (and I wll be due a wider panel then too) and also do a BlueHorizon/Medichecks panel at the same time.
It's all rather frustrating. I'm rather hoping the 30c temperatures with 90& humidity will take the edge off my dreadful temperature regulation issues. I might find finding a hot water bottle a challenge.
Oh, I get it now, duh! No, you're not missing anything, I was thinking the <60 was a result as well as the <20 - my mistake, sorry. So TPO antibodies not raised, but you can have Hashi's with negative TPO but positive TG antibodies. And of course, you can have Hashi's without raised antibodies. But again, there was no rise in your FT4 level so that might rule it out.
but my plan when I come back is to have both the standard NHS tests done (and I wll be due a wider panel then too) and also do a BlueHorizon/Medichecks panel at the same time.
Good plan, that will hopefully give you a better picture. I don't think I could cope with that humidity level, but I hope you have a wonderful time. Come back with your new results when you have them
MMaud, its much better to type out your results, because pictures can be difficult to see. Ideally you want to make it as easy as possible for those who are reading the results, because if people can't read them they often just won't reply. Or if they make a mistake in reading them you may get incorrect advice. In this case I think SeasideSusie also didn't see that you started thyroid treatment halfway through the spreadsheet.
To answer your main question, yes it sounds like you're being treated by the book. Best practice is to have a blood test every 6 weeks, and to adjust the dose based on that. Changing 25mcg is ideal. Unfortunately we often end up waiting a bit longer than 6 weeks, but you haven't been waiting too much longer.
This means it can take several months to get to our ideal dose, but unfortunately everything moves very slowly with hormones.
Getting the full set of blood tests after your trip sounds a good idea. Vitamins all need to be optimal for thyroid hormones to be used effectively, and being hypothyroid trashes our vitamins so it's common to be low.
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Blood test results 
Some evidence to take to Gp needed please.
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A friend
