Started on a trial dose of 50microgrammes of levo about 6 months ago as tsh was raised but t4 was scraping along the bottom of range.
After an ultrasound scan on my thyroid (and seeing thyroiditis and a nodule present) my doctor then requested new bloods. My tsh was now in range (3.4)ish but at my request, she upped my dose to 75 as I was keen to get tsh around 1. (as suggested to me on here and nice guidelines.) I’m pretty sure the tsh range is 0.1-4
I’ve just had my basic bloods done again at my gp after 6 weeks of being on 75 microgrammes and again, as you would expect, tsh has come down, this time it’s 1.8 - but here’s my query....
why is my t4 still scraping along the bottom of the range and not going up? I would expect tsh to come down and t4 to go up.
I know from blood tests from years ago that I was in the top half of the range for t4
Any suggestions from you wonderful people where things might be going wrong?
I have an appointment with my gp soon and need to go armed with ideas and solutions!!
Ideally I’d like to have full blood tests to compare and contrast but right now I’m pressured for time.
Thanks in advance
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gigitheweegie
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If, for example when your thyroid was working fine, it might typically produce equivalent of about 125mcg Levothyroxine per day.
As soon as we take any dose of Levothyroxine, the pituitary sees it, and reduces TSH. Thyroid stops working so hard. So you have added 75mcg Levothyroxine per day, but your own thyroid output is reduced.....so there's still a shortfall
For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.
* This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised.
Sounds like you have Hashimoto's after ultrasound
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose 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)
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
However you can still have Hashimoto's and never have raised antibodies. Confirmation of Hashimoto's can be by ultrasound alone
thanks slowdragon, i just worry that i'm going to get to a point where the doc says TSH is perfect now so you are on the correct dose of levo when clearly i'm not! will have a read at your links and go armed! perhaps i won't need to be but its always better to have the knowledge in the first place
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