Sense checking my logic

[MMaud]

Here I am again, with some probably unanswerable questions. I’m trying to decide on my next course of action. I’m sorted in my head on the bigger strategy, but it’s the immediacy I’m pondering.

To set the scene:

I’ve been taking Levothyroxine for about a year now, titrating at the slowest rate known to man (I have an ultra-cautious GP, who recognises I’m not classically hypoT), so have got myself to 125mcgr a day, with the TSH not holding its own, and T4 absolutely where it was before I started on anything; very low in range. T3 at last test was below range. I am still symptomatic; which for me is mainly intolerance to cold, a certain amount of forgetfulness and brain fog, and just generally, not my usual whirlwind self.

I’m due tests next week, and herein lies my dilemma.

Initially, I was given the paperwork for just the thyroid function test, which usually is just the perennially useless TSH and T4, but as I have been in SE Asia for the last 2 months, I can live with that this time around, as that hasn’t represented “normal living”, and almost feels meaningless, but I know I need to have it done, or my GP won’t consider a further titration. On the upside, I feel certain if I’m going to achieve a decent natural Vit D score again (I was naturally at just sub 100 before all this started, plummeting to 21), it could be now. I stopped the supplement before leaving, but have been in exposed to the sun every day, just going about my business.

My master plan is to get this set of bloods out of the way, as potentially a bit warped by the most recent past, then at the next iteration in 6 week-ish take note and deploy a MediChecks/Blue Horizon full panel for “next steps”. I’ll be asking for a further titration this time around because as bonkers as it sounds, I have been chilly in the evenings here. Daytime temps have been around 38c, and evenings around 34-35c. So, my symptoms haven’t gone. (I am so dreading coming home on Monday to whatever that scary temperature is going to be!)

Cutting to the chase, I accessed my online medical record a few days ago to order my repeat Levo, so that I can collect it as soon as I get home, and noticed that my annual bloods had been postponed. Presumably my GP remembered I’m away . As a T2 in remission, I have a raft every year to monitor that.

As I had reason to call the surgery, I asked if I could be left papers to have the whole raft done at once, as I’d be going to the phlebotomy clinic anyway. My internal dilemma is, is that such a great idea, now after such an extraordinarily different recent past?

I have no concerns about the results, they will be what they’ll be, but wonder if my last 2 months living a different life – particularly in the sunshine and warmth would materially skew any more of my results. The Vit D is the most obvious, but I’m wondering about the other vitamins etc.

As the paperwork has been printed, awaiting my collection, I can choose to use the original papers I have just for the TSH, then keep the big batch for next time, or just go for the whole hog.

I guess my dilemma is, if I’m having the MediChecks/BlueHorizon next time around, I’m probably better to have the balance of the tests at the same time, for an even wider picture (there’ll be lipids, bone profile, liver function etc in there).

I think in writing this I have decided I’ll do the single test this time around, then the bigger batch next time, but are there arguments against that, bearing in mind it is massively unlikely even my fab GP (albeit she doesn’t know much about thyroids!) will just repeat the whole shebang after a few weeks.

Thanks as ever.

[helvella Administrator Thyroid UK]

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