Bloods after starting Levothyroxine

[DobbySocks]

When should the next blood test be to check the impact Levo is having on my TSH level? My GP said 4-6 months, I was under the impression it needed to be check around 6 weeks after starting treatment?

[RedApple Administrator]

DobbySocks, It sounds as if you've only recently started thyroid hormone treatment. In which case, you are correct. Levels should be tested around 6 weeks after first starting thyroid hormone, and then again 4-6 weeks after each change of dose until you find your optimum dose.

[shaws Administrator]

Change your doctor. I wouldn't have any faith in him. You're right he/she is wrong.

Some hints:-

Always get your blood test at the earliest possible, fasting (you can drink water) and allow a gap of 24 hours between last dose of levothyroxine and the test and take it afterwards. This helps keept the TSH at its highest as that seems to be the only thing doctors look at. Levo should be taken on an empty stomach with one full glass of water and wait an hour before eating.

[DobbySocks in reply to shaws]

After the battle to get treatment and now this I was thinking I need to change GP. Going to go back and insist on a check at the appropriate time. I’ve now been on it for four weeks.

Wish me luck!

[shaws Administrator in reply to DobbySocks]

That's good. Also follow the advice how to get the optimum results.

[Hidden in reply to shaws]

I've always been tested (after each change in dose of Levo) after about 8 weeks. Leaving you 4-6 MONTHS at his stage is ridiculous

[shaws Administrator in reply to Hidden]

If we aren't feeling very well and symptomatic it is does seem like a long time between tests.

[Hidden in reply to shaws]

I know. Still haven't got there yet. Not much energy in spite of bloods being apparently good

[MaisieGray]

Testing 4-6 monthly is appropriate once your TSH is stable; until then it's c6 weekly. You can refer your GP to relevant section of the NICE Clinical Knowledge Summary for treatment of hypothyroidism:

For people who do not need admission or referral, treat overt primary hypothyroidism with levothyroxine (LT4) — do not prescribe combination therapy (LT4 and LT3) in primary care.

See the section on Prescribing information for further information on initiation and titration of LT4.

Review the person every 3–4 weeks after initiation of LT4 and adjust the dose according to clinical and biochemical parameters, aiming to:

-Resolve the symptoms and signs of hypothyroidism.

-Normalize serum TSH and improve thyroid hormone concentrations to the euthyroid state.

-Avoid overtreatment, especially in the elderly.

Once a stable TSH is achieved, TSH can be checked 4–6 monthly and then annually.

In fact the initial reviews are better done around 6 weekly rather than 3-4 weekly as that's the approximate time it takes for the initial dose of Levo, and subsequent increases, to reach what is called the 'steady state'; but if your GP gives you your blood request form at 3-4 weeks you can simply delay having it done.

[RedApple Administrator in reply to MaisieGray]

'Avoid overtreatment, especially in the elderly.'

MaisieGray, do you know what age it is that a patient is considered by the NHS to be 'elderly' ?

[helvella Administrator Thyroid UK in reply to RedApple]

Agreed with that question.

But I also have to ask why the emphasis on over-treatment being avoided? Isn't under-treatment potentially just as bad? The aim should be right-treatment - whatever that is.

[RedApple Administrator in reply to helvella]

I guess it's the usual thing of doctors believing over treatment causes serious heart issues, whereas under treatment doesn't.

[Hidden in reply to RedApple]

"whereas under treatment doesn't"

Even though it does!

[MaisieGray in reply to helvella]

It certainly seems to imply a certain train of thought in the minds of the authors .........

[MaisieGray in reply to RedApple]

Traditionally, medical professionals have regarded 65 as the age at which somebody becomes elderly........ which makes you wonder why the dosing for Levothyroxine differentiates between 18-49 yrs, and >50 yrs.

There was some collaborative work a few years ago between US and Austrian researchers, looking at whether 65 yrs continued to be relevant given that people are living longer but I don't think medically it has yet shifted from that.

[RedApple Administrator in reply to MaisieGray]

Yes, living into one's nineties is quite common now, so that would imply being 'elderly' for 25+ years. And, given that state pension age has gone beyond 65 in the UK, it's utterly ridiculous to say you're elderly at 65!

[MaisieGray in reply to RedApple]

Yes, apparently 60 is the new middle age! 🙂

A German paper was published in 2007 by Sieber CC , entitled "The elderly patient - who is that?"

Abstract

From a chronological viewpoint, medical treatment of the elderly (geriatrics) starts from the age of 65 years old. This definition per se is nowadays certainly not really an adequate definition of an elderly patient and the reason to be treated by a geriatrician. In addition to chronological age, other factors must be considered in order to define the elderly patient. Functional reserves decrease with age, which leads to increased vulnerability. Frailty as a term describes this situation and can be defined pathophysiologically by a mainly subclinical inflammatory state. Therefore, in 2007 the German Society of Geriatrics (DGG), the German Society of Gerontology and Geriatrics (DGGG), and the German Group of Geriatric Institutions (BAG) have jointly developed a definition of the geriatric patient.

It would be interesting to access the full paper to see what their new definition was.

[DobbySocks in reply to MaisieGray]

Thank you for this. I always just find it so awkward having to go back and disagree with the doctor. Feel like they’re going to just be dismissive.

[Agapanthus1 in reply to DobbySocks]

Me too and I’ve had some awful treatment from medics! You could always write-I find it easier to be assertive that way, plus it will be recorded on your notes. Good luck!

[Hidden]

Hi there, levothyroxine usually has its maximum effect on your blood results with about four to eight weeks. So a GP should usually retest your blood and adjust your dose after eight weeks of starting or of a dose change. This is important as you will almost certainly need dose adjustments. Others here will advise on what to get tested along with TSH.

Hope your treatment goes well,

Michael

[Blot]

There is often a dip after the initial good reaction which could be anytime from 2 to 6 weeks. Different for everyone. No blanket time. You need to know if the synthetic T4 is stimulating the body’s production of T3 adequately and not triggering Reverse T3. The general guide is your own reaction and not overdoing things in the initial stages. Keep stress levels down if you possibly can - pace yourself. So often it’s all gig hi because one feels better followed by a slump. Give the body a chance to accept the synthetic T4 alongside the remnants of your own diminishing supplies of T4. They are the precursors of the Hormone T3 not the hormone itself. The TSH might not go down that fast and will fluctuate in the beginning so having tests too early may confuse rather than reassure. Hope this helps

[auldreekie]

Yes agree it's not necessary to wait that long. 6 weeks I think is reasonable. Try to keep doc sweet but ask for sooner.

Yup change doc if necessary. You'll get hardened up in fighting for correct treatment. Good luck. A.

[Hidden]

My Partner started with a reading o f19 TSH testing for a general blood test, he was put on 25 mcg Levo for 6 weeks and is now on 50mcg and is having a blood test this week. You should change your GP he/she is useless and will make you ill.

[pamgarner]

I just went through getting my dosage correct,I went every 6 weeks.I finally got the correct dosage and it is now 6 months, I did this from june 2018 to march 2019 to get it right

[LAHs]

Yep, I drove my good doc crazy with blood tests when I was first on Levo but fortunately he was interested in things thyroid. We got there though and so his efforts paid off. My good doc retired but as a result of our efforts I now just get a blood test every year and pay for it myself (a full thyroid panel). I ignore my current doc who thinks he is doing me a big favor by requesting TSH and T4 about once a year, I just do it to humor him. Love Bunnyjean's closing sentence, "You should change your GP he/she is useless and will make you ill". So true, I am on my third Endo and third GP, don't be shy to change your doc, I know it's difficult the first time.

[Africschoice]

I was told 3 months and as my TSH levels were so high I was having it tested every other week and as they brought it to a reasonable level they put a note on my medical notes not to be tested for 3 months in order for the levels to level out so to speak