My doctor didn't feel it was necessary to speak with me - just left a message saying my levels are 'close to normal now' and that I should stay on 100mcg for another 3 months then get a repeat blood test. Those of you with experience out there - does this seem like the right dose? I obviously want my T4 to be far higher than that, and TSH at 1 or thereabouts. Is it likely that my numbers will continue to improve without my Levothyroxine being increased? Thanks!
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Panya
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It is possible that there will be further improvement but you are right to want to see TSH close to 1 or below and FT3 and FT4 in the top quarter of the range.
It's going in the right direction as you can tell. However, your TSH is still out of range and your Free Thyroxine very low (presumably the ranges are the same). Therefore, your GP should be following protocol and increasing dose of Levo by 25mcg and retesting 6-8 weeks later, waiting another 3 months is not right, in my opinion.
See How should I initiate and titrate levothyroxine:
Ask GP to test vitamin D, folate, ferritin and B12 at next test
Have you had both TPO and TG thyroid antibodies tested yet? If not, these need testing too
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
The GP won't do the vitamin tests. After telling me I didn't need the antibody tests ('because it doesn't make any difference if it is auto-immune or not - the treatment's the same') I strongly requested the test anyway and he grudgingly approved it. But when the results came back the antibody tests hadn't in fact been done. I don't exactly have a lot of confidence in this doctor.
Labs often refuse to test antibodies even if GP requests
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
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 .
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking Levo thyroxine
Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet.
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