Medichecks blood test results Thyroid. Is my current dose of Levothyroxine correct?

[nark]

Hello again kind people!

Today I received the following results from Medichecks, which I would like help in understanding, insofar as my symptoms suggest to me that I still have an underactive thyroid as referred to in my last, recent post.

I am on a dose of 75 mg Levothyroxine but constantly feel unwell (alopecia, weight gain, depression, oedema, low basal body temp, fatigue......etc)

So, here goes...

TSH 2.63 mlU/L (Range 0.27 - 4.2)

FREE T3 4.02 pmol/L (Range 3.1 - 6.8)

FREE THYROXINE 17.1 pmol/L (Range 12 - 22)

Thyroglobulin Antibodies <10 kU/L (Range < 115)

Thyroid Peroxidase Antibodies 12.5 klU/L (Range < 34)

CRP HS (Inflammation) 2.03mg/L (Range <5)

My vitamin and Iron levels are good apart from Vitamin D (low) and Vitamin B12 (high, probably as I recently had my 3 monthly injection for my Pernicious Anaemia).

Thanks, in anticipation.

[NWA6]

Oh Nark! 😔 it all sounds awful. But yes you’re right you need more Levo. Try and push it up to the top of the range 20 or above and see if that FT3 will rise cause that’s dire 😬 Will your GP prescribe a raise?

I use the Betteryouspray Dlux plus K2 3000, it raised my Vit D to in range in a month and after 3months it’s not optimal at over 100

[nark in reply to NWA6]

Thanks Paula. I know my GP won't prescribe a higher dose as on his results (TSH and T4 are the only ones he will allow) I'm classed as being within the "normal" range, so that's good enough for him, despite my symptoms (a common story, i realise).

So kind of you to reply.

Best wishes.

[NWA6 in reply to nark]

Yes I used to be in the same position. On 3/4 occasions I was able to push my GP into raising my Levo, just keep going back every week with your symptoms and try and get them to understand that if they insist on using a range instead of symtoms then you could increase your Levo so your TSH sits at the bottom on that range. After all how can they possibly know that that’s not where your number should be

[Hashihouseman]

I wonder what time your blood draw was ? I use medichecks finger prick system and take mine as near to midnight as possible when TSH is getting near maximum (2 am) which can be as much as 2-3 points higher than daytime samples. In other words if my TSH was the level you just posted at midnight I might be relaxed about it - unless my symptoms were dreadful! I would also say that your ft4 is more than high enough and that while increasing it further by more Levothyroxine could well increase your ft3 you may suffer Some anomalies from the higher ft4 - confusing huh! The only way to really get to the bottom of this is to experiment with more T4 and / or a little T3. There are plenty of links floating around for where you can source these things privately. Personally I would not recommend going over 5 µg of T3 and I would try another 25 µg of T4 and see what happened to your free T3 levels after 3 to 4 weeks and how your symptoms respond. If your doctor won’t play ball, you could either source some levothyroxine privately or you could simply ‘lose’ a prescription and apply for another whilst using the ‘lost’ prescription to increase your dose and do a Medicheck! If you are anything like me you may be a poor converter of T4 to T3 and you may get some benefit from splitting your levothyroxine dose into at least two portions midnight and waking and supplementing with up to 5 µg of T3 and keep a symptom diary to see how things change day by day over 2 to 4 weeks. Then do a Medi check! If you don’t want to experiment with T3 or prefer not to source it privately then simply increasing levothyroxine is the obvious answer on a trial basis to see if it improves things and is probably the best diagnostic tool you can use! I cannot see any reason not to try a small increase in levothyroxine given that your TSH is well above 1.0 and it seems unlikely that you will suppress it to unphysiological levels by Another 25 of levothyroxine...... but that is the point of doing it, to see what happens - you could be even more cautious with levothyroxine increases and, using 25 µg pills, do half of the extra 25µg for four weeks and then the other half if necessary after a blood test. Again if you’re anything like me even 12.5 µg of levothyroxine makes a noticeable difference, either too much or not quite enough.

[DeeD123]

You could download the nice guidelines on treated tsh for your gp. It states that it should be in the lower part of the range. Good luck

[SlowDragon Administrator]

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).

Is this how you did this test?

TSH is too high, FT3 too low

Improving vitamins should help improve conversion

How low was vitamin D?

What was actual folate result?

Actual Ferritin result?

Do you supplement a daily good quality vitamin B complex to help keep B vitamins in balance?

one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).

Or Jarrow B-right is popular choice, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Are you on strictly gluten free diet

[ellarose1234]

Medichecks always give you a read out of your results to explain them. What did they say about them?

[nark in reply to ellarose1234]

Thanks. They said they were within the normal range but that my vitamin B12 was too high. (I think perhaps because I recently had my 3 monthly injection for my pernicious anaemia.)

[SlowDragon Administrator in reply to nark]

How low was vitamin D?

How much vitamin D are you supplementing

All four should be optimal, ideally before starting T3

Vitamin D at least around 80nmol and around 100nmol may be better

Folate at least 10

Serum B12 at least 500

Active B12 at least 70

Ferritin at least half way in range

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

[LAHs]

If it were me I would just increase my dose to *ABOUT* 100 mcg per day for about a month, see how you feel then get another blood test. You will have to cut your pills but if you want to average 94 mcg per day ( because 100 is hard to get with 75 pills) take 1 and a half pill the first day then the straight 75 the second day then repeat and so on and so forth.

Pay careful attention to all the vitamins and minerals mentioned on this site and add selenium (I eat 2 Brazil nuts per day for this) because this is the catalyst needed for the selenoenzymes T4 and T3 to do their necessary conversion (T4 to T3).

So long as you feel well, take your results to your doc and get the right and convenient 100 mcg pills.

[nark in reply to LAHs]

Thanks so much for the advice.