My daughter was diagnosed hypothyroidism three months ago.
TSH 4.28 (0.27-4.10)
T4 free 13.3 (12-22)
ATP 15.3 ( 0-34)
She was given 0.25 levothyroxine
After eight weeks the second test
TSH 2.02
T4 12.1
T3 4.0 (3.1-6.8)
ATP 15
Could you tell me if this has improved as she doesn't feel any better.
Thank you for your support
Can you provide the lab ranges with those results (very important)? Also, was her dosage changed after her second bloods?
Yes, we absolutely need the ranges to interpret the results, because they vary from lab to lab. 
Was no FT3 done on the first test?
If the ranges are the same for both tests, then the reason her FT4 has dropped is probably because she was started on too low a dose. That does happen. Why was she only given 25 mcg? Is she very young or very old? Does she have a heart condition? A normal starter dose is 50 mcg.
I asked that to the doctor and he told me because she is only 17. I told him that in my family we are three sisters and a brother and we all have hashimotos but he replied that everyone is different and I was lost for words
At 17 she can easily cope with the full starter dose. The man doesn't know what he's talking about! But the dose has nothing to do with having Hashi's. So, he hasn't increased her dose? She's so obviously under-medicated. He's doing her more harm than good. Can she see someone else in the practice?
No change, 0.25 tablet every morning. I added the lab ranges
Go with your daughter and See different GP and insist on dose increase or urgent referral to an endocrinologist of your choice
Standard starter dose is 50mcg (unless over 50 years old)
Starting on 25mcg frequently makes patients feel worse
It's enough to turn your own thyroid hormone production down, as shown by reduction in TSH from 4.28 to 2.02
But FT4 (Levothyroxine level) has actually reduced from 13.3 to 12.1
So she now has even less thyroid hormones available
She needs 25mcg dose increase in Levothyroxine and bloods retested 6-8 weeks after each dose increase (or brand change) in Levothyroxine
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)
Always take Levo on empty stomach and then nothing apart from water for at least an hour after.
Many take Levothyroxine early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.
verywell.com/should-i-take-...
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.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Can see she has had a TPO antibodies tested (ATP - appears to be negative) ideally she should also have TG antibodies tested, but NHS refuses to test TG antibodies if TPO antibodies are negative.
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).
See GP for dose increase in Levothyroxine and request vitamin levels are tested too
Oh dear! Actually the doctor probably hasn't seen the results..the nurse was the one who told me that everything was okay and to keep taking the same med dosage. I am really mad about this as I have paid money for the doctor to look after this, not a nurse that hasn't got a clue.
I'm afraid you've been robbed! If he doesn't even know that he should have started her on 50, then he's not much of a thyroid doctor.
Those labs certainly are no ok. The nurse just said that because they are in-range, and she doesn't know any better. But, the TSH is too high - needs to come down to 1 or under. And the FT4 is right at the bottom of the range. Someone needs shooting!
True! but more than anything I am really angry as it is my girl's health as she is very low emotionally and this is affecting her life in a big way. You are great help thanks so much
Yes, it would do. And it's terrible the way these doctors have no idea what they're doing. But, I'm afraid the situation is more or less universal.
I spoke to the nurse today who had a chat with the doctor and she said that the test results are fine so she told me more or less to take it or leave it. Terrible! I feel like crying...
I think I would be crying, in your place. Well, it just goes to show that this doctor knows absolutely nothing about thyroid. What is he, anyway? A GP? An endo? He's certainly not a thyroid specialist.
He is a GP (in Ireland all the GP are private) . I would like to see an endo but GP has to give me a referral letter even for a private specialist and he wont, as he thinks everything is fine
OK. Well, he's just ignorant, I'm afraid. GPs never get much training in thyroid, not even private GPs. In all the years they spend in med school, they only get one afternoon on the whole endocrine system. So, you can imagine how little time was devoted to the thyroid - and you know how complicated that it. So, he just doesn't have the necessary training, I'm afraid.
But, if all GPs are private in Ireland, can you not go and see a different one? Sounds like this one slept through his endocrine afternoon!
I have gone to two different ones.. the first one told me that the levels were only just out of range and she didn't need med. He didn't listen to me when I told him she was very unwell. So I took her to see different GP and I explained how she was feeling very unwell and I though she needed the medication. He checked the blood test done, her weight, examined her neck and heart bit. Then he told me that her heart bit was a bit slow so he was giving her .25 medication and to wait for the next results.
When I got the results and told me everything was okay I was a bit suspicious that not everything was okay... after that I contact you and you are more help that anybody else
I see. Looks like you're not going to get much help from them, then.
What you could do is post a new question asking if anybody knows doctor that is good with thyroid in Ireland. We must have other Irish people on here. They would have to PM you, of course.
True..that's a good idea
Please don't allow yourself or daughter to be fobbed off with 'everything looks normal'. What is normal anyway? Your normal is different to mine which is different to everyone else. I asked my GP what is normal and he told me "when Im nicely in the middle of the reference range". No acknowledgement of symptom removal 🙄
From my own experience GP's either refuse to accept or can not conprehend that 'in range' does not me symptom free. At my last bloods the nurse asked why I was having a blood test 8 weeks after the last one for the same things. I said I was still very synptomatic. She looked at my previous blood results and said 'my TSH did look a little too low' 🙄😔🤦♀️. I said it was meant to be lower and she looked very confused.
They don't understand how sick you can feel when your hormone levels are all over the place.. I told the doctor my girl need the hormone replacement or anti-depressants and he looked at me as I was crazy. I told him I felted the same at her age before I was diagnosed, I was very sick and didn't want to get up from bed and that how my daughter feels now... I could see like he was thinking I was an over protective mother and making things up
Its hard to find middle ground. Say too little and they fob you off. Say too much and you become a problem patient. At end of the day patients have the right to query treatment. Surely any reasonable GP would want to have shortcomings highlighted if it means hapoy, healthy patients?
Thank you for all your help. I am living in Ireland but I am Spanish and we are going for a holiday in a couple of weeks time so I am thinking to take her over there for a private endocrinologist consultation as in here can take long time, even if you go private. I will bring all the test done in here and hopefully she will start to feel better. Thanks again
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